The consensus among a group of experts consulted by this means is that the relaxation of trade restrictions will cause an increase in COVID-19 infections. What is unknown is the magnitude of the increase and the ability of the Department of Health (DS) to quickly detect a rise and the buds that are emerging.
Epidemiologist José Becerra, retired from the Centers for Disease Control and Prevention (CDC), compares the development of the pandemic in Puerto Rico to a car driving down a highway slope. “If the car has good brakes, no problem, but if the brakes are bad, you may have to use the (emergency) ramp.”Becerra said.
Executive Order 2020-066, which comes into force this Saturday, September 12 and establishes the new provisions to contain the emergency of the COVID-19, includes the reopening of beaches for bathers, cinemas, gyms and casinos, as well as other flexibilities, announced Thursday the governor Wanda Vazquez Garced.
In August, when the infections reached their peak, the car was speeding and accelerating. With the latest trade restrictions, new infections were slowing down. That is, the car is slower. “But it is still between 300 to 350 (contagions) a day. The cart continues at high speed and the bad brakes are still bad ”, he pointed out.
“Infections have dropped by half compared to August, but we are still much higher than it was in March. The reality is that any opening will generate more cases because there are more people interacting. Care must be taken so that cases are not triggered again as happened once (in the middle of the summer) ”, said, for his part, the president of the College of Surgeons, Víctor Ramos.
Puerto Rico would be better prepared for a reopening, like the one that Governor Wanda Vázquez Garced decreed on Thursday, if laboratories had access to reagents that are needed to perform diagnostic tests (known as PCR or molecular). This, for example, would allow to administer more tests, detect more infected and isolate them to stop the spread.
In addition, a greater number of diagnostic tests would allow better measure infections through other metrics such as the positivity rate, one of the most used to detect the extent of infections with the SARS-CoV-2 coronavirus.
Becerra indicated that another issue to be resolved is the transmission, with delays, of negative COVID-19 tests from clinical laboratories to the Department of Health. This information is important in the epidemiological analysis of this novel coronavirus in Puerto Rico.
These delays are not just with the government. She recalled the case of a woman, suspected of being infected, who. completed his quarantine without receiving the result of the diagnostic test. When he finally got it, he found out that it was all a false positive and that he did not have COVID-19.
He also stated that, although most municipalities have copied the model for tracking the infected established by the epidemiologist Fabiola Cruz in Villalba, for whom he praised, many municipalities have alternative systems, complicating the scientific analysis of outbreaks for the entire island. In addition, she indicated that information on outbreaks is needed more quickly.
“We need a longer-term plan… It was believed that closing was enough, but it wasn’t. That was the moment when the infrastructure had to be created and the Department (of Health) strengthened… Diagnostic tests need to be increased so that we have many results and they are reported promptly, ”said Becerra.
The new executive order
This Saturday, September 12, the provisions of the new executive order come into force that establishes the measures to mitigate the effects of the pandemic in Puerto Rico.
In the commercial aspect, Vázquez Garced authorized the operations of the casinos, cinemas and gyms, eliminated restrictions on movement and sale of alcoholic beverages on Sundayyes, and allowed the restaurants, shops and churches operate at half (50%) their normal capacity. Previously, they could only fill one in four chairs (25%).
In the same way, the governor extended until 10:00 at night, -three hours after what was arranged until yesterday- the hours that restaurants and supermarkets can sell intoxicating drinks. Those businesses whose income comes in a greater proportion from the sale of alcohol, such as cafeterias, hammocks, discos and bars, must remain closed.
In other non-commercial aspects, the new executive order maintains the curfew between 10:00 p.m. and 5:00 a.m. the next day, continue with the virtual classes for education systems, allows visits to the beaches, but with masks on if people are out of the water, and authorizes the use of marinas while prohibiting “rafting.”
Alza will delay return to classrooms
“What worries me is that cases will increase and the goal of reopening schools will be further. We should already be working for that. It couldn’t be more important to open an entertainment center than a school. There are too many children who are not taking classes, ”said Ramos.
That was a shared concern. Ángeles Rodríguez, a former state epidemiologist, understands that in order to better determine the course to follow in public education systems, what happens in other jurisdictions where classrooms are open despite COVID-19 is being awaited.
“They are waiting for the experiment to emerge in the United States,” said Rodríguez, who was very concerned about the reopening with the current level of infections.
Becerra, for his part, stressed that the situation is more problematic for children in the lower grades, who need a lot of encouragement to learn and those who have some kind of lag. “For me, those are the sectors that I would give priority to … But we are not ready for that yet,” he said.
Along with the announcement of the new executive order, Vazquez Garced announced the dissolution of the medical and economic working groups that advised La Fortaleza on the response to the COVID-19 pandemic. Decisions, instead, will be based on a metric system in which if the contagions increase, commercial restrictions are activated and vice versa.
The infectologist Humberto Guiot, a member of the La Fortaleza medical advisory group, explained that the system is guided by the rate of positivity of the virus, the transmission rate, the number of new cases and the occupation of patients in intensive care units.
These metrics will allow defining, by color, which places or economic sectors may continue to reopen and which others should be closed.
Dr. José Rodríguez Orengo, director of the Public Health Trust, recently reported that the level of risk will be measured in four colors: green, yellow, orange and red. Green, he indicated, would allow a reopening while red would recommend the total closure of a certain sector.
This system generates mostly positive reactions among the experts consulted. The president of the College of Surgeons stressed that a decision-making system focused on metrics improves transparency in decision-making and prevents favoritism to a particular sector.
“Sounds good to me in theoretical terms. That helps sectors not to think that there is a particular favoritism or something against some sector. But I think that the opinion of clinicians on this is important and vital. It cannot be that a scientific model replaces clinical criteria. I always like that it doesn’t become a straitjacket, “said Ramos.
“It is an imperfect system, but it is the best we can build with the data we have. They are trying to balance the risks, ”said Becerra, who collaborated in the project together with a large group of professionals from various medical and scientific disciplines in general.
Becerra indicated that these mechanisms seek to manage the spikes of infections. Highlighted that if people follow the recommendations for physical distancing, use of masks, constant hand washing or disinfection and limit their exposure to high-risk places, especially closed spaces where air recirculates -as it happens in the vast majority of places with air conditioning-, the advance of the pandemic can be stopped.
“This is a virus that has sustained community transmission. You can get it in many places right now. People have to be prudent and avoid spaces that may represent a risk as much as possible, ”said Ramos.
Reporter Marga Parés Arroyo contributed to this story.