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Congressional Letter Expresses Health Concerns in Territories

Several Members of the House Committee on Natural Resources sent a letter to U.S. Health and Human Services Secretary (HHS) Alex Azar on May 18 to seek clarity on HHS criteria for prioritizing the distribution of Coronavirus Disease 2019 (COVID-19) resources to U.S. territories.

“[I]t is important to know if HHS is taking territories’ fragile economic and public health infrastructure into consideration when determining the criteria,” the letter explained.

The correspondence began with a statement of the factors that may cause particular vulnerability to the coronavirus in Puerto Rico.

Puerto Rico faces unique COVID-19 challenges and vulnerabilities due to an economic crisis, a series of recent natural disasters, and unequal access and treatment under federal programs. The island is still recovering from the brunt of hurricanes Irma and Maria and hundreds of earthquakes suffered this year. These natural disasters, in addition to economic contraction, have weakened Puerto Rico’s already poor healthcare system and infrastructure.

Furthermore, the island is at greater risk of negative impacts from COVID-19 due to the age of its population and a range of comorbidities, including: a higher prevalence of hypertension, diabetes, coronary heart disease, obesity, asthma, and incidences of other infectious diseases such as dengue, compared to U.S. averages.

The local government of the Island has been strict with safety measures, and the number of cases in Puerto Rico has remained relatively low. However, the amount of testing being done in Puerto Rico is also low, amounting to less than 1 per cent of the population. The letter from the committee gives a reason for the lack of testing: “One of the primary reasons is that clinical laboratories are struggling to acquire reagents, collection materials and protective equipment that are necessary to increase testing capacity.”

Many states were in the same position last month, but most were able to increase their testing to higher levels. The White House task force on Coronavirus has asked states to strive for 30 tests per 1,000 residents, and States like Oklahoma have recently reached half that — about 15 tests for every 1,000 people. Puerto Rico is performing 15 tests per day for every 100,000 people.

“Limited access to tests has hindered the island’s ability to establish a science-based plan to gradually reopen the economy, putting millions of lives at risk,” the letter pointed out.

The correspondence went on to list four questions to which the authors want answers to by Friday:

  • Lists of declared COVID-19 hot spots or other COVID-19 priority designations since HHS began generating these for use by private sector providers.
  • Detailed criteria used to declare a COVID-19 hot spot or priority jurisdiction.
  • Measures being taken to increase test kit and protective materials, reagents, and supplies distribution to Territories.
  • Whether territories’ vulnerable population and frail economic and healthcare context is being taken into consideration in the HHS priority criteria.

Signing the letter were Raul Grijalva (D-AZ), Rob Bishop (R-AK), Michael San Nicolas (D-GU), Nydia Velazquez (D-NY), Jenniffer Gonzalez-Colon (R-PR), Gregorio Kilili Camacho Sablan (I-MP), Stacey Plaskett (D-VI), Aumua Amata Radewagen (R-AS), Darren Soto (D-FL), Jose Serrano (D-NY), Alexandria Ocasio-Cortez (D-NY), Joaquin Castro (D-TX), Jesús G. “Chuy” García (D-IL), and Juan Vargas (D-CA).

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