Puerto Rico Faces a Critical Moment During the Pandemic

73% of all confirmed COVID-19 cases were reported in July. In these past two weeks, the number of hospitalizations has fluctuated between 399 and 533 patients.

To provide reliable data regarding the COVID-19 virus in Puerto Rico, and an expert interpretation of them, 9 Millones established a collaboration with the Salud Pública en Acción (Public Health in Action) project, started by epidemiologist Roberta Lugo Robles. This story was translated by María Cardona.

Up to August 7, the Puerto Rico Department of Health data showed a total of 21,424 positive tests (molecular and serological). This equals an increase of 2,576 confirmed cases and 2,067 probable cases since our report on August 1st.

“The confirmed cases continue rising. In the month of July, around 73% (5,549 cases) of confirmed cases up to this point were reported,” said epidemiologist Roberta Lugo Robles.

This week, three epidemiological interpretations of the available data stand out:

• During the month of July, close to 73% of the total confirmed cases were reported.

• During the last weeks of July, a plateau in the number of hospitalizations was observed.

• The positivity rate should be interpreted with caution.

[Pictured above: The epidemiologic curve shows August 4 as the peak, but without all of the data, it’s hard to confirm if this is true. Source: Statistical Institute of Puerto Rico, data up to August 11, 2020]

COVID-19 in Puerto Rico

The distribution of confirmed cases according to gender remains the same at a ratio of 50/50 with a median age of 42 years.

Confirmed cases between the ages of 30 to 59 are still reported to be the highest population at risk for infection with a total of 4,330 cases. This equals about 50% of all confirmed cases up to date. Out of the 2,579 confirmed cases added this past week, 36% belong to the age range of 20–39-year-olds. This is a tendency that’s been observed over the last few weeks.

“The tendency highlighted in previous reports continues, as young adults keep contracting the virus. This tendency can be observed in both confirmed and probable cases. Fifty-three percent of confirmed cases and forty-eight percent of probable cases are in the 20 to 49 age range,” added Lugo Robles.

Geographical distributions of cases, the metropolitan region, which contains the highest population in Puerto Rico, continues to have the majority of confirmed positive cases with a total of 2,924 (35.8% of total cases), followed by Bayamón with 1,687 cases (20.7%) and Mayagüez with 929 cases (11.4%).

The five towns with the highest rate of confirmed cases are San Juan, Bayamón, Carolina, Guaynabo, and Mayagüez.

[Pictured above: Geographic distribution of confirmed cases. Circles are proportionate to positive cases. Source: Health Department, a report from August 8, 2020 http://www.salud.gov.pr/Estadisticas-Registros-y-Publicaciones/Estadsticas]

Plateau in the number of hospitalizations

By August 15, data showed a total of 406 hospitalizations, 66 patients in intensive care, and 46 on mechanical ventilators. During these past two weeks, the number of hospitalizations has fluctuated between 399 and 533 patients.

“We’ve continued the plateau in hospitalizations that started at the end of July, which could be an indicator that infections have been contained or that the majority of new cases have presented a low or moderate illness,” said Lugo Robles.

[Pictured above: Number of hospitalizations. Source: COVID-19 monitoring in Puerto Ricohttps://rconnect.dfci.harvard.edu/covidpr/]

As of August 15, the death toll reported due to complications from the virus adds up to 329 total. Out of these deaths, 201 were confirmed through molecular testing and 128 were probable deaths. Probable deaths are deaths attributed to COVID-19 through a positive serological test or clinical or epidemiological criteria.

The Health Department has not updated the Contact Tracking or the Convalescent Cases reports since July 23, 2020. Around 34% of all cases have been contacted.

Testing capacity and positivity rate

Data from the last weeks indicates that we continue experiencing an active transmission within the community with around 1,000 new confirmed cases every week. At present, the testing capacity continues to be robust. According to data provided by the Puerto Rico Health Trust, during the eight weeks before August 8, on average, 28,000 tests have been conducted in labs. Since the start of the pandemic, over 375,000 tests have been processed.

“The sudden fall in the graph can be attributed to a delay in the data. We must wait at least a few weeks to make claims regarding whether testing capacity has decreased or not,” said Lugo Robles.

Regarding positivity, data shows a continually growing tendency since the start of July. However, the positivity rate is affected by various factors as discussed in previous reports. Therefore, the high rate of positivity between 15.0% and 18.0% we’ve observed daily in the last week could be due to a data delay.

“The Health Department tends to prioritize reporting on positive testing, which leads to not knowing the exact denominator (amount of tests done) for at least a few weeks. Consequently, the positivity rate of the last few weeks appears to be very high,” said Lugo Robles.

Another factor that could be affecting this is the prioritization of tests. The Health Department’s new guideline prioritizes symptomatic patients, increasing the probability that more tests come out positive and, therefore, raising the positivity rate. This complicates interpreting the positivity rate on the archipelago.

[Pictured above: Positivity rate and testing capacity. Source: COVID-19 Monitoring in Puerto Ricohttps://rconnect.dfci.harvard.edu/covidpr]

Keep protecting yourself

What we do know is that the use of masks and other preventative measures has reduced cases, hospitalizations, and deaths.

“We continue in a critical period within the pandemic with active transmission in the community and a high number of hospitalizations. It is not the time to let our guard down,” said Lugo Robles.

[Protect yourself and avoid contact by wearing your mask, washing your hands, and keeping physical distance.]