Puerto Rico and COVID-19: A Precarious Healthcare System Faces Serious Challenges
By Erick J. Padilla Rosas
From Eugene, Oregon
The COVID-19 pandemic poses a great challenge to countries with high levels of poverty, limited medical infrastructure, and a lack of universal access to health care. So far, the number of confirmed cases of coronavirus in Puerto Rico is 286 and 11 deaths. [1] Puerto Rico, an unincorporated territory of the United States, does not fare much better in terms of public access to health care services than most underdeveloped countries. To make things worse, in the three years prior to the novel coronavirus pandemic there had been a reduction in public access to the government health care system. Eligibility requirements for the federal health plan began to be more rigorous in 2017 due to irregularities found in the status of nearly 30,000 patients who had acquired help from the Medicaid system without being eligible for it. At this time eligibility for the program is directed at patients who receive a net income of no more than $800 per month.[2] With such a low income threshold, only half of the citizens living below the poverty level in Puerto Rico are eligible for coverage. Since 60% of the population lives below the poverty level, the eligibility requirements exclude many Puerto Ricans who cannot afford private health insurance.[3] In addition to these obstacles with regard to access to healthcare, the Puerto Rican archipelago’s health system now suffers from the lack of reliable leadership with the dismissal of Health Department Secretary Rafael Rodríguez Mercado on March 13, 2020. [4]
The socio-economic conditions
The unemployment is also taking a heavy toll on Puerto Ricans. By January 2020, nearly 94,000 Puerto Rican citizens were already unemployed. This figure represented an increase of 2,000 unemployed compared to January 2019.[5] Between March 16 and March 30, some 76,928 Puerto Ricans applied for unemployment benefits; that’s not counting those who have not yet had access to the Internet or someone to help them with the application process. [6] To date, unemployment claims in the Puerto Rican archipelago have reached more than 100,000.[7]
Fortunately, last week Puerto Rico approved an unprecedented financial package of $787 million to blunt the economic blow caused by the pandemic. Democracy Now reports:
“Measures include a three-month moratorium on mortgage payments, as well as other loans; bonuses for essential services providers such as medical staff and police; and improving remote education by buying tablets and educational tools. Governor Wanda Vázquez also said Puerto Rico’s public sector employees will keep getting paid, and small businesses and self-employed workers will receive cash to cope with the crisis.” [8]
Given the limited public access to health care services and high poverty and unemployment rates, this minimal relief is urgently needed. It is in the face of these economic challenges and deficits in the health care system in Puerto Rico that the Governor took swift action aimed at fighting the novel coronavirus pandemic.
The historical-political context of the Governor’s response
After the events of the summer of 2019, when Puerto Rico’s citizens demanded the resignation of former Gov. Ricardo Rosselló Nevares, the political atmosphere in Puerto Rico has fallen short of robust democratic participation.[9] The Constitution of the Commonwealth of Puerto Rico provides that when there is a vacancy in the office of Governor, the Secretary of State becomes the Governor. However, this position was left vacant before Rosselló resigned. Therefore, the line of succession fell under the responsibility of the Secretary of the Department of Justice, Wanda Vázquez Garced, the current Governor of Puerto Rico. Although Vázquez was not elected democratically by the people of Puerto Rico, she is constitutionally the governor. As such, she has taken the lead in addressing the responsibility to take political action on the pandemic and has a measure of democratic legitimacy.
Governor Wanda Vázquez declared a curfew on March 15, 2020 to be effective that same day from 9:00 p.m. until March 30, and this order has now been extended until April 12. [10] Among the directives included in the governor’s executive order, cars with license plates ending in even numbers will only be allowed to travel on the streets on Mondays, Wednesdays, and Fridays. On the other hand, the license plates of cars ending in odd numbers may be used on Tuesdays, Thursdays, and Saturdays. On Sundays, grocery stores and supermarkets will be closed. Citizens may leave their homes only to buy food or go to the pharmacy, financial institutions, gas stations, and health centers such as hospitals, with the exception of dental offices. Citizens are allowed to be out of the home with justifiable reasons from 5:00 a.m. to 7:00 p.m. Those companies and public services whose tasks involve the health and safety of citizens may continue to operate. This category includes police officers, messengers, car mechanics, gas stations, telecommunications services, and other functions essential for the proper functioning of a quarantined society.
