Five things you should know today
1) Lack of coordination in Puerto Rico
The local press is full of mixed signals as the Director of the Puerto Rico Statistics Institute (“PRSI”) disclosed that the official statistics regarding the COVID-19 pandemic have defects that in some cases could not be remedied. According to Orville Disdier, Director of the PRSI, the problem goes to “the origin, to the very design of the system implemented to collect the data.”
At the same time, a recent front-page headline announced that “there is a downward trend in COVID-19 infections in Puerto Rico”. Apparently that conclusion is based on an undisclosed, unofficial model that was leaked to the press. The secret model is “based on mortality rates as well as on the number of reported new cases”. We will have to wait until the model and its methodology are disclosed to pass further judgment, but we do find it peculiar that the number of new cases is a key variable, given that the Puerto Rico Department of Health has admitted it does not even know with certainty the number of positive cases in Puerto Rico (see also Dr. Disdier’s declarations above).
Meanwhile, a group of public health professionals warned that the lockdown order and shelter-in-place restrictions had to be lifted with caution, given the lack of reliable data, insufficient testing, and inability to trace contacts. Daniel Colon Ramos, professor at Yale University, was especially forceful, stating that governmental incompetence was forcing people to face a false choice between their life or their job.
Finally, in the midst of all the foregoing, Governor Wanda Vazquez Garced announced that she will be unveiling soon a plan to reinitiate economic activity. According to the Governor, the plan will be “endorsed” by the medical task force that is advising her on these matters. This even though the New York Times reports Puerto Rico lags behind the 50 states and DC in tests per capita.
In sum, at this point, it is difficult to get a clear picture of what is going on in Puerto Rico with respect to the COVID-19 pandemic due to a lack of coordination, mixed messages, and lack of state capacity.
2) Puerto Rico government receives $2.2 billion from CARES Act
The government of Puerto Rico announced that it had received $2.2 billion allocated to the island through the CARES Act. This is certainly good news as it provides additional liquidity to the central government of the island. However, it is unknown at this point how these funds will be spent. The announcement also raises flags about the island government’s capacity to rapidly disburse aid to those that need it. For example, the Puerto Rico Department of Labor has been unable to process the additional funding it has received for Unemployment Insurance claims as well as payments under the federally-funded Nutritional Assistance Program. The increased demand for social assistance was foreseeable when the government announced the lockdown order and the shelter-in-place rules back in mid-March. Yet, it has failed to deliver much-needed aid to the people most affected by those unfortunately necessary policies.
3) Center for Health Security issues guidance for governors
The Center for Health Security at the Bloomberg School of Public Health at Johns Hopkins University has issued a report setting forth guidance for governors regarding a phased opening of the economy. The authors of the report stress that a move toward reopening the economy should be considered when the following 4 criteria have been met:
- “The number of new cases has declined for at least 14 days;
- Rapid diagnostic testing capacity is sufficient to test, at minimum, all people with COVID-19 symptoms, as well as close contacts and those in essential roles;
- The healthcare system is able to safely care for all patients, including having appropriate personal protective equipment for healthcare workers; and
- There is sufficient public health capacity to conduct contact tracing for all new cases and their close contacts.”
The report also provides useful guidelines for assessing the risks associated with opening different sectors of the economy. It should be required reading for public health officials in Puerto Rico.
4) The learning curve
These days it is common to hear expressions such as “we need to flatten the curve” or “crush the curve” in reference to the graphic depictions of the exponential increase of COVID-19 cases. There is another curve we should be focusing on, though, and that is the learning curve about this disease. We know remarkably little about how this disease affects the human body and specifically why some patients show no symptoms at all, while others become acutely ill and in many cases unfortunately die. As Dr. James Hamblin writes in The Atlantic, one of the most interesting theories about COVID-19 is that it is really an autoimmune disease and the variation observed in the severity of the symptoms is not due to the virus itself but to the reaction of the host.
Many doctors have observed a pattern of quick decline in many patients: one day they feel like they have mild flu, the next they are in the ICU. According to Hamblin, “such a quick decline—especially in the later stages of an infectious disease—seems to result from the immune response suddenly kicking into overdrive. The condition tends to be dire. Half of the patients with COVID-19 who end up in the intensive-care unit at New York-Presbyterian Hospital stay for 20 days…Many of these patients arrive at the hospital in near-critical condition, with their blood tests showing soaring levels of inflammatory markers.” Perhaps herein lie some important clues for future research on this terrible disease.
5) PREPA gets some relief from lower oil prices
The embattled Puerto Rico Electric Power Authority (“PREPA”) has gotten some much-needed breathing room from lower oil prices as well as from a sharp decrease in demand due to the lockdown and shelter-in-place restrictions. Consumers are expecting a significant reduction in their bills as oil prices decline sharply. Furthermore, as reported in Utility Dive, PREPA has seen its reserve margin grow and outages fall and is “operating better than ever,” according to CEO José Ortiz. Pardon our skepticism, but we have heard this before.
Also, the consequences of the sharp drop in oil prices have not played out in full yet. There will be geopolitical repercussions as Venezuela, Russia, and Iran see a big decline in state revenues. Also, emerging economies that depend on oil exports for jobs and foreign currency may witnesses social and political unrest. Demand for renewable energy projects may decline, as many of these projects become less competitive relative to electricity generation based on traditional fossil fuels. On the positive side, oil importers should get much-needed leeway during these difficult economic times.
Quote of the Day
“The reward of a thing well done, is to have done it.”
—Ralph Waldo Emerson
Note from the editor
Testing, testing, testing. We know, we sound like a broken record. But the importance of testing for the SARS-CoV-2 virus cannot be overstated. Every single plan we have seen to reopen the U. S. economy, whether from the left, the right, or public health organizations, all of them, are based on the premise that robust testing capacity is in place before the reopening of the economy begins. Without sufficient and accurate testing it is impossible to make public health decisions in a responsible way.
The government of Puerto Rico made the right decision in closing down the economy early back in mid-March, but it has failed to take advantage of the last six weeks to put in place a widespread testing program and to build up its capacity for contact tracing. That delay has caused significant discontent among business people and workers alike, as they also understand that testing and tracing are key to reopening the economy, yet only see the Puerto Rican government commit blunder after blunder in these important areas.
The time has come for the Puerto Rican government to make an honest self-assessment. If it is unable to implement the testing regime necessary to safely reopen the economy, then it should admit as much and seek the required technical assistance from either the federal government or the World Health Organization. Otherwise, there lies chaos.
This is the end of today’s briefing.
Stay safe and well informed!