Puerto Rico needs more molecular testing

High positivity rates indicate a need to increase testing capability and the existence of sustained transmission within the community.

Sep 11, 2020

To provide reliable data regarding the COVID-19 virus in Puerto Rico, as well as an expert interpretation of them, 9 Millones established a partnership with the Public Health in Action project, which was started by epidemiologist Roberta Lugo Robles. This article was translated from its original Spanish version by María Cardona.

As of September 5, data provided by the Department of Health shows a total of 34,533 positive COVID-19 tests in Puerto Rico. Out of these, 16,269 are positive via molecular testing and 18,264 are positive via serological testing.

This is equivalent to an additional 1,040 confirmed cases and 645 probable cases since our last report on August 30.

“We are on track to repeating the same story we saw in August and experiencing limited testing capacity. This will blindside us since we lack a vital element, molecular testing, to identify transmissions,” stated epidemiologist Roberta Lugo Robles.

This week, three epidemiological data points of COVID-19 in Puerto Rico stand out:

During the first week of September, the average hospitalization cases were 370 daily patients.
September data shows an average of 3 to 4 daily deaths.
The Puerto Rico Department of Health suggested a number of around 12,499 convalescent cases, that is, people recovering from COVID-19.

COVID-19 in Puerto Rico

The distribution of confirmed cases by gender shows that 53% of cases are female and 47% are male averaging of 42 years of age.

However, the largest number of transmissions has been detected in the 20 to 29 age range with 2,880 cases, followed by the 40 to 49 age range with 2,813 cases. Out of the 1,947 confirmed cases added this week, 51% of them belong to the ages between 20 and 49.

Geographic distribution Source: PR Department of Health (08/30/2020)

Geographically speaking, the San Juan metro area continues having the highest rate of confirmed positive cases with a total of 5,850 (37% of total cases), followed by Bayamón with 3,671 (23.1%), and Caguas with 1,724 (10.8%). The towns of San Juan, Bayamón, and Carolina reported the highest number of cases during the week with 203, 103, and 77 additional cases respectively.

Hospitals reach 56% of their total capacity

By September 6, the Puerto Rico Department of Health’s data showed a total of 377 hospitalizations, 73 patients in intensive care, and 67 on ventilators.

For the past two weeks, the number of hospitalizations has continued to fluctuate between 349 and 409 patients. During the first week of September, the daily hospitalization average was 370 patients.

“We are observing a plateau in hospitalizations, which averages nearly 380 patients daily since mid-August. Hospital occupancy is currently at 56% of its total capacity,” added Lugo Robles.

Hospitalizations Source: Monitoreo de COVID-19 en Puerto Rico

With 43 new deaths recorded since our last report, the death toll rises to a total of 477. Out of these, 317 correspond to confirmed cases (where molecular testing was done) and 160 were identified as probable deaths. Probable deaths are deaths attributed to COVID-19 through positive serological testing or clinical/epidemiological criteria.

“Data from the first week of September shows an average of 3 to 4 daily deaths. Currently, in the month of September, 21 deaths due to COVID-19 have been reported,” said Lugo Robles.

During the month of August, around 6 deaths were reported daily.

Daily COVID-19 Deaths. Source: Monitoreo de COVID-19 en Puerto Rico

The Department of Health reports 12,499 convalescent cases

According to data from the July 31 contact racking report, nearly 44% of all confirmed cases have been contacted. As a result, 8,641 contacts have been traced, out of which 7.75% were identified as positive for COVID-19. The highest number of contacts has been identified in Mayagüez (19.1%) followed by Ponce (15.4%), and Caguas (12.2%).

Reports on convalescent cases have still to be updated by the Department of Health since July 23. However, the Department of Health’s dashboard offers a number of 12,499 convalescent cases as of September 6, 2020.

A convalescent case means that a person has COVID-19 confirmed through a molecular test (RT-PCR), was not hospitalized, and it has been over 14 days since their last positive molecular test.

You can see the latest reports on tracking and convalescent cases in our previous data report.

High positivity rates indicate a need for more testing

Data from the first week of September shows a positivity rate that fluctuates between 13% and 14%. This tendency was observed during the month of August. The high positivity rate is indicative of the fact that we are facing a limitation in testing capacity.

During July, Puerto Rico performed between 5,000 and 8,000 daily tests. During the past two weeks, on average, 2,200 tests have been performed daily. This indicates that the decrease in testing capacity has had a huge impact on positivity indicators.

An uptick in positivity rates indicates a need to increase testing capacity and a sustained transmission within the community.

Blue: Amount of tests done Yellow: Positivity Rate Source: Monitoreo de COVID-19 en Puerto Rico

Current Panorama: We need molecular testing

It has been over 14 days since the last Executive Order and we continue seeing a rise in positivity rates and active transmission throughout the community. On September 12, a new Executive Order with more relaxed measures will be put in place.

Another important aspect that needs attention is contact tracing. The monitoring and tracking of contacts should be able to identify and describe outbreaks alongside the risk factors associated with it to design and conduct educational and preventative campaigns that manage to reduce transmission.

“It’s imperative that the Puerto Rico Department of Health settle testing capacity and contact tracing limitations, two vital elements of the

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