Physicians Association president: ‘This just got worse; (at this point) anyone can get COVID-19’
By Pedro Correa Henry
Special to The Star
As the island Health Department reported an astonishing and downright scary number of COVID-19 cases on Sunday, Puerto Rico’s medical community is bracing itself as the continuous increase of positive cases is leading to more hospitalizations, which could lead to more casualties and a possible collapse of the public health system.
The Health Department reported 325 confirmed and 255 probable cases of COVID-19 early Sunday, numbers that are changing by the minute.
Puerto Rico Physicians and Surgeons Association President VÍctor Ramos said the recent positive case rises did not come as a surprise as the tests dated back to around the Fourth of July weekend, when citizens flocked to local beaches and family events to celebrate the holiday without complying with guidelines for either physical distancing or the use of face masks.
However, Ramos said people, especially those around 20 to 29 years old, must understand that the disease caused by the coronavirus is a serious matter and they need to protect themselves and their loved ones.
“This just got worse; anyone can get COVID-19, anyone can die from this. There are people who are more vulnerable than others, but anyone, including young and healthy people, could get sick,” Ramos said. “We have seen people who were 29, 27, 26, even 13 years old, associated with this disease. Most of our recent infection cases were from people who are 20 to 29 years old. They believe that they will never get COVID-19; they think they are immortal.”
The pediatrician raised concerns as the pressure in hospitals builds up due to an increase in patients with symptoms related to COVID-19 and patients with decompensated chronic diseases who have been without the needed medical attention since March.
“Both sorts of patients are arriving simultaneously at hospitals, and there is pressure building in hospitals outside the metropolitan area, as this area holds more hospitals than any other sector in Puerto Rico,” Ramos said. “We already have hospitals that are quite full in the northern and western regions. We have to keep an eye on how this situation behaves in the coming days.”
When The Star asked for the surgeon’s opinion on the COVID-19 Citizens Task Force demanding that Gov. Wanda Vázquez Garced amend the recent executive order with stricter rules, such as implementing the Dry Law across the island, recommending emergency-based resources to control travelers’ flow from airports, shutting down all businesses on Sunday except essential services and reverting churches to remote services, he said the rules implemented on Friday were more than enough; however, citizens must cooperate and the government should take charge in enforcing compliance with the restrictions.
“Citizens should follow rules, social distancing, using face masks that cover both nose and mouth properly, washing your hands; it’s not complicated what we are asking people to do,” Ramos said. “The recent Executive Order addressed two concerns: delaying tourism back to August 15, although we have to see how the Health Department’s protocol works as it is a novel process, and controlling alcoholic beverage sales, as many of the cases, once we traced them, were due to travelers’ activities and private or family events that involved alcohol consumption.”
Ramos added that he is opposed to limiting businesses’ hours of operation. He pointed out that if businesses operate for fewer hours, there is a higher chance of more crowding.
“The main issue we had during the weekend was not that these businesses were open, it was the [size] of crowds of people who came by to consume especially alcoholic beverages,” Ramos said. “When the order stated the shutting down of casinos, gyms, and other non-essential services, it’s not that they didn’t comply with safety measures, it’s that we are on a positive case spike and there is no reason for these businesses to be open [at this time].”
When it came to the safety of healthcare workers in the midst of the situation, the doctor told The Star that with more positive cases, there is a higher chance for them to be infected. He said the numbers of medical workers with COVID-19 plateaued at 31 cases for the past two months. At press time, that number had gone up to 43, including two fatalities and a third patient on a ventilator.
“With more COVID-19 cases, the quantity of personal protective equipment available in the medical field is reduced, which becomes an issue since everyone fighting against this virus needs it,” Ramos said. “You could order some, but the gear might be put on backorder.”
Puerto Rico Hospitals Association President Jaime Plá said meanwhile that since the pandemic began in Puerto Rico, hospitals have been preparing and making the necessary adjustments to safeguard the health of employees, patients and visitors. He said hospitals have enabled isolation areas in order to attend to possible COVID-19 patients safely. Plá noted that, at press time, there were 315 hospitalizations due to COVID-19 infection, which represents 4 percent of hospital capacity.
“Hospitals have been able to educate and prepare themselves, and, as of today, [they] are more prepared to attend to COVID-19 patients specifically that they could not attend before,” Plá said. “Hospitals can handle more cases before there is a real and direct emergency. Obviously, the preparation that we must address has to do with when the intensive care unit beds are depleted or if the available ventilators are depleted. But we have around 800 ventilators available for use; we could have 800 patients on ventilators and we still would meet their needs, although we recognize that we do not want to reach that quantity.”
However, Puerto Rico Medical Services Administration (ASEM by its Spanish acronym) Executive Director Jorge Matta González said the ASEM hospital on Friday received patients in its emergency room for whom the hospitals of origin did not relay notification that they had tested positive for COVID-19. Matta González said that, at that moment, they worked on transferring those patients from the emergency room to the Medical Center’s University Hospital for Adults (UDH by its Spanish initials), where the majority of COVID-19 patients are being admitted.
“Receiving a COVID-19 patient requires activating our protocols, which include, among other things, making sure that we have rooms available and that our personnel is duly prepared to provide the required attention,” Matta González said. “It is because of this that transfers from other hospitals should be organized, well reported, and follow every rule to ensure that both the patients and the health professionals are safe while serving and receiving any other case.”
The ASEM chief said that after resolving the issue, they had around four rooms available at their emergency room to accommodate any patient who needed one. Likewise, he said the hospital is capable of helping and serving seven patients who are suspicious or positive for COVID-19 in an isolation room. Meanwhile they installed two carps with exterior negative pressure that can maximize their capacity.
“Actually, the UDH, which is the institution that admits most patients from the Medical Center, relies on 16 negative pressure rooms that are available at this moment,” Matta González said. “In addition, if the hospital anticipates an increase of patients in the next few days, we have instructed them on using two negative pressure areas that can have up to 30 patients each. The units will be ready once it is necessary to admit patients in these areas, which will expand our hospital services considerably.”
At the moment, Matta González said, the Health Department is investigating the event and urged every citizen to not lower their guard, to maintain social distancing, and to use their face masks.