The people of Puerto Rico are no strangers to crisis, nor are they unfamiliar with a chaotic response from government. And so far, residents say, the local political controversies that have arisen in the face of the coronavirus pandemic are reminiscent of officials’ response to Hurricane Maria and other natural disasters that have devastated the island in recent years.
As of April 8, Puerto Rico had seen more than 600 cases and over 20 deaths from Covid-19, the disease caused by the novel coronavirus. The low numbers can partially be contributed to the aggressive social distancing measures the government adopted after the island confirmed its first case on March 13 (a 68-year-old Italian woman who came to the island on a cruise). The island has been on lockdown since March 15, and people aren’t allowed to leave their homes from 7 pm to 5 am. It’s one of the strictest measures imposed in the US, and violators are punished by either a $5,000 fine or a six-month jail term. Enforcement has also been stern: hundreds of people have been cited so far, according to the Associated Press.
But experts also expect that a lack of testing has created the illusion of lower case numbers. The island has one of the lowest testing per capita rates in the US, with only Oklahoma below it, according to the Covid Tracking Project. Although it has a population of 3.2 million, Puerto Rico had only run 4,539 tests as of Tuesday.
In response, administrators paid two companies, Apex General Contractors and 313 LLC, $38 million for a million Covid-19 tests — only to find out that the tests were unusable because they weren’t approved by the Food and Drug Administration. Unfortunately, the government will only be able to pursue a 50 percent refund, leaving them $19 million in the hole. To further fuel criticism, there have also been allegations that the two companies were donors to the governor’s New Progressive Party (PNP), the Miami Herald reports.
“When I say I don’t trust the government, in essence, I don’t trust the people that right now are in the positions of power and are making these decisions,” said Oscar Ojeda, a researcher and activist in Puerto Rico.
That’s not the only scandal the government is fighting: The island is now on its third health secretary in three weeks, and officials are discovering stockpiles of unopened medical equipment that was originally meant for Hurricane Maria.
For Puerto Ricans, these scandals are disappointing but not surprising, given the government’s poor track record with disaster response, Ojeda said. However, the trauma of Hurricane Maria has helped Puerto Ricans organize faster against the virus. Even before the lockdown, he said, most of the population had social distanced voluntarily. Meanwhile, doctors are increasing telemedicine efforts, and nonprofits have been stepping up by gathering and delivering critical medical supplies to hospitals.
But Ojeda said he’s frustrated that the people of Puerto Rico are taking on responsibilities that belong to the government.
“How much is enough resiliency?” he asked. “How much are we going to have to take control over the government’s responsibility to ensure a robust quality of life for the citizens? How much responsibility should we actually have to take up upon our shoulders?”
Puerto Rico is still recovering from not only Hurricane Maria in 2017 but also a series of earthquakes that shook the island in January. Hurricane Maria had a $43 billion impact on Puerto Rico’s economy — a devastating blow for an island that has already racked up more than $70 billion in debt. Then the earthquakes cost the island another $3.1 billion in property damages, as well as lost wages, business, and tourism from power outages. People had to rebuild their lives from the bottom up.
These disasters, coupled with inadequate aid from the federal government due to its territorial status, have left the island with a population that is older and poorer — both characteristics that make its population more vulnerable to a Covid-19 outbreak.
Immediately after Hurricane Maria, at least 123,000 people left the island, many of them working-age adults looking for jobs in the mainland US. That left many older people behind, and the population share of those beyond the age of 65 increased, going from 14 percent in 2008 to 21 percent in 2018, according to the Pew Research Center. This same group has been identified by the Centers for Disease Prevention and Control as high risk for Covid-19.
Puerto Rico’s status as a US territory, coupled with a long history of ineffective economic policies, corruption, and natural disasters, has also made its population poor: 44.9 percent of the population lives below the poverty line, a number that is much higher than the national average of 13.1 percent. About half of the island’s population relies on Medicaid, and 640,000 people receive food stamps. That means that many can’t afford to seek the proper medical attention to monitor their health and detect the virus in a timely manner.
The high poverty level also affects people’s basic quality of life during quarantine, said Javier Nieves, an activist on the island. The shutdown is particularly painful for many of those who barely scrape by on a regular day and now no longer have an income.
“It’s pretty frustrating and really painful. A lot of people are going to die because of all this irresponsibility,” Nieves said. “People live check by check. People live on WIC and food stamps.”
The local government passed a $787 million aid plan in March that includes $500 to self-employed people and a 90-day moratorium on mortgage, car, and personal loan payments. It’s one of the most generous stimulus plans released at a local level, but Nieves said more radical measures — such as a halt on bills and rents — need to be implemented to provide a proper social safety net for Puerto Rico’s vulnerable populations (Puerto Ricans are also eligible for federal unemployment benefits through the recently passed CARES Act).
Then there’s the more deeply rooted issue of Puerto Rico’s poor health care system, which only got worse after Hurricane Maria. Thankfully, Dr. Wendy Matos, a professor at the University of Puerto Rico’s medical school, said, the hospitals haven’t been overwhelmed yet — but that could change when the island reaches its anticipated peak in early May. And if a major outbreak does happen, the island’s health care systems are poorly prepared: For a population of 3.2 million, there are only about 10,500 medical specialists and 500 ventilators, although experts predict they will need at least 3,000 if the virus spreads.
