Puerto Rico lost its opportunity to be an example of an efficient strategy to manage and fight COVID-19, and according to experts, today it is entering a period of uncertainty that could lead to the implementation of new restrictions after the upsurge of new infections recorded over the past weeks, as the island goes into the fourth phase of economic reopening.
"The lockdown was an investment people made at a great cost, and there was a moment in June when we said loud and clear, 'Puerto Rico has a golden opportunity to leverage this investment and eradicate the virus,'" said Professor Daniel Colón Ramos, a neuroscientist at Yale University.
However, to reach than it was necessary to establish specific controls that, along with the geographic reality of Puerto Rico, presented the ideal conditions to control the epidemic, as was the case with New Zealand and Japan. "In the same way it (Puerto Rico) closed in a hurry, it opened in a hurry," he said.
At that time, there were also fewer controls at local airports and a lack of reliable data. "they didn´t do what had to be done and this is the last call. It's not about imposing the lockdown again, you have to do things wisely and well thought out. The conversation can't be 'open or close' or deciding between the economy or health. Those are false dichotomies, they are illogical and they are not constructive," the scientist said.
Yesterday, the Health Department reported 148 new infections, totaling 2,583 confirmed COVID-19 cases on the island. On the other hand, suspected infections reached 7,071, with 106 additional ones reported yesterday. On Saturday the agency confirmed eight deaths but no deaths yesterday, so the figure remained at 167.
Those figures, however, could rise after authorities in Florida confirmed yesterday 15,300 new cases, a record for a state in a single day. Florida is one of the jurisdictions with significant air traffic to Puerto Rico, and just yesterday there were 31 flights scheduled from four cities in that state to the island.
Colón Ramos stressed that the virus cannot be ignored, but that it must be recognized that there are alternatives and that adjustments to avoid the collapse of the health system must be identified. And also those regions where cases are increasing, where the hotspots are, and how they arose must be identified.
The scientist suggested that beyond imposing closing hours, sector closures should be determined, always looking at the economic impact versus health impact. “There are economic activities that have a great value and small risk, these economic activities should be protected and maintained instead of closing them at a certain time,” he explained.
A recent analysis by the Center for a New Economy (CNE) revealed that the health, education, and retail sectors have the highest risk rates for COVID-19 transmission, while agriculture, manufacturing, transportation, and storage have the lowest.
Deepak Lamba, CNE's research director, stressed that this analysis does not seek to define which economic sectors should be closed down, but rather to feed the discussion with better data and information and thus help in decision-making.
Risk levels in these sectors, however, are tied to the measures taken - if any - to minimize dangers. "If the government fails to make decision-making transparent, to effectively communicate what is happening and what needs to be done, we are not going to convince a large part of the population to stay home," Lamba said.
Medical Task Force will make recommendations
Dr. Juan Carlos Reyes, a member of La Fortaleza's Medical Task Force on COVID-19, said yesterday that the government has to rethink the new ease of restrictions and did not rule out a return to a 14-day lockdown - the incubation period of COVID-19 - to "put out the fire" if numbers continue exceeding those registered in May and June. "We are in an upswing, and we have to make changes in our policy because thinking about continuing to reopen sectors is an uphill battle," he said.
The Medical Task Force advising Governor Wanda Vázquez Garced in this emergency will meet today with Health Secretary Lorenzo González with their concerns and recommendations.
Reyes anticipated that revaluating extending capacity from 50 percent to 75 percent in shops will be one of the suggestions. Another issue that will be discussed is the return to classes and how, if contagion continues to increase, public and private schools may not return to face-to-face classes.
In the epidemiologist's opinion, re-opening phases have been implemented without meeting the basic requirement of a consecutive reduction of new cases for 14 days. "We couldn't keep opening up places this way," he said.
Although Reyes did not specify which economic areas he believes should close if the current scenario continues, he said evidence indicates that, amid an upsurge in cases, any place that has recirculated air, where people spend more than 15 minutes and with poor social distancing is considered "high risk." He expressed concern about the behavior identified in some bars.
On Friday, the Health Department ordered the closure of two businesses in Ponce where social distancing rules were not being followed. The lack of masks was the main violation. On Saturday, the agency did the same at the Mamacitas hospital in Culebra, and yesterday at the Metropol restaurant in Barceloneta, where after learning of positive COVID-19 cases among employees, they hadn´t taken the necessary prevention measures to avoid the spread of the virus.
Reyes said the mask has become an "entry ticket" for many establishments but, minutes later, they get rid of it.
The epidemiologist stressed that although the entry of tourists into the island continues to be a determining factor to explain the increase in contagion, he recalled that it cannot be ignored that there is community transmission in Puerto Rico and, as an example of this, he mentioned the outbreaks recently detected in a nursing home in Carolina and the hospital in Culebra.
Airport at crossroads
This Wednesday the island reopens tourism activities, and although passengers arriving in Puerto Rico are requested to deliver a negative COVID-19 test result, there is concern among experts, given the alarming number of infections in Florida. The Aerostar company, which manages the Luis Muñoz Marín Intentional airport, could not say how many flights from that state arrived on the island yesterday. However, the flight-tracking website Flightradar24 had a total of 31 flights registered from Orlando, Miami, Tampa, and Fort Lauderdale.
Epidemiologist Melissa Marzán, who heads the Surveillance System at Ponce Health Sciences University, agreed that everything points to a reduction in some activities. She said this time they need to be more specific and added that things like the maximum number of people that can be gathered in the same space without being considered a crowd must be defined. "We have to make recommendations based on the evidence of the past few weeks, but we have to improve the implementation of protocols in different places," she said.
Marzán, who was invited to today’s meeting, said that closing shops for one day - as has been suggested through social networks - would not have a significant impact. “We have to look at the areas where the risk is higher and be stricter in those areas,” she stressed.
Although on Saturday Vázquez Garced insisted that the government is not responsible for the increase in contagion -even though the rise coincides with the executive’s determination to reopen the economy in mid-June- both Marzán and Reyes agreed that the responsibility is shared.