Puerto Rico Journal

SAN JUAN, Puerto Rico — Zika has landed forcefully in America, in one of its poorest and most vulnerable corners, a debt-ridden territory lacking a functioning health-care system, window screens and even a spray that works against the mosquitoes spreading the virus in homes, workplaces, schools and parks.

There are 117 confirmed cases of the virus in Puerto Rico, four times the number at the end of January. The island territory, which has a population of 3.5 million people, is “by far the most affected area” in the United States, Tom Frieden, director of the Centers for Disease Control and Prevention (CDC), said Friday. The number will almost certainly rise sharply in coming weeks, making it ever more likely that the virus will spread to the continental United States.

[Why the U.S. is vulnerable to the alarming spread of Zika virus]

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Dozens of flights move daily between San Juan and Orlando, Washington, New York and other major cities on the mainland. Cruise ships stop here as part of their Caribbean tours. College students will soon head here on spring break.

The growing outbreak has laid bare how deeply Puerto Rico’s debt crisis has cut public programs, including basic health and environmental control services needed to fight the virus. Most homes and public schools — and even some medical facilities — don’t have window screens. A specialist in birth defects at Puerto Rico’s top hospital has trouble obtaining basic supplies, such as toner for his office printer. There are hundreds of abandoned houses — not only in low- and middle-income neighborhoods but also in gated communities — because owners have fled to the mainland as a result of the economic crisis.

At dusk, health department workers spray permethrin in the middle-class neighborhood of Riveras de Cupey in San Juan, Puerto Rico. The government is beefing up anti-mosquito measures as the Zika virus spreads through the island. (Allison Shelley for The Washington Post)

Experts say urgent action is needed before mosquitoes reach their peak with the start of the rainy season in April. Experts from the CDC estimate that 700,000 people — about 20 percent of the population — could be infected across the island by the end of the year, based on previous outbreaks of dengue and chikungunya, related viral diseases.

In response, the CDC has sent 30 experts from its Atlanta headquarters and elsewhere to Puerto Rico, adding to the 70 CDC staff members based here who usually work on dengue fever but now are focusing on Zika. Frieden is expected to visit soon. President Obama’s $1.9 billion emergency Zika request to Congress includes $250 million for Puerto Rico.

“I don’t think we’re going to be able to stop the Zika outbreak,” said Steve Waterman, chief of the CDC’s dengue branch, located on the city’s west side. “There will be a substantial Zika outbreak that will peak in the summer and fall. It’s likely that thousands of pregnant women will be exposed and infected, so that’s why our efforts are focused on protecting as many pregnant women as possible.”

[Scientists find first links between Zika and temporary paralysis: What you need to know]

Five of the 117 confirmed cases involve pregnant women. And unlike in the continental United States, where cases are the result of infected travelers to Latin America and elsewhere bringing the virus back home, almost all the cases in Puerto Rico involve people bitten here by infected Aedes aegypti mosquitoes, which also spreads dengue fever and chikungunya.

What you need to know about the Zika virus and how it spreads

Because of the suspected link between Zika and potentially devastating birth defects, authorities are focusing on protecting as many pregnant women as possible. That includes 4,000 expectant mothers living in parts of the island where mosquitoes are spreading the virus. That’s more than one-third of Puerto Rico — primarily San Juan, the northeast and the southern coast.

[What is Zika and what are the risks as it spreads?]

Only the CDC and Puerto Rico’s health department labs can perform the special Zika testing. The labs expect to run 100,000 tests over the year for pregnant women, five times as many as they handle now, Waterman said. Determining whether someone is infected is complicated because most people don’t show symptoms. It’s also hard for tests to easily differentiate between dengue and Zika infections.

On Monday, authorities in Puerto Rico began distributing free Zika prevention kits to pregnant women that were created by the CDC and the CDC Foundation. The kits include information and tools to help them reduce risk of infection and include repellent, products that kill mosquito larvae, and condoms.

Mosquitoes have ample breeding grounds here. In the Villa Palmeras cemetery in barrio Obrero, a low-income neighborhood in northeastern San Juan, virtually all of the thousands of graves have built-in flower stands where water, and mosquito larvae, collect. There are 109 cemeteries across Puerto Rico and thousands of flower holders.

Mosquito larvae also flourish underground, in water meters and vent pipes of septic tanks, which contain more water than elsewhere in the United States, said Roberto Barrera, a CDC entomologist.

[How a tiny mosquito became one of the world’s ‘most efficient killers’]

And then there are the mountains of used tires, which mosquitoes flock to, said Johnny Rullan, a former health secretary who is helping the government eliminate breeding sites. Puerto Rico has accumulated more used tires than anywhere else in the United States, experts said. In the past three weeks, temporary collection centers have received more than 561,000 tires.

Elwin Moran, 26, helps pile used tires at a former shoe factory in Humacao, Puerto Rico. The Humacao environmental board is collecting abandoned tires from neighborhoods. (Allison Shelley for The Washington Post)

‘Part of living on the island’

Perhaps the most difficult challenge is changing people’s attitudes and behavior about an ever-present pest that is as much a part of life here as steamy weather and graceful old banyan trees.

“What can I say, it’s part of living on the island,” said José Fernandez, a supervisor at a tire collection center in Humacao, in the southeast.

Emeris Canales Morales, 27, a single mother who is 23 weeks pregnant, lives in a home that overlooks a small cemetery on one side and a fetid canal on the other. Plastic bottles and other trash collect along the banks of the canal. Her windows have no screens. In December, the mosquitoes were biting so hard that she woke up with red welts covering her arms.

