Even Puerto Rico couldn’t avoid omicron

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In early December, after a two-year hiatus from the stage, Bad Bunny returned home to Puerto Rico to give his most dedicated fans the gig of their lives. The reggaeton star may have delivered with his show “P FKN R” – a two-day, $ 10 million show and tribute to Boricua culture at a massive 60,000-person stadium in San Juan. But it also turned out to be a superspreader event.

All spectators were required to show proof of Covid-19 vaccination and wear masks, or risk a fine of $ 100 and exclusion from the concert. Although their vaccination status was checked at the gate, there was not much application of the mask warrant, and many participants removed them once they got to their seats. As a result, around 2,000 participants tested positive for the virus afterwards, contributing to a 4,600% increase in cases on the island last month. December 2021 represented a third of the total recorded cases in Puerto Rico, and now the island’s positivity rate is 36%.

The concert was emblematic of what went wrong in Puerto Rico – and other parts of the United States amid the spread of the omicron variant. Many Puerto Ricans feel more protected than they actually are due to the island’s high vaccination levels, but two shots of the vaccine have been found not to be a sufficient defense against omicron, which is more transferable than previous variants. And the increase in the number of people infected means more people are ending up in hospital, straining medical infrastructure.

Just a month ago, Puerto Rico seemed to be in a better position than other parts of the United States. It has one of the lowest Covid-19 death rates in the United States and for months it has dominated the country in terms of vaccination rates. A unified messaging campaign from the scientific community and government leaders has enabled the island to largely avoid the politicization of the virus and vaccine. And Governor Pedro Pierluisi has implemented some of the toughest vaccination mandates in the country. Without all of that, the last wave could have been much more deadly.

But even Puerto Rico was not immune from the highly contagious variant of omicron, which has contributed to an increase in the number of cases and hospitalizations in the United States. Gatherings during the holiday season, which in Puerto Rico extend from Thanksgiving to mid-January with the Three Kings Day celebrations, have exacerbated the problem. And given that many Puerto Ricans are vaccinated – nearly 78% as of January 6 – infections on the island have been generally mild, giving people a false sense of security in the latest wave.

“It’s a new twist, it’s Christmas, and there’s a high vaccination rate, so people feel more free to go out because they are vaccinated. And it appears that, however, omicron escapes the vaccine, at least for contagion, ”said Maria Levis, CEO of Impactivo, a public health consultancy in Puerto Rico.

Public health officials predict the peak will last about two more weeks. Meanwhile, the Puerto Rican government has done what other U.S. states and territories have refused to do, reinstating restrictions on gatherings, travel and school openings on the recommendation of scientists and public health officials. However, there is little he can do about the continuing shortages of hospital staff, which continue to threaten not only the well-being of Covid-19 patients, but also others in search of life-saving care.

Puerto Rican government takes action to prevent new wave, but meets with some resistance

On the advice of public health officials, the Puerto Rican government responded quickly to the emergence of omicron by reviving and tightening restrictions that were previously in place.

The governor delayed the start of public schools by two weeks and recommended that private schools do the same. It made recalls mandatory for employees in the health and education sectors, and all schoolchildren aged 5 and older must have their first dose by January 10.

Drivers line up at a drive-thru test center run by the Puerto Rico Health Department in the parking lot of Hiram Bithorn Stadium in San Juan, Puerto Rico on December 18, 2021.
Ricardo Arduengo / AFP via Getty Images

Those attending mass events must now provide not only proof of vaccination, but also a negative Covid-19 test taken within 48 hours of the event. All establishments serving food and drink must require vaccination or a negative test for entry, and the capacity of these places is limited to 50 percent or 250 people maximum. All passengers on flights to Puerto Rico must also test negative. And businesses must close between midnight and 5 a.m. and are not allowed to sell alcohol during those hours.

Major events on the island have therefore been canceled or turned into a virtual event, including the Miss World pageant and a 10,000-person New Years celebration.

For some Puerto Ricans, these measures do not go far enough. Some have worried about the governor’s decision to delay the start of the school year rather than what they see as the safest option: reverting to distance education. Others see the governor’s actions as wise. But overall, there is a notable weariness over Covid-19 prevention protocols among young people.

The highest incidence of cases during the recent spike was among people aged 15 to 39, said Victor Ramos, president of the Puerto Rico College of Physicians, which advises the governor on pandemic strategy. The virus has spread to their workplaces, schools and universities, holiday season and big events – and they have brought it home to older and more vulnerable populations.

