Although in the United States there have been cases of transmission between people with no travel history, the Puerto Rico Department of Health only examines those who have traveled or had contact with travelers. (Ramón “Tonito” Zayas)

The Puerto Rican government continues to limit coronavirus testing to those who have traveled or had "prolonged" contact with people who have been to places that reported cases, and this, according to experts and international agencies, prevents the government from having a real idea of how widespread the disease that keeps the planet on alert may be on the island.

Limiting tests, despite widespread concern since the first three positive cases were detected and with the island almost paralyzed by the strict restrictions imposed by the government, is the reason why until yesterday morning only 18 tests had been performed. Five cases tested positive, nine negative and four are awaiting results.

The government has also failed to make what is known as an epidemiological projection, a usual tool in situations like this one that would allow anticipating different possible scenarios of the spread, to determine what resources would be needed and to make sure they are available.

The state epidemiologist, Carmen Deseda, said yesterday that they haven´t made an epidemiological projection because they have not detected community spread cases, which are those that occur with people who have not traveled or been in contact with someone who has traveled.

Experts say the government has not detected cases of community spread because it is limiting testing to those who have traveled or have been in contact with those who have traveled. People with symptoms that do not meet these criteria are simply not tested.

Deseda added she does not believe cases will escalate because the administration is confident that the population will respect restrictions on movement and contact.

"We are not considering that in the next few months we may see the levels Italy has," Deseda said, referring to the European country with the second-highest number of infections in the world.

The virtual lack of testing, plus the lack of epidemiological projection, means the government is handling this crisis blindly, without objective data to guide its actions, liberalizing where it can or restricting where it has to.

"There is not enough objective data to be able to project what is going to happen. If there is no data, we do not know how many patients are minimally asymptomatic, which ones have more symptoms, which ones are hospitalized with other diagnoses. It is very difficult to project what is going to happen here. It would be almost a guess," said Dr. Guillermo Vázquez, an Infectious Disease Specialist at the University of Puerto Rico's (UPR) Medical Sciences Campus.

"What has to be done, inmy humble opinion, is to open these lab tests throughout Puerto Rico and send for testing those cases considered to be of this condition," Vázquez said.

The World Health Organization (WHO) also called yesterday to increase the availability of tests. "We have seen a rapid escalation in social distancing measures, like closing schools & canceling sporting events & other gatherings. We have not seen an urgent enough escalation in testing, isolation and contact tracing, which is the backbone of the response," said the agency's director, Tedros Adhanom Ghebreyesus.

An ill man looking for answers

Gilberto Bigio, a young cafe employee, told El Nuevo Día yesterday that he has had a dry cough, headache, sore throat, fever and difficulty breathing since last Thursday.

After testing him for mycoplasma and influenza, which came back negative, his doctor recommended him to go to an emergency room and ask to be examined as a possible case of coronavirus.

Bigio said he spent seven hours in the emergency room of the San Juan Municipal Hospital, where he was told that no tests would be available until today, but he was not referred to any facility under the jurisdiction of the state Health Department either, which does have them.

"I'm going to stay locked up at home until this is over. If I get worse, I'm going back to the hospital. I can't go out, I can't work," said Bigio, who believes he may have got the coronavirus from some Korean, Mexican and European tourists he and his couple were in contact with at a nightclub in Old San Juan last week.

The Health Department assures it has materials for 1,000 tests and can carry out up to 100 a day if they extend technicians' shifts since each set of tests can take about six hours to be completed, said the agency's biosecurity director, Jessica Cabrera.

The government is also in the process of increasing its testing capacity by recruiting private laboratories.

Yesterday, no government spokesman could say how much testing capacity they expect to achieve through this new measure.

But Dr. Deseda reiterated that tests are limited to people who during the previous 14 days have had prolonged contact "with someone who has been in one of those places that have reported positive cases."

In statements that contradict what many experts say here and around the world, Deseda said: "For the virus to be transmitted from person to person, you have to be in contact with that person for several hours. It's not casual contact."

Dr. Vazquez recalled that a person gets the virus by coming into contact with another person's respiratory secretions, regardless of how long they are together or how deep their contact is. It's enough for someone to cough on top of someone else or for a person to come into contact with some surface where an infected person sneezed within the three hours that the virus is estimated to survive in the environment.

"In the mainland, there is already community transmission. It's not that the passenger came and transmitted it to another person, but people who haven't traveled are transmitting it to others," Vázquez said.


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