In early December, after a two-year hiatus from the stage, Dangerous Bunny went residence to Puerto Rico to offer his most devoted fanbase the live performance of their lives. The reggaeton star could have delivered together with his “P FKN R” show — a two-day, $10 million spectacle and tribute to Boricua tradition at a large 60,000-person stadium in San Juan. But it surely additionally turned out to be a superspreader occasion.
All concert-goers have been required to point out proof of Covid-19 vaccination and to put on masks or else threat a $100 high-quality and elimination from the live performance. Although their vaccination standing was verified on the door, there wasn’t much enforcement of the masks mandate, and plenty of attendees took them off as soon as they bought to their seats. In consequence, an estimated 2,000 attendees examined optimistic for the virus afterward, contributing to a 4,600 p.c soar in circumstances on the island final month. December 2021 accounted for a 3rd of the overall circumstances recorded in Puerto Rico, and now the island’s positivity rate is 36 percent.
The live performance was emblematic of what has gone flawed in Puerto Rico — and in different elements of the US amid the unfold of the omicron variant. Many Puerto Ricans really feel extra protected than they really are because of the island’s excessive ranges of vaccination, however two pictures of vaccine have proved to not be a adequate protection within the face of omicron, which is extra transmissible than previous variants. And extra individuals getting contaminated has meant extra persons are ending up within the hospital, straining medical infrastructure.
Only a month in the past, Puerto Rico gave the impression to be in a greater place than different elements of the US. It has among the lowest Covid-19 death rates within the US, and for months led the country in vaccination rates. A unified messaging marketing campaign from the scientific neighborhood and authorities leaders has allowed the island to largely keep away from politicization of the virus and the vaccine. And Gov. Pedro Pierluisi has applied a few of the strictest vaccine mandates within the nation. With out all of that, the newest wave may have been rather more lethal.
However even Puerto Rico wasn’t resistant to the extremely contagious omicron variant, which has contributed to a spike in caseloads and hospitalizations throughout the US. Gatherings in the course of the vacation season, which in Puerto Rico spans from Thanksgiving to mid-January with Three Kings Day celebrations, have exacerbated the issue. And on condition that many Puerto Ricans are vaccinated — practically 78 percent as of January 6 — infections on the island have been usually delicate, giving individuals a false sense of safety in the course of the newest wave.
“It’s a brand new variant, it’s Christmastime, and there’s a excessive vaccination price, so individuals really feel extra free to exit as a result of they’re vaccinated. And it looks like, although, omicron is eluding the vaccine, a minimum of for contagion,” mentioned Maria Levis, CEO of Impactivo, a public well being consulting agency in Puerto Rico.
Public well being officers challenge that the spike will final for about one other two weeks. Within the meantime, the Puerto Rican authorities has achieved what different US states and territories have refused to do, reviving restrictions on gatherings, journey, and college openings on the suggestion of scientists and public well being officers. Nonetheless, there may be not a lot it may possibly do about persistent hospital staffing shortages, which proceed to threaten not solely the welfare of Covid-19 sufferers, but additionally others in search of lifesaving care.
The Puerto Rican authorities is taking steps to forestall one other wave, but it surely’s assembly some resistance
On the recommendation of public well being officers, the Puerto Rican authorities reacted rapidly to the onset of omicron by reviving and strengthening restrictions that had beforehand been in place.
The governor has delayed the start of public schools by two weeks and really useful personal faculties do the identical. He has made booster pictures obligatory for workers within the health and education sectors, and all schoolchildren age 5 and older should have their first dose by January 10.
These attending mass occasions now have to offer not solely proof of vaccination, but additionally a damaging Covid-19 take a look at taken inside 48 hours of the occasion. All institutions serving foods and drinks need to require vaccination or a damaging take a look at for entry, and capability at these locations is restricted to 50 p.c or 250 individuals most. All passengers on flights to Puerto Rico even have to point out a damaging take a look at. And companies should shut between midnight and 5 am and should not allowed to promote alcohol throughout these hours.
For some Puerto Ricans, these measures don’t go far sufficient. Some have raised concern concerning the governor’s determination to delay the beginning of faculty fairly than what they see because the safer possibility: moving back to remote instruction. Others see the governor’s actions as clever. However general, there may be notable fatigue over Covid-19 prevention protocols amongst younger individuals.
The best incidence of circumstances in the course of the latest spike has been amongst individuals ages 15 to 39, mentioned Victor Ramos, president of Puerto Rico’s Faculty of Physicians, which is advising the governor on pandemic technique. The virus has been spreading of their workplaces, their faculties and universities, vacation celebrations, and enormous occasions — and so they have been bringing it residence to older, extra weak populations.
