Governor Wanda Vázquez Garced confirmed yesterday the first tests to detect the new strain of the coronavirus COVID-19 on the island upon the arrival of an Italian tourist on a cruise with symptoms linked to the virus.
The governor immediately ordered to take the most restrictive measures with cruise ships that plan to dock in San Juan Bay to avoid repeating the situation.
However, at a press conference, she reiterated that this is a suspected case and not a confirmed one. The samples from a 68-year-old woman and her husband -both on the cruise- will be sent to the Centers for Disease Control and Prevention (CDC) in Atlanta today.
Vázquez Garced said they are handling the situation as a “suspected case” and recalled that the clinical picture of this woman on the boat did not suggest coronavirus. "We are taking an additional measure and sending those tests to the CDC," said Vázquez Garced.
She said that the tourist comes from northern Italy and arrived on the island yesterday on the Costa Luminosa cruise ship, which left Fort Lauderdale, Florida on February 24. The woman was taken to Ashford Presbyterian Hospital in San Juan in the morning after two days on the ship undergoing antibiotic treatment.
The governor said that as the cruise was approaching Puerto Rico, this woman reportedly had a case of pneumonia.
Once at the hospital, the doctors decided to place her and her husband in isolation and contacted the Health Department to have them tested for COVID-19. Sources said that during the afternoon, the doctors insisted on taking samples from the woman.
The patient will remain in isolation, as will her husband - who has no symptoms - at the Ashford Presbyterian Hospital, said Health Secretary Rafael Rodríguez Mercado. They were both taken samples to identify COVID-19, the results expected to be ready in a period of 24 to 28 hours, the secretary said.
Both Vázquez Garced and Rodríguez Mercado praised the work of the hospital staff. "It is a case similar to pneumonia. But since our responsibility is to take care of the people, we are going to take the samples to rule out a case of coronavirus," Vázquez Garced said.
Passengers got off the ship
The Tourism Company executive director Carla Campos said the Costa cruise line arrived in San Juan with some 2,500 passengers on board for the first time yesterday. Since the cruise ship did not identify the woman's condition as coronavirus, they took no extraordinary measures to prevent passengers from getting off the ship neither was it placed in quarantine, Campos said.
The official estimated that 40 percent of the passengers got off the ship, although she later said this was not an exact percentage.
Port Authorities Executive Director Joel Pizá said that the woman tests positive for COVID-19, she presented symptoms on the ship and the cruise line failed to notify the Coast Guard and the CDC, as required by federal authorities, the company is exposed to a fine of more than $92,000.
Vázquez Garced said her government is in communication with the CDC and the Coast Guard to inform if the woman tests positive for COVID-19 so that they can take action with the other passengers. Until last night, it was not confirmed if other passengers or crew members were showing symptoms.
"The Ports Authority contacted the Coast Guard and CDC, and they will have information on all passengers and the line's guidelines so that future destinations can make informed decisions," Pizá said.
The cruise ship was to dock today on the neighboring island of St. John and then would sail to Spain.
According to the Ports Authority´s executive director, the woman was able to board the cruise ship in Florida because she did not present symptoms and Donald Trump's administration guidelines, at the moment, only impose restrictions on passengers from China and Iran, not Italy.
Starting today, all cruise ships must report to the Ports Authority, the Health Department and the Tourism Company on passengers or crew members with symptoms of respiratory infections to enter the San Juan Bay, the governor said. These are additional requirements since they must also inform federal authorities. Likewise, the pilot boats that guide large vessels to the docks will have to verify that cruisers meet this requirement.
This report will allow the government to decide what measures to take to prevent the spread of the infection on the island.
"A boat that does not certify that it has filed the reports to the CDC and the Coast Guard does not enter San Juan Bay," Piza said.
This is the first case on the island that meets the criteria for the Health Department to authorize the test for coronavirus. Previously, there were cases of respiratory symptoms similar to the coronavirus, but it was determined they did not meet the clinical criteria to justify testing for COVID-19.
The World Health Organization (WHO) confirmed 106,893 cases of COVID-19 in 103 countries and territories until 8:30 p.m. today and, 3,639 deaths reported worldwide.
Last week, Health Secretary Rafael Rodríguez Mercado confirmed that the agency had not received the material to perform the tests on the island, but that samples would be sent to the Centers for Disease Control and Prevention (CDC) in Atlanta.
The Health Department protocol decided with the advice of federal authorities, establishes that the test to detect the virus has to be processed by the CDC in Atlanta. At the local level, it depends on the approval of the state epidemiologist, Carmen Deseda.
An individual´s travel history, as well as fever or respiratory disease symptoms, are among the factors considered to evaluate patients, Another factor is whether the patient presents a respiratory condition without an identified alternative diagnosis.
Hours earlier, Assistant Secretary of Health Concepción Quiñones de Longo had indicated that the Health Department had not approved even one screening test for patients with possible coronavirus symptoms, a scenario that raised serious questions in the island's medical community.
She said she understood doctors' "concern" but that they were following recommendations from the Center for Disease Control and Prevention (CDC). "Since there are still not millions of tests available for the entire population, we are being very strict in clinical and medical history criteria to select who should be tested," she said in an interview with El Nuevo Día.
"I understand concerns showed by these doctors in the sense that identifying the first case of coronavirus in Puerto Rico is very important, but we have to work with the resources we have available right now, and the resources we have available do not allow us to test everyone if they do not meet the criteria established by the CDC," she added.
The Health Department protocol, developed with the advice of federal authorities, establishes that the test has to be processed by the CDC in Atlanta. At the local level, tests depend on the approval of the state epidemiologist.
"If the case does not meet the criteria, we wouldn't be in a position to test that person because there are not millions of tests available for everyone who has even the slightest suspicion, so we are being very strict in meeting specific requirements," she said.
There have been possible cases reported in the last week which had not been confirmed, even those patients had not been tested. "They have not met the current criteria. This could change. As the incidence of this condition changes, the CDC will probably issue different instructions, but no samples have been collected yet and we haven't collected samples to send to Atlanta yet," she insisted.
When asked when the tests might be available on the island, Quiñones de Longo said that they would be available next week. And when asked how many tests would be available, she answered that previous experiences indicate the CDC will determine the number of tests. "They have their criteria of incidence or prevalence of a condition to determine which test materials or resources to send," she said.
Former Health Secretary Ernesto Vázquez Quintana had questioned the agency's decisions. Former State Epidemiologist Ángeles Rodríguez had also questioned the agency in an interview with El Nuevo Día. While other expert voices, such as infectious disease expert Javier Morales, hadwarned about the importance of considering medical opinion when approving or ruling out a test.
"I can tell you they are not considering medical opinions, by imposing their views - the Health Department and Dr. Carmen Deseda who is the one who has to decide whether a case has to be tested for the coronavirus - they put doctors in a difficult position," said Vázquez Quintana.
He said the agency cannot intervene with the right of doctors to practice their profession. "When one asks how to handle this epidemic they say, precisely, that the first case is very important, but if we don't test people how are we going to find the first case?" he added.