The issue becomes more dire in rural areas like Vieques, a neighboring island that still hasn’t been able to open its only hospital since Hurricane Maria, according to Mark Martin, who founded the community group Vieques Love. Its substitute health center, built to fill the void of the hospital, isn’t equipped to treat Covid-19 patients. “Vieques is treated as a rural area, so its health system is built to stabilize and then ship you over to the main island where they have real hospitals,” Martin said. The system failed during the hurricane, yet the government has done little to provide relief.
The government “isn’t learning from Maria,” he said. “They really should be boosting the local health center to a higher classification — if not a hospital, a higher level of treatment.”
The island’s vulnerability to Covid-19 is precisely why Gov. Wanda Vázquez imposed some of the strictest social distancing measures in the US. Most businesses, other than grocery stores, banks, and pharmacies, are closed. And even these stores are inaccessible between the hours of 7 pm and 5 am, when Puerto Ricans aren’t allowed to leave their houses.
Despite other valid criticism of the government, it’s important to give credit where credit’s due, Matos said: The curfew and lockdown has helped the island dodge a more catastrophic scenario.
“I am a health educator and my background is in public health, but I never imagined that the virus was going to be so viral, so contagious,” she said. “I think that people are doing well and that the government took the right steps at the right moment, which was to lock down.”
Unfortunately, government scandals have raised skepticism among Puerto Ricans, Matos said. People are especially angered by the sheer mismanagement of testing kits: Because the government mistakenly ordered rapid testing kits that weren’t approved by the FDA, it is at risk of losing $19 million — an unfortunate loss for an island that is already in $74 billion of debt.
Matos added that the lack of tests has contributed to the low number of confirmed cases, as many patients go undetected. The criteria for administering a test is incredibly strict, so it is difficult to detect community spread of Covid-19.
Then there’s the frequent overturn in key cabinet positions, adding to the instability within the government. The island is on its third secretary of health in the past three weeks: The first, Rafael Rodríguez-Mercado, resigned after the island botched its response to early cases by mishandling samples, which led to delayed test results; the second, Dr. Concepción Quiñones de Longo, held her position for two weeks before resigning because she was unhappy with how the department was run. The latest, Dr. Lorenzo Gonzalez, has been doing a better job than his predecessors at handling the virus, Matos said, and is slowly starting to gain the trust of the people.
Then there is the discovery of stashes of personal protective gear donated during Hurricane Maria. On Saturday, the health secretary announced that officials found a warehouse with $4 million worth of supplies, although most of it had expired. He added that an additional cache of usable face masks, gowns, and gloves was found in Vieques’s abandoned hospital.
It’s ironic that the mismanagement of Hurricane Maria donations turned out to be a boon for health professionals fighting Covid-19 — but it doesn’t excuse the government’s past negligence, nor does it instill any confidence in the people that similar mistakes won’t be made again. For local activists who were long aware of this negligence, the narrative of the discovered supplies being a “blessing in disguise” is frustrating, Martin said.
“It’s insulting that the health center now says we discovered this thing that we didn’t know, that these people didn’t tell us about, and we’re going to use them for good,” he said. “So I think that they played a role that is not giving us our tranquility … what [they’re bringing] is controversy.”
The Puerto Rican government has a poor track record when it comes to supporting its people in a timely manner during a crisis. It took some families a year to get their electricity back after Hurricane Maria. People were still living in tents a month after January’s earthquakes. By now, Puerto Ricans are used to feeling abandoned, Martin said.
Puerto Ricans “waited for FEMA, they waited for the state government during Maria, and basically they never really came until people had gotten used to trauma and had figured out ways to cope or die,” he said. “There’s a lot of mistrust regarding what the government is going to do.”
The past three years have taught Puerto Ricans to be more self-sufficient so that they don’t have to rely on the government, Matos said. Although they may not have been prepared for an outbreak like the Covid-19 pandemic to hit, they already knew how to gather and distribute resources effectively, she said.
“We were ready in terms of ‘What do I need to do?’” she said. “Our survival mechanisms were up and running.”
The key lesson Martin learned after Hurricane Maria was to build a stockpile of supplies as quickly as possible. It’s why his organization has swiftly set up donations and purchased supplies for doctors and nurses in Vieques. His group bought a $26,000 ventilator, $10,000 worth of personal protective gear, a disinfecting machine, and some nontoxic disinfectant for common areas. They’ve also brought six doctors from the main island to Vieques to train local doctors, nurses, and EMTs on how to combat Covid-19.
Similar efforts to protect the community have been made by nonprofits on the main island. Accion Social de PR, a community organization that supports low-income families, is partnering with the Afya Foundation and San Juan Marriott Resort & Stellaris Casino to deliver medical supplies to the homes of sick and older people. And groups like Makers Against COVID-19, the Rogue United, and mechanical engineering students from the University of Puerto Rico have teamed up to 3D-print face shields for health care workers.
At the same time, Martin said, disaster preparation should be spearheaded by the government, not the people. Although officials have helped build a biohazard unit for potential patients and provided some protective gear, aid shouldn’t stop there if they want to rebuild trust with the people of Puerto Rico.
“We would like to see a much more direct accountability of the people who should be supplying [these necessities], because sometimes, we’re so used to not getting them that we forget that this is like a mandate that somebody should be sending the stuff,” he said. “I think in the midst of chaos, accountability gets lost.”