Two years after the start of the pandemic, it is difficult to convince these young people to stay at home, especially when, due to widespread vaccination, the typical case of Covid-19 in Puerto Rico has not resulted in more symptoms. severe than those of a cold. Many also believe that with Covid-19 becoming endemic, it is only a matter of time before they catch the virus, so they might as well be done with it. The problem with this strategy, however, is that it could still spread it to people who are at a higher risk of hospitalization.

“The symptoms were very mild for the people who contracted it, and that also plays into the severity of the situation,” Levis said. “People are also just tired. “

Meanwhile, public health officials are warning Puerto Ricans that two doses of the vaccine is not enough. Less than 40 percent of the population received a booster. But problem, not everyone is eligible for a booster yet, as it hasn’t been six months since their last shot or three months since they received the Johnson & Johnson vaccine.

Although symptoms of Covid-19 are generally milder for those vaccinated, omicron is more transmissible, even in people who have had two injections. The combination of vaccinated people letting their guard down and the fact that most people in Puerto Rico have not received a booster has created an opening for the spread of omicron. The result is a growing number of cases, currently nearly 400% more than last winter’s peak, as well as an almost 600% increase in hospitalizations over the past two weeks at a time when the The island’s public health infrastructure is in trouble.

Despite being launched into the omicron curve, the government of Puerto Rico has responded exactly as public health officials have advised, and they are confident the new measures will bring the pandemic back under control. The same cannot be said of other states and territories in the United States, which have largely avoided a return to pandemic lockdowns.

Health workers wearing masks and gowns stand outside a line of cars and write passenger information on clipboards.

Workers register people to be tested for Covid-19 in the parking lot at Hiram Bithorn Stadium in San Juan on December 18.
Ricardo Arduengo / AFP via Getty Images

Puerto Rico’s healthcare system is under pressure

Hospital staff shortages are currently proving to be the greatest strain on healthcare resources in the United States, and Puerto Rico is no exception.

“We have the beds,” Ramos said. “The problem we have is the staff. They are tired, they have to stay home because they are contagious, and some are on vacation because of the holidays.

This means that the quality of the complex and resource-intensive care that Covid-19 patients need might not be as high as it could be. And that non-Covid-19 patients, especially those who already had limited access to doctors, could face delays in care, which could create long-term health problems that will survive the pandemic.

There had already been a massive exodus of doctors from Puerto Rico after Hurricane Maria hit the island in 2017, in part due to low salaries and insurance reimbursement issues that kept them from paying for their offices and their costs. staff. The following year, the specialist medical workforce had shrunk by 15%, meaning that there were only about 9,500 employees to serve the entire population of 3.2 million, as the ‘Catherine Kim reported for Vox.

The numbers had recovered somewhat by the time the pandemic emerged. But many medical staff had to stay home and self-quarantine when they tested positive for Covid-19.

The Centers for Disease Control and Prevention recently changed its recommendation for people to quarantine for five days instead of 10 if without fever for 24 hours without using antipyretic drugs and other symptoms have improved. While controversial, these guidelines could allow asymptomatic healthcare workers to return to work much earlier, helping to alleviate staff shortages and the availability and quality of medical care for all.

But burnout is also a problem. Many healthcare workers have moved away from direct care of Covid-19 patients in favor of less risky jobs, such as vaccinations and lab work, Ramos said.

All of this means that the ability to treat not only Covid-19, but also other patients with urgent medical conditions remains a challenge nonetheless. According to the federal government, 72 of the island’s 78 municipalities are medically underserved and have “unmet health care needs.”

This problem is compounded by the fact that many doctors on the island have cut back on-site services and patients with risk factors for Covid-19 are afraid of accessing in-person care for fear of contracting the virus. This has led to an explosion of needs in the mental health sector and an increase in the incidence of chronic diseases, such as diabetes and hypertension, Levis said.

“It makes it clear the imperative that if Covid is endemic and we’re going to see these flare-ups emerge, we need to make sure we have other ways of communicating with patients,” Levis said.

Unless these long-standing challenges in Puerto Rico’s healthcare system are addressed, in addition to the immediate staff shortage, any future wave of a pandemic will continue to pose a health risk to Covid-19 patients and patients. anyone else seeking care.


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