The Economist - UK (2021-11-20)

46 United States The Economist November 20th 2021

PuertoRicoandcovid-19

Rich in experience

H

urricanemaria killedabout3,000

peopleandleft partsofPuertoRico

withoutelectricityfor 11 months afterit

madelandfallinSeptember2017.Forthe

pastfouryears its inhabitantshave en­

duredfrequentelectricityblackouts.Then

earthquakes then hit the island in late

2019­early2020.Sowhenthefirst covid

casewasdocumentedtwomonths later,

PuertoRicowasstillreelingfromprevious

disasters.Thehospitalsystemwasindis­

array:about15%ofmedicalpersonnelfled

forthemainland afterHurricaneMaria,

andtheearthquakesforcedmanyclinicsto

close.SomePuertoRicanswerelivingin

tent shelters, where infectious diseases

couldspreadeasily.Manyfearedthatcovid

woulddevastatetheweakenedisland.

InfactPuertoRico,anAmericanterrito­

ry of 3.3m people about 1,000 miles

(1,600km)south­eastofFlorida,hasfared

muchbetterthanmostofAmerica.Theis­

landexperiencedlowerinfectionratesper

personthanallAmericanstates(5,843cas­

esper100,000sinceJanuary21,2020).Of

course,lowcaseratescouldbetheresultof

infrequenttesting.Thepositivityrate(the

percentageofcovidteststhatarepositive)

isusedasanindicatorofhowwidespread

infectionisandwhetherenoughtestingis

beingdone.AsofNovember15th,Puerto

Rico’spositivityratewas5­7.9%fortheen­

tirepandemic,justslightlyabovetheshare

atwhichtheWorldHealthOrganisation

thinksthevirusisundercontrol.

Since January2020, PuertoRico saw

3,258 deaths from covid­19 (102 deaths per

100,000  people).  Of  the  American  states,

only Vermont (60), Hawaii (68) and Maine

(92)  had  fewer  deaths  per  person.  This  is

despite the fact that the island’s demogra­

phy does not work in its favour. Over one­

fifth of Puerto Ricans are 65 or older, com­

pared  with  16%  of  Americans  overall.

Those with pre­existing conditions are al­

so at greater risk of severe covid infection,

and  Puerto  Rico  is  over­represented

among these diseases. It is also four times

poorer  than  the  rest  of  America:  44%  live

in poverty.

Why has Puerto Rico done so well? Un­

like  much  of  America,  the  island  enacted

strict rules early. The government brought

in  a  lockdown  in  March  2020,  two  days

after its first confirmed covid case. Non­es­

sential  businesses  were  ordered  to  close,

and a curfew was enforced from 9pm until

5am.  Anyone  who  broke  it  faced  a  $5,000

fine  or  a  six­month  jail  term.  “Puerto  Ri­

co...enact[ed]  some  very  intense  and  very

stringent protocols when covid first came

out,” explains Brice Acosta, formerly of the

Federal  Emergency  Management  Agency.

“I  think  that  really  helped  them  control

things in the beginning.” Variations of this

lockdown continued for over a year. When

all  American  states  (except  Hawaii)  re­

opened  over  the  summer,  Puerto  Rico  did

not and kept many restrictions in place. 

Detachment from the mainland also al­

lowed  Puerto  Rico  to  limit  travel  into  the

territory. Cruise­ship passengers were pro­

hibited during the pandemic, and even ful­

ly vaccinated ones were not allowed to en­

ter  Puerto  Rico  until  August  this  year.  In

March 2020 the Federal Aviation Adminis­

tration  granted  Puerto  Rico  permission  to

require all commercial flights to land at the

international airport in San Juan for health

screening before heading to other destina­

tions.  Today,  all  passengers  landing  in

Puerto  Rico  must  show  proof  of  vaccina­

tion or a recent negative covid­19 test.

Other American jurisdictions detached

from the mainland also benefited from the

distance. Alaska experienced relatively few

deaths per person compared with the rest

of America (109 per 100,000), as did the us

Virgin  Islands  (79)  and  Hawaii  (68).  All

three  limited  domestic  and  international

travel.  Hawaii’s  rules  were  particularly

stringent:  some  tourists  were  arrested  for

breaking  quarantine  rules,  and  domestic

travellers must still present a negative co­

vid test or vaccination card to avoid having

to quarantine for a stretch before paddling

out  on  the  North  Shore.  But  despite  these

restrictions, each of these jurisdictions has

experienced covid surges over the past few

months  that  have  overwhelmed  hospitals

and  caused  patients  to  be  turned  away.

Puerto Rico did not.

Widespread vaccination is the likeliest

reason  for  this  difference.  Puerto  Rico  is

the most vaccinated jurisdiction in Ameri­

ca. As of November 16th, 74% of the island’s

population was fully vaccinated (America’s

average  is  59%).  Hawaii,  Alaska  and  the

Virgin  Islands  have  struggled  to  vaccinate

their  populations,  with  60%,  54%,  and

47%  of  residents  vaccinated  respectively.

Victor Ramos, a doctor who is president of

Puerto Rico’s association of physicians and

surgeons,  credits  a  strong  childhood­im­

munisation  system  for  the  successful  co­

vid­19 campaign. He is confident that Puer­

to Rico will also successfully vaccinate eli­

gible  childrenover  the  coming  months.

For America,itis a glimpse of what might

have been.n

S AN JUAN

How an impoverished, battered island

handled covid-19 better than the us

Here’s how

Politics

Spending and

voting

A

merica’s progressives reckon  they

would win more elections if only Con­

gress  would  pass  their  left­leaning  eco­

nomic  agenda.  The  presidential  cam­

paigns  of  Bernie  Sanders  and  Elizabeth

Warren in 2020 were animated by the idea

that raising taxes on the wealthiest Ameri­

cans to pay for much more spending would

turn out younger and less engaged voters.

A watered­down version of the same theo­

ry  is  being  applied  by  some  Democrats  to

Joe  Biden’s  bipartisan  infrastructure  bill,

which  allocates  $550bn  in  new  spending

over the next ten years for various public­

works  projects  and  was  signed  into  law

this  week.  The  total  price­tag  of  $1trn  is

higher than the Democrats’ most recent in­

frastructure­focused  stimulus  package,

Barack  Obama’s  2009  American  Recovery

WASHINGTON, DC

Will Democrats be rewarded for their

largesse? The precedents suggest not