‘The cases are exploding like never before.’ Puerto Rico sees spike in COVID infections

Puerto Rico, which achieved the highest rate of fully vaccinated people against coronavirus in the United States, is experiencing a record-breaking rise in COVID-19 cases, raising alarms as Christmas holidays and parties on the island are fast approaching.

The island’s positivity rate — or the percentage of people who are testing positive — was at 2.56% on Dec. 11. By Dec. 22, it had skyrocketed to 16.49%, according to Puerto Rico Department of Health data. There were 833 total cases confirmed with molecular and antigen testing in Puerto Rico between Dec. 5 and Dec. 11. Between Dec. 12 and Dec. 19, that number was about 10,700 — a 1,184.5% increase in a week.

“The cases are exploding like never before in Puerto Rico,” said Rafael Irizarry, an applied statistics professor at Harvard University who runs a Puerto Rico coronavirus data dashboard. “We haven’t seen anything like it.”

Irizarry, who also has a separate dashboard for vaccinations, sources his numbers directly from the island’s Department of Health and found there were more than 5,000 cases reported on Dec. 20, breaking records for any infection numbers reported on a single day.

The delta variant has been the dominant coronavirus variant on the island since July, according to health department tracking. Between Nov 14 and Nov 27, the variant made up 100% of all positive tests sequenced. But omicron, which officials believe is rapidly spreading on the island, made up 30% of tests sequenced Nov 28 and Dec 11.

Experts and scientists are worried that the rapid climb in numbers is coinciding with Christmas in Puerto Rico, often dubbed the longest in the world. The rate of infections among young adults between 20 and 29 is the highest among all age groups on the island, and much higher than the current infection rates among the 65-74 age group, said Irizarry.

But in previous waves of cases, experts noted that in the days after young people in Puerto Rico get sick, infections follow in older adults, who are disproportionately more likely to get hospitalized because of COVID-19.

The increase “is happening at a time when young people are going to visit their grandparents for Christmas parties and family gatherings,” said Daniel Colón Ramos, president of the Scientific Coalition, a group of scientists that offers Gov. Pedro Pierluisi public policy recommendations on the pandemic.

The spike also comes weeks after world-famous Puerto Rican rapper Bad Bunny held a two-day concert in San Juan, for which hordes of fans stood in line for hours to enter the venue. The weekend functions have been linked to at least a thousand cases on the island.

“It was like the perfect storm,” said Colón Ramos, “And the reason that event is emphasized is that it is a lesson. But if you eliminate the Bad Bunny concert, there would have still been a surge in cases in Puerto Rico. Perhaps not with the same magnitude or intensity, but there is a rebound globally.”

Puerto Rico’s race against omicron

Throughout the pandemic, Puerto Rico has enacted among the strictest pandemic management measures in the United States, including lockdowns, dry laws, vaccination mandates and curfews. In this latest rise of infections, Pierluisi ordered that anyone who goes to a venue that serves food or drink must show negative COVID test results or proof of vaccination to enter. Before, restaurants had the choice of not asking for either if they operated at half capacity. And any domestic passengers traveling from the United States mainland to Puerto Rico, regardless of their vaccination status, must present a negative test within 48 hours or less of arrival.

The Department of Health, in collaboration with the scientific community and civil society, has led an aggressive vaccination campaign since December 2020. Seventy-six and a half percent of the island’s population has completed its vaccination cycle as of Dec. 22, according to Centers for Disease Control and Prevention Vaccination Data.

“It will have a protective effect,” Colón Ramos said of the high levels of inoculations during this new surge of cases, “I think without that vaccination rate, this would be a disaster.”

In the race against the surge, the Puerto Rico Department of Health is pushing booster doses for the more than one million people who are eligible. About 26% of people on the island have received a booster dose, according to CDC data. The agency also continues its child vaccination campaign, as well as its efforts to reach the unvaccinated or partially vaccinated.

“From the start, the booster has been received with enthusiasm,” said Dr. Iris Cardona, the Puerto Rico Department of Health’s chief medical officer, who has led the government’s vaccination effort. “But again, as happened in the initial vaccination exercise a year ago, the booster recommendations were staggered, which could have caused delays and confusions with boosters. We are going to make our best efforts to ensure that these people receive the booster.”

Officials are also evaluating whether boosters will be mandatory for certain activities and jobs, she added. On Wednesday afternoon, the governor announced that all health and education workers will be required to receive their booster by Jan. 15. The island’s local health agency has organized a mass vaccination event, known as “VacuTrulla,” with live Christmas music and performances to entertain those who attend. Vaccines and boosters are available. There are over 900 vaccination sites across the island.

There has been an increase in people getting booster shots since the surge started, and more than 9,500 people received boosters over the weekend. Malls have been vaccination hot spots during the holiday season.

“They are averaging thousands of doses a day,” Cardona said.

Worries of holiday virus spread

Experts are cautioning residents and officials to take safety measures to prevent spread during Christmas. The Governor’s Scientific Coalition, which Colón Ramos spearheads, issued multiple recommendations to navigate the holiday surge.

It emphasized that the “safest route in these moments of uncertainty” is to limit nonessential holiday gatherings and suggested considering postponing or canceling them, and offered recommendations on how to limit events that could encourage crowding and become ‘super-spreaders,’ including putting caps on the number of participants. The coalition also encouraged officials to eliminate barriers to testing and urged island residents to complete vaccination and booster cycles.

“You cannot control the biology of the virus, but you can control the precautionary measures,” said Daniel Colón Ramos, “The recommendations that we are giving are conservative recommendations. They aspire to keep the society operating and interrupt the lives of people as little as possible but to mitigate the impact, the possible impact of hospitalizations.”

Restaurants are canceling their famous holiday parties. The city of San Juan called off the musical performances of the Fiestas de la Calle San Sebastián, one of the largest annual street festivals on the island. The Puerto Rico Symphony Orchestra suspended its Christmas show.

The governor said on Tuesday he still plans to host a massive New Year’s celebration, which will be televised by ABC Network, for 10,000 people at the Convention Center District. The event is being financed by the nearly $2 trillion American Rescue Plan, which President Joe Biden signed into law in March to help the country — including local state and territory governments — recover from the pandemic’s economic fallout.

“It’s a great opportunity for Puerto Rico to project itself in international and national media,” he said on Tuesday morning in an interview with local broadcast journalist Julio Rivera Saniel.

But a day later, on Wednesday afternoon, the governor announced that the bash, which features Daddy Yankee and other well-known artists, will be held virtually.

Colón Ramos and other members of the coalition told the Miami Herald that the spike in cases is alarming, but they believe Puerto Rico — especially considering the island’s high vaccination rates and receptivity to boosters — has the tools available to control the spread.

“Puerto Rico has grown in the face of the adversity of COVID, in the face of all the situations we have had to live through in recent years, and I am sure that before omicron it will also do so,” said Dr. Kenira Thompson, another member of the Coalition. “We have been able to surpass other surges. We will do it again.”

This story was originally published December 23, 2021 at 7:00 AM.