November 28, 2020

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Explain the four alert levels for the control of COVID-19

With the aim of communicating in a simple way the level of emergency that the country is experiencing in relation to the pandemic

Photo: Steven Vance / Visualhunt

San Juan – The Department of Health and the Puerto Rico Public Health Trust (PRPHT), a program of the Trust for Science, Technology, and Research of Puerto Rico (FCTIPR) developed a model of four alert levels established from key metrics for the control of the COVID-19 pandemic in Puerto Rico in order to communicate in a simple way the level of emergency that the country is experiencing in relation to COVID-19, it transpired on Monday.

“Since last September, when Governor Wanda Vázquez Garced passes the baton to the Department of Health to direct the efforts of the pandemic, the Department of Health uses the COVID-19 Risk Levels Model to make recommendations based on the level of alert, prior to the expiration of executive orders. The model is used to determine, with the support of members of the medical and economic task forces, the recommendations related to population mobility, economic and social restrictions, as well as the level of response to COVID-19 infections “, explained the Secretary of the Department of Health, Lorenzo González Feliciano in written communication.

The COVID-19 Risk Levels Model establishes the reference framework for responding to the four defined alert levels.

The model assigns a color to each alert level.

The metrics included in the model, as well as the risk levels and proposed measures, are continuously reviewed based on the knowledge and experience acquired in managing the pandemic, as well as new information and scientific evidence on the behavior of the virus.

For his part, Dr. Miguel Valencia, who directs the Death Surveillance System related to COVID-19 in the Department of Health, added that “it is important to emphasize that both in the analysis of the data to determine the level of alert in the that we find, as in the recommendations made to the governor, representatives of scientific and economic groups participate to jointly make the best decisions for the country. The model guides us to make the recommendations that are always aimed at protecting the health of the population and affecting the country’s economy as little as possible ”.

Dr. José Rodríguez Orengo, executive director of the PRPHT, explained that “the model uses the alert levels: green, yellow, orange and red to determine the prevention, containment and mitigation measures to follow. The metrics include: the positivity rate, the rate of positive cases in 14 days per 100,000 inhabitants, the number of transmission (reproductive) and the hospital capacity, particularly the capacity of intensive rooms. The model was established with the purpose of having a clear guide to make accurate determinations, in accordance with our experience with COVID-19 and the recommendations of the economic sector ”.

Given this, the secretary of the Department of Economic Development and Commerce (DDEC), Manuel A. Laboy Rivera, said “these alert levels are an important part when making future determinations on the operation of economic sectors. We face a great health and economic challenge, which makes us constantly evaluate the functioning of the economic sectors so that the protocols established for commercial operation are always complied with, while safeguarding the health issue. Since the beginning of the pandemic, we have joined forces with the private, academic and interagency sectors to jointly develop tools that allow us to have clear data on the evolution of COVID-19, and lead us to offer correct recommendations ”.

GREEN LEVEL (Minimal Risk)

The green alert level implies a minimal risk of community transmission with isolated infections. At this level, there are no movement restrictions for citizens, so it does not include a curfew. Regarding the economic sectors, everyone must follow preventive measures such as hand washing, the requirement of a mask and physical distancing, in addition to disinfection protocols; Initially, the economic sectors can operate at 90 percent capacity in their common areas and increase to 100 percent after four consecutive weeks at the green level. However, in the case of ports, the screening of all passengers and the recommendation that travelers enter with a negative molecular test result will be maintained.

YELLOW LEVEL (Moderate Risk)

The yellow level means that the risk of sustained community transmission is moderate, with the potential for community outbreaks and rapid growth in infections. At this level, a curfew is recommended from 11:00 p.m. to 5:00 a.m. every day. In the case of airports, screening of all passengers is maintained, but the ports would not accept cruises or ships from other destinations for recreational purposes. Meetings of no more than 10 people are allowed, always taking the proper precautionary measures. At this level the provision of essential services, public transportation, medical services and elective surgeries are allowed. In addition, the operation of care centers, pharmacies, supermarkets, manufacturing, call centers, data centers, security services, construction, tourism, film industry and telecommunications is allowed; however, other sectors will have restrictions.

At the yellow level, travel agencies, beauty salons, spas, maintenance and repair centers, professional and medical services, as well as the real estate industry, would continue to operate by appointment only. Open-format shopping centers, insurance companies, laundromats, vehicle inspection centers, car washes, financial services -excluding banks and cooperatives- and funeral services will be able to operate at 60 percent capacity.