Two years into the pandemic, it’s troublesome to persuade these younger individuals to remain residence, particularly when, as a consequence of widespread vaccination, the everyday case of Covid-19 in Puerto Rico hasn’t resulted in signs extra critical than these of a chilly. Many additionally imagine that with Covid-19 changing into endemic, it’s solely a matter of time earlier than they get the virus, so they could as nicely get it over with. The difficulty with that technique, nevertheless, is that they nonetheless may unfold it to people who find themselves at greater threat for hospitalization.
“The signs have been actually delicate for folk which have gotten it, and that additionally performs into how critical individuals assume it’s,” Levis mentioned. “Persons are additionally simply drained.”
In the meantime, public well being officers are warning Puerto Ricans that two doses of the vaccine isn’t sufficient. Less than 40 percent of the inhabitants has obtained a booster. However problematically, not everyone seems to be eligible for a booster shot but, because it hasn’t been six months since their final shot or three months since they bought the Johnson & Johnson vaccine.
Though the signs of Covid-19 are usually milder for the vaccinated, omicron is extra transmissible, even amongst individuals who have had two pictures. The mix of vaccinated individuals decreasing their guard and the truth that most individuals in Puerto Rico haven’t obtained a booster shot has created a gap for omicron to unfold. The result’s a rising variety of circumstances, at the moment at nearly 400 percent more than final winter’s peak, in addition to a virtually 600 percent increase in hospitalizations within the final two weeks at a time when the island’s public well being infrastructure is struggling.
Regardless of being thrown the curveball of omicron, Puerto Rico’s authorities has responded precisely as public well being officers have suggested, and they’re assured that the brand new measures will get the pandemic underneath management once more. The identical can’t be mentioned of different states and territories within the US, which have largely eschewed a return to pandemic lockdowns.
Puerto Rico’s well being care system is underneath pressure
Hospital staffing shortages are at the moment proving to be the largest pressure on well being care assets throughout the US, and Puerto Rico isn’t any exception.
“We’ve got the beds,” Ramos mentioned. “The issue we’ve is personnel. They’re drained, they’ve to remain residence as a result of they’re contagious, and a few are on trip due to the vacations.”
Meaning the standard of the advanced and resource-intensive care Covid-19 sufferers require might not be as high because it may very well be. And that non-Covid-19 sufferers, particularly those that already had restricted entry to physicians, could face delays in care, which may create long-term well being points that can outlast the pandemic.
There was already a mass exodus of docs from Puerto Rico after Hurricane Maria hit the island in 2017, partly as a consequence of low wages and points with insurance coverage reimbursement that made it unattainable for them to pay their places of work and employees. By the next yr, the medical specialist workforce had shrunk by 15 p.c, that means that there have been solely about 9,500 employees to serve the whole inhabitants of three.2 million, as Catherine Kim reported for Vox.
The numbers had recovered considerably by the point the pandemic emerged. However many medical employees have needed to keep residence and quarantine after they take a look at optimistic for Covid-19.
The Facilities for Illness Management and Prevention not too long ago changed its recommendation for individuals to quarantine for 5 days as an alternative of 10 if fever-free for twenty-four hours with out using fever-reducing treatment and different signs have improved. Although controversial, that steerage may enable asymptomatic well being care employees to return to work a lot sooner, serving to alleviate staffing shortages and the supply and high quality of medical take care of all.
However burnout can be a problem. Many well being care employees have left direct care of Covid-19 sufferers in favor of much less dangerous jobs, similar to vaccination and lab work, Ramos mentioned.
All of this has meant that the capability to handle not solely Covid-19, but additionally different sufferers presenting with pressing medical points nonetheless stays a problem. In accordance with the federal authorities, 72 of the island’s 78 municipalities are medically underserved and have “unmet health care needs.”
Aggravating that concern is the truth that many physicians on the island have decreased their on-site companies, and sufferers with Covid-19 threat components are afraid to entry care in particular person for worry of contracting the virus. That has led to an explosion of want within the psychological well being sector and rising incidences of power illnesses, like diabetes and hypertension, Levis mentioned.
“It drives residence the crucial that if Covid is endemic and we’re going to be seeing these surges pop up, we have to be sure that we’ve alternate methods of speaking with sufferers,” Levis mentioned.
Until these longstanding challenges in Puerto Rico’s well being care system are addressed, along with the speedy personnel scarcity, any future waves of the pandemic will proceed to pose a threat to the well being of Covid-19 sufferers and anybody else in search of care.