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Recognizing that confusion prevails regarding the number of positive cases COVID-19, the state epidemiologist, David Capó, indicated that, to date, the data in the hands of the government points to “a slowdown” of the epidemiological curve, especially in “the intensity and severity of infections” in Puerto Rico .
In an interview with El Nuevo Día, and while the questions regarding the handling of the tests carried out to date continue, Capó emphasized that such signs of “slowdown” do not imply that Puerto Rico can modify the current restrictions on commercial activity or the curfew in force a little over a month ago.
Rather, such indications, explained the epidemiologist, are positive insofar as the hospital system is not under pressure to respond to the health crisis.
“The severity of the infections is slowing down and that is positive. That is what we want to continue ”Hood said.
He stressed that it will not be until next May 8 and towards the second half of May when the government can begin to analyze what type of economic activities could be reclassified as essential and resume their gradual operation.
According to Capó, in Puerto Rico and the United States, the doubling of deaths “begins to recede”, one of several considerations to understand the advance and course of the pandemic.
He explained that since each country begins with its first coronavirus case, the number of deaths is usually high and as cases are controlled, a decrease in hospitalizations and daily deaths is expected.
“This has been an encouraging sign in the sense that the deaths do not depend on the tests (carried out),” said Capó.
In Puerto Rico, Capó said, the experience indicates that half of the cases diagnosed by means of a molecular test will end in a visit to the emergency room or hospital on medical recommendation. Of those, the epidemiologist said, approximately 20% will need intensive care and of those, at least one will die.
In the case of the island, the epidemiologist maintained, between March 8 and April 8, Puerto Rico has been “transitioning” from doubling its fatal victims by COVID-19 in one day to every two days “and now, we are between three and almost four days ”.
“What we are saying is that the number of deaths has been maintained at one or two deaths daily,” explained the expert.
Although the government’s objective is to reach a point where there are no daily deaths from coronavirus, the data -to date- indicates that, in relation to the start of the pandemic, that is, on March 8, the number The death toll from the respiratory condition has “stabilized,” relatively speaking.
However, Hood is not comfortable with letting his guard down. This is because, although they are also stable, the Demographic Registry records between one and two deaths from suspected coronaviruses daily.
Understanding the pandemic without resources
The problem is that the signs of “a slowdown” in the epidemiological curve are of little value when there are doubts about the testing of COVID-19.
“The confusion is understandable, especially when there is some kind of positive alert (of cases) or when it is reported that the employee of a company tested positive, but when that information is given we do not know if it is a result by a quick test, which may be a false positive, or if it was (a test) molecular, “said Capó.
Capó indicated that now that the data has been refined to share it with the Puerto Rico Institute of Statistics (IEPR), the government separates the results of rapid tests from those obtained by molecular tests to have better quality information.
The same has been done with the count of fatalities, separating the deaths by COVID-19 from those suspected of being in the condition reported by the Demographic Register.
In essence, Capó tries to make sense of a key public health management that, over the years, has been disjointed and decimated.
It has not been until now, almost five weeks after the closing order and curfew, that the unit led by Capó – and which barely has 20 employees for all of Puerto Rico – has received reinforcements – about 50 – from the rest of the agency. . This, despite the fact that many Health Department officials had not been fully working in the past month because of the emergency declaration.
The amount of information to be processed and the task of tracking patients and their contacts is so great that not even all of the Health employees would be able to cope, Capó said. The epidemiologist seeks to train municipal employees and university students to assist them in the process, especially in case tracking, a strategy that has not yet matured.
Furthermore, although the epidemiological team receives the data, Capó has no control over the processes that precede the figures, nor does it control the quality or the test administration process.
For this reason, for example, Capó could not specify what the gap in evidence pending results responds to. The “Epi” unit as it is called in the jargon of the agency also does not manage data on hospitalizations and intensive care. Such data is collected by the agency’s Biosecurity program, the epidemiologist explained.
“That is why we insist so much that the guidelines must be followed,” said Capó.
Tests, hospitalizations and deaths
Given that many doubt the figures offered by the government, El Nuevo Día asked Capó about the reliability of the rapid tests that the government has acquired and used for a month.
Capó maintained that his understanding is that this process of validating the quality of the tests (a process subsequent to corroborating the sensitivity of these with the manufacturers when it comes to buying them) has been carried out by the medical “task force”.
“That is another component that we do not work at Epi. My impression is that the ‘task force’ together with another Health team evaluates the criteria. We measure the results of the tests obtained and give recommendations, “he explained. “The evaluation that a test is being valid and reliable, we are not working on it ourselves.”
According to the most recent data released, until this Thursday, the confirmed cases of COVID-19 in Puerto Rico were around 915. Of these, 726 positives were obtained using molecular tests and 189 from serological tests. The total number of fatalities, which includes suspicious deaths, is around 67.
El Nuevo Día insistently requested hospitalization data in the discussion with Hood. The official assured that the information would be available on the COVID-19 dashboard, a portal that has been out of operation for at least three days, due to a power failure and subsequently, problems with the servers, it was reported.
At the time of publication, hospitalization data had not been provided and the statuscovid19.pr.gov site remained unusable.
Now that more serological tests will be administered, Capó believes that the number of positive cases accumulated under the rapid tests method will be very likely to increase, but recalled that these tests could be “false positives” or they could be cases without risk of severity of hospitalization and death.
In this confusing scenario, Capó argued, it is that “the death curve is the one that adds the most value.”
And if the encouraging signs are confirmed, they occur after a month of confinement and the practices put in place by people, including hand washing, the use of hand sanitizer and masks.
“At this time we cannot (we can make changes), when we start to have zero deaths, that will be the beginning of the ‘plateau’ to begin to analyze and make the determinations,” said Capó, insisting that the measures of social distancing will have to continue . “We will have to go little by little.”
“We are going to need the masks for a long time and the issue of hugging and kissing is also going to take a long time,” said Capó.
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