The US commonwealth of Puerto Rico will face a major crisis if it cannot contain a Covid-19 outbreak when it arrives. And it will arrive soon, if it hasn’t already. A cruise ship passenger diagnosed with pneumonia was admitted to a San Juan hospital and isolated while waiting the results of a coronavirus test. Meanwhile, her fellow passengers visited the city’s sights, restaurants, and bars. In addition, a doctor from Panama visited the island March 4 for a salsa festival in spite of showing symptoms, and has now been diagnosed with the disease in Panama.

As a population, Puerto Rico is at greater risk of sickness and death compared to the mainland United States. The severity of Covid-19 increases sharply in elderly people, with estimates from China suggesting mortality among people who have the infection around one in 12 for people ages 70 to 80, and one in seven for people over 80. According to the Census, Puerto Rico has a higher proportion of elderly people compared to most places in the United States — 21 percent over 65 Puerto Rico in 2017 compared to 16 percent in the rest of the United States. In addition, Puerto Rican elderly residents are seven times as likely to live in poverty compared to the rest of the country. If we look at hospital preparedness, and consider one metric of our readiness to care for patients with Covid-19 — intensive care unit beds — Puerto Rico has five times fewer ICU beds per capita compared to the rest of the country.

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