Puerto Rico Just Had Its ‘Worst Moment’ for Covid-19 Cases

The Four Percent

SAN JUAN, P.R. — Throughout the pandemic, Dr. Víctor Ramos, a pediatrician, had not seen more than two Covid-19 patients hospitalized at the same time at San Jorge Children & Women’s Hospital in San Juan, the Puerto Rican capital, where he works nights. When he left after one of his shifts a few days ago, the hospital’s pediatric patient count had grown to 10.

“We had never seen that,” he said.

Some children were dehydrated after the coronavirus gave them high fevers, Dr. Ramos said, but others had the inflammatory syndrome that afflicts some children with Covid-19. One of the children hospitalized with severe Covid was just 3 months old, he said.

Puerto Rico has experienced its worst coronavirus outbreak of the pandemic over the past five weeks, with an explosive growth in cases exceeding records that had been set in December. Only this week did the numbers stop rising, giving the territory its first respite since the surge began in mid-March.

Behind the rise, experts say, was a confluence of factors, including the arrival of variants that probably made the virus more contagious right when people weary of staying home and hopeful about vaccines began to let their guard down, returning to work in person and shopping and dining indoors. Tourists poured in for spring break season. People gathered to celebrate Holy Week, a time when many are off work.

“The government relaxed restrictions around January and February — it opened the economy completely,” said Mayor Luis Javier Hernández Ortiz of Villalba, a town in south-central Puerto Rico. “This gave the virus opportunities to spread that it didn’t have a year ago. Now the virus has the opportunity to spread in all places.”

Starting on April 28, travelers who do not show proof of a negative Covid-19 test upon their arrival will be fined $300 unless they submit a test result within 48 hours. (The previous rules allowed travelers the option of isolating for 10 days if they could not provide a negative test result. Some have been arrested after breaking quarantine orders.)

Scenes of tourists behaving badly — flouting mask orders, crowding local hangouts and refusing to heed demands that they respect pandemic rules — have routinely made headlines. But contact tracing suggests many of the new infections have come not directly from tourists, but from Puerto Ricans going to work, restaurants and shops in person, public health experts say.

Mr. Pierluisi, who took office in January, has resisted pressure for a more stringent partial lockdown endorsed by opposition lawmakers and recommended by his own coalition of experts. The coalition said malls and restaurants were not essential, signaling that they could be temporarily closed. The governor said in a news conference this week that the recent measures he did take were working but needed more time to fully take effect.

“The situation is stabilizing,” he said. “There must be a very measured, very prudent approach to these types of decisions.”

His predecessor, Wanda Vázquez, imposed strict rules early on in the pandemic, ordering the country’s first lockdown. That helped Puerto Rico avoid a drastic increase in cases for many months but also dearly cost the economy. Long lines formed to receive unemployment benefits.

The latest outbreak can be managed with more gradual measures, Mr. Pierluisi said, citing the existence of virus treatments, a contact tracing system in Puerto Rico’s municipalities and the availability of vaccines.

About 1.65 million people — about 31 percent of the population — have received at least one vaccine dose, according to a Times database, which relies on statistics from the Centers for Disease Control and Prevention. Dr. Carlos Mellado López, the Puerto Rico health secretary, said in an interview that the Health Department estimated the number was actually higher, about 2.2 million people.

But one public health message — get your shot — might have blunted another — be careful about the rapidly spreading virus — said Mónica Feliú-Mojer, the director of communications at Ciencia Puerto Rico, a nonprofit group that supports scientists and their research.

“We went to one woman’s home and all she had was the same mask she’s been wearing since last year,” Sister Faustina said.

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