The retail sector, closed-model shopping centers, gyms, and casinos will be able to operate at 60% capacity, avoiding groups of more than ten people, maintaining physical distance and strengthening cleaning and disinfection protocols. Drive in theaters or cinemas, as well as individual sports will be allowed. The marinas may operate with surveillance systems, without allowing group activities or “rafting” and maintaining the cleaning and disinfection of common areas. The capacity of people allowed per boat will depend on its size.

Cinemas, theaters, shooting centers, museums, bookstores, casinos, game rooms, gyms and swimming pools in hotels may operate as long as they do not allow group activities or the consumption of food or drinks, as well as guaranteeing that they will maintain the measures disinfection and protection at all times. The bars, hammocks, party bus services will not be able to operate and political activities, including caravans, are prohibited. Short-term room rentals will be allowed in establishments duly registered and certified by the Puerto Rico Tourism Company.

ORANGE LEVEL (Substantial Risk)

The orange level implies a substantial level of risk, so it is necessary to take more restrictive measures, because there is evidence of a substantial, but controlled community transmission, for a sustained period of time. The orange level includes a curfew from 10:00 pm to 5:00 am daily.

The operation in ports and airports would remain the same as that established under the yellow level, the gathering of people in common spaces is prohibited and the practice of group sports is not allowed. The operation of bars, hammocks, party bus services, political activities is not allowed, and visits to the beaches will only be allowed to practice individual sports. The operation of short-term rental establishments is prohibited and campsites are not allowed.

The retail sector, closed model shopping centers, gyms and casinos will be able to operate at 30% capacity. The establishments that are allowed to operate must be more restrictive with their disinfection and cleaning measures, require the use of a mask at all times and maintain physical distancing, within the permitted capacity, established in the executive order.

RED LEVEL (Critical Risk)

The red level signifies a substantial, uncontrolled level of community transmission, a critical situation that would lead to the implementation of a total closure or lockdown.

Under the red level, economic activity and citizen mobility will only be allowed for essential purposes. The operation of essential service establishments is allowed, including government operations. Supermarkets, pharmacies, essential financial services establishments, gas stations and security services will be able to operate. The operation of telecommunications service companies, agriculture and restaurants will only be allowed to operate in pick-up mode. At this level, elective surgeries are prohibited and the prohibition of other sectors established under the orange code is maintained.


It is important to emphasize the importance of proper case investigation and contact tracing to control the spread of the virus at all alert levels.

In addition, the implementation of protocols against COVID-19 by all sectors.

Likewise, it is established that people who have a confirmed diagnosis of COVID-19 must remain in isolation; as well as any person who has had direct contact with a positive case, must remain in quarantine and follow the epidemiological indications.

“We have received the support of representatives of the medical and economic sector to establish a model that has the objective of safeguarding the health of the population above all things, but always taking into consideration the economic impact. We study models implemented in other countries such as the United States, France, Spain and Israel. The recommendations established under each level are precautionary to reduce the sources of contagion, taking into account the reality of the country at that specific moment, as well as the indices and markers that we constantly analyze, ”Rodríguez Orengo stressed.

Likewise, Dr. Rodríguez Orengo explained that “the use of colors in the model facilitates the understanding of how the country is in relation to the virus, but more than that, it establishes clear and precise recommendations that must be implemented and followed to stop the contagion of the virus on the Island ”he highlighted.

“Community contagion is rampant, with days of more than 700 cases. People must be aware of making changes in actions and habits to prevent getting sick or making others sick. Let no one forget that each case represents a human being. It is useless to implement the measures if people do not apply them, “he said.

The Secretary of the Department of Health added that the model was established with the intervention and acceptance of the medical task force and the economic task force.

In addition, González Feliciano thanked all the professionals, scientists and experts who have worked together to make the most accurate recommendations for the country.

“In addition to scientists and representatives of the economic sector, representatives of the churches and the Citizen Task Force have collaborated in the effort to provide orientation and education to the population. The COVID-19 pandemic is the health emergency that has disrupted us the most in recent decades and we have taught that together we can work with Puerto Rico as a priority. Now we trust that the population also puts health first and is responsible and firm in the implementation of prevention measures ”.

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