Although stopping the entry of the virus into Puerto Rico has not been possible, this unincorporated territory of the United States was among the first countries in the Americas to take rigorous measures to control the spread of the virus. [11] The implementation of such measures in some cases required cooperation of US government authorities. For example, because Puerto Rico’s airports operate under the authority of the Federal Aviation Administration (FAA), the governor had to draft a petition to the federal government to have flights restricted to the island. As a result of this intervention, only one of the island’s three main airports is currently providing domestic flights, though the petition proposed closing the airports for all domestic flights for at least 14 days.
Preparing for an increase in COVID-19 cases
A nurse from the Mayaguez region who prefers to remain anonymous told the author that at the moment, there are enough hospital beds to deal with the limited number of cases. However, this time “no hospital has the capacity to receive a massive influx of patients under the appropriate isolation protocols.” Regarding the safety equipment needed by health care professionals to care for coronavirus patients, he states that “protective equipment is scarce and the administration of each hospital keeps it restricted as needed. I have not been denied any equipment at this time, but I personally recognize my rights and the regulations that protect me as a nurse and those that protect patients.”
To date, there has been no reported lack of beds to treat patients in hospitals. According to Dr. Juan Salgado, member of the Interagency state medical group, “Puerto Rico has 6,000 hospital beds and an estimated 60%, that is to say 3,600 beds, are available to receive patients” [as of March 28]. However, if COVID-19 infections in Puerto Rico continue at the same rate of growth, in three weeks there will not be enough available in the archipelago’s hospitals to treat patients.[12] In any case, the Puerto Rico Medical Task Force, the health advisory institution on COVID-19 issues in Puerto Rico, is already planning to equip some sports centers and hotels to treat COVID-19 patients before it is too late and before the hospitals and health centers are at full capacity.[13]
On a positive note, in response to a potential shortage of hand sanitizer, some of Puerto Rico’s distilleries have stepped up to the plate. Serrallés Distillery, Inc., has produced 70% ethyl alcohol to provide free of charge to help hospitals and health clinics in Puerto Rico to alleviate the current ethyl alcohol shortage.[14] For its part, as the Miami Herald reports, “one of the world’s largest rum factories, the Bacardi plant in Puerto Rico, has tweaked its production lines to pump out ethanol needed to make hand sanitizers.”[15] The bottles of hand sanitizers are to be distributed among those health and security personnel and volunteers who work day after day against the spread of the pandemic. Without a doubt, these are just two examples of how Puerto Rican companies have joined forces to fight the pandemic.
The Department of Health has published a preparedness and response plan against the COVID-19 entitled “Plan de Preparación y Respuesta ante el Coronavirus Novel 19 COVID-19.”[16] In collaboration with the Puerto Rico Medical Task Force COVID-19, the government of Puerto Rico and Puerto Ricans are taking to the social networks to share information, help raise awareness, and educate citizenry about the importance of staying home for the duration of the pandemic and until the Center for Disease Control changes its recommended protocols.[17]
Erick Javier Padilla Rosas is a Philosophy master student in the Department of Philosophy and Religious Studies at Louisiana State University (LSU), where he works as a teaching assistant. His publications include: “From Colonized Thought to Decolonial Aesthetics: The Search for a ‘Philosophical Voice’ Amongst Puerto Rican Colonized Subjects,” published by the Council on Hemispheric Affairs (COHA) on May 28, 2019; “Movilización popular en Puerto Rico: más allá de un chat…,” published also by COHA on July 25, 2020; and “El inicio de un nuevo orden boricua,” published by Revista Cronopio on December 20, 2019.
Fred Mills assisted as editor of this article
Main photo: Patients are screened in this tent in front of the emergency room of Hospital Perea in Mayagüez (Credit: Wilfredo Soto)
End Notes
[1] Departamento de Salud. Gobierno de Puerto Rico. April 1,, 2020. http://www.salud.gov.pr/Pages/coronavirus.aspx. See also BBC News Mundo, “Coronavirus: el mapa que muestra el número de infectados y muertos en el mundo por el covid-19,” 12 de marzo de 2020. https://www.bbc.com/mundo/noticias-51705060
[2] Laura M. Quintero, “Disminuyen personas elegibles para Mi Salud,” El Vocero. 14 de agosto de 2017. https://www.elvocero.com/gobierno/disminuyen-personas-elegibles-para-mi-salud/article_b122501e-807c-11e7-971f-bba17276d2dc.html
[3] Elga Valle, “La pobreza en Puerto Rico,” Enciclopedia de Puerto Rico. https://enciclopediapr.org/encyclopedia/la-pobreza-en-puerto-rico/
[4] El Vocero PR, “Gobernadora acepta renuncia del secretario de Salud,” 13 de marzo de 2020. https://www.elvocero.com/gobierno/gobernadora-acepta-renuncia-del-secretario-de-salud/article_e8a31cd8-6591-11ea-9d09-47aa98665ea2.html
[5] Departamento del Trabajo y Recursos Humanos, “Empleo y desempleo en Puerto Rico,” Encuesta de Grupo Trabajador, enero 2020. https://estadisticas.pr/files/inventario/empleo_y_desempleo/2020-03-25/EMPLEO%20Y%20DESEMPLEO%20EN%20PUERTO%20RICO.pdf
[6] Metro PR, “Más de 76,000 personas han solicitado el desempleo,” 30 de marzo de 2020. https://www.metro.pr/pr/noticias/2020/03/30/mas-de-76000-personas-han-solicitado-el-desempleo.html
[7] Metro PR, “Más de 15,000 puertorriqueños solicitan desempleo en 24 horas,” 1 de abril de 2020. https://www.metro.pr/pr/noticias/2020/04/01/mas-de-15000-puertorriquenos-solicitan-desempleo-en-24-horas.html
[8] Democracy Now, “Puerto Rico Passes $787 Million Financial Package as Coronavirus Pandemic Further Cripples Economy,” Independent Global News, March 24, 2020. https://www.democracynow.org/2020/3/24/headlines/puerto_rico_passes_787_million_financial_package_as_coronavirus_pandemic_further_cripples_economy
[9] Iris Alejandra Soto Ruiz and Erick Javier Padilla Rosas, “Movilización popular en Puerto Rico: más allá de un chat…,” Council on Hemispheric Affairs, July 25, 2019. https://coha.org/movilizacion-popular-en-puerto-rico-mas-alla-de-un-chat/
[10] Yaritza Rivera Clemente, “Toque de queda por el coronavirus,” El Vocero PR, 15 de marzo de 2020. https://www.elvocero.com/gobierno/gobernadora-decreta-toque-de-queda-por-el-coronavirus/article_e8c283a2-66c7-11ea-aea1-03a07fae93f0.html
Metro PR, “Estos son los cambios en el toque de queda emitido por la gobernadora,” 30 de marzo de 2020. https://www.metro.pr/pr/noticias/2020/03/30/estos-los-cambios-toque-queda-emitido-la-gobernadora.html
[11] Eldiario.es, “Las estrictas medidas en Puerto Rico contra el COVID-19 favorece un bajo contagio,” 23 de marzo de 2020. https://www.eldiario.es/sociedad/estrictas-Puerto-Rico-COVID-19-favorecen_0_1008950115.html
[12] Yennifer Álvarez, “En tres semanas sistema hospitalario local pudiera agotar disponibilidad de camas,” Noticel, San Juan, Puerto Rico. https://www.noticel.com/ahora/top-stories/20200328/en-tres-semanas-sistema-hospitalario-local-pudiera-agotar-disponibilidad-de-camas/
[13] Juan Marrero, “Task Force recomienda usar hoteles y facilidades deportivas como centros de salud,” Metro PR, 31 de marzo de 2020. https://www.metro.pr/pr/noticias/2020/03/31/task-force-recomienda-usar-hoteles-y-facilidades-deportivas-como-centros-de-salud.html
[14] Sabrosía Puerto Rico, “Destilería boricua anuncia producción de alcohol etílico para donar a hospitales,” 15 de marzo de 2020. https://www.sabrosia.pr/actualidad/2020/03/15/destileria-boricua-anuncia-produccion-alcohol-etilico-distribuir-hospitales-sector-salud.html
[15] Jim Wyss, “Rum to the rescue? How Bacardi is tweaking production to fight the coronavirus,” Miami Herald, March 24, 2020. https://www.miamiherald.com/news/nation-world/world/americas/article241460771.html
[16] Departamento de Salud, “Plan de Preparación y Respuesta ante el Coronavirus Novel 19 COVID-19,” Gobierno de Puerto Rico, marzo, 2020. http://www.salud.gov.pr/Dept-de-Salud/Pages/Unidades-Operacionales/Oficina-de-Preparacion-y-Coordinacion-de-Respuesta-en-Salud-Publica.aspx
[17] See “Puerto Rico Medical Task Force Covid-19” at facebook: https://www.facebook.com/puertoricomedicaltaskforcecovid19/