[Have you had an experience with Zika? Tell us about it.]

At a prenatal clinic for high-risk pregnancies at San Juan’s University Hospital at the Puerto Rico Medical Center, she was among the first to sign up for free Zika screening for women in their first and second trimesters.

Tourists visit two of Puerto Rico’s most famous landmarks — Fort San Felipe del Morro fortress and Santa Maria Magdalena de Pazzis cemetery. Mosquitoes thrive in wet conditions, such as cemeteries. (Allison Shelley for The Washington Post)

She won’t know the results for at least another week. Her first two pregnancies ended in miscarriages because of complications from diabetes. She is hoping for the best this time.

“I haven’t had the fever or the red eyes or the rash,” said Canales, who lives in Loiza, a northeast community that is one of the island’s poorest areas.

[Of 9 U.S. women with Zika, 2 abortions and 2 healthy babies]

But even for pregnant women, it’s hard to stay vigilant against the mosquito.

“When there was chikungunya, we joked about it until everyone had it,” she said. “Until people have the sickness, nobody in Loiza will take it seriously.”

Said Brenda Rivera, chief epidemiologist for Puerto Rico’s health department: “Controlling Zika is going to be a daunting task.” The department is coordinating the island’s response to the public health emergency.

Entomologist Roberto Barrea examines materials at a lab where his team breeds thousands of mosquitoes for research at the CDC’s dengue branch in San Juan. (Allison Shelley for The Washington Post)

Poor and unprepared

Women in Puerto Rico give birth to about 33,000 babies a year. The island has one of the highest teenage birth rates in the United States, and many public high schools have no window screens. The government is estimating how much it would cost to add screens, said Grace Santana, chief of staff to Gov. Alejandro Javier García Padilla.

Nearly half of Puerto Rico lives below the poverty line. The thousands of pastel-hued public housing projects that dot the island don’t have air conditioning. Residents don’t have window screens, in part because they can’t afford them, but also because they don’t want to block the breeze. Adding screens to those homes would cost about $70 million, said Santana.

At dusk on a recent day, a maroon pickup truck drove through the streets in the middle-class neighborhood of Riveras de Cupey, in San Juan’s south, spraying permethrin, a commonly used insecticide, from a machine mounted on the back.

But Aedes aegypti mosquitoes already have developed resistance to permethrin in some parts of Puerto Rico, said Audrey Lenhart, a CDC research entomologist. She is testing which insecticides are most effective, something that was never done before.

How a bloodsucker transmits the Zika virus

“The Puerto Rican government doesn’t really have a well-developed vector control and surveillance program,” she said, referring to basic programs to eliminate insects, birds and other vectors that transmit disease.

[Unknowns about Zika make it more “insidious, cunning, and evil” than Ebola]

CDC teams are helping authorities rebuild mosquito control programs, expand testing, and monitor and track thousands of pregnant women and their babies. They also are working with U.S. companies to provide window screens for women’s homes, and to bring to market a CDC-invented trap that could be a potent and cheap way to snare and kill adult mosquitoes.

For doctors such as Alberto De La Vega, an expert in high-risk pregnancies at the University Hospital in San Juan, Zika is one of many serious concerns. He worries that additional Zika testing will create huge demands on an already burdened health system.

“We’re having problems getting supplies, but we have to uphold U.S. standards,” he said. He has modern ultrasound equipment, but he pays out of his own pocket for the paper sheets that cover exam room beds.

He tells his patients they need to remove standing water and wear repellent.

“What we can do as physicians is very little,” he said. “By the time we identify problems with the fetus, it’s usually well into the second trimester, and by then it’s too late.”

Everything you ever wanted to know about the Zika virus and its spread across North and South America. (Daron Taylor,Claritza Jimenez/The Washington Post)

‘I’m going to have the baby’

The new mystery disease has infected Zulmarys Molina Paredes, 29. She’s one of the five pregnant women with a confirmed Zika diagnosis. But at 16 weeks in her pregnancy, an ultrasound shows her baby developing normally.

Molina and her 2-year-old son, Marco, live in Humacao in a peach-colored public housing project with her mother, aunt and brother. She is the sole breadwinner. She thinks she became infected at the private university where she works as an admissions officer, during tours of the campus. The campus has an artificial lake surrounded by trees full of mosquitoes.

Her headaches began Feb. 5. The following Monday, she looked in the mirror and was stunned.

“I was starting to put on my makeup and realized I was covered in a rash,” she said. “I got really scared.”

The emergency room doctor sent Molina’s blood to be tested. Nine days later, she was told her test was positive for Zika. But the doctor also said scientists didn’t know how often women with Zika infections have babies with birth defects such as microcephaly, where they are born with abnormally small heads.

Given the uncertainty, she is choosing to believe — and to pray — that everything will be fine. An amniocentesis is scheduled for next week. More ultrasounds will follow.

“I don’t care what happens. I’m going to have the baby,” Molina said. “I have faith that she’s going to be fine.” Her due date is Aug. 6. She will name her daughter Michaela.

Wednesday, March 2, 2016

How a Debt Bailout for Puerto Rico Short-Circuits Options for Reform - Washington Wire

How a Debt Bailout for Puerto Rico Short-Circuits Options for Reform - Washington Wire
Wednesday March 2nd, 2016 at 12:33 PM

ENLARGE

The Puerto Rican flag flies at the capitol building in San Juan. Photo: Getty Images

Salim Furth is a research fellow in macroeconomics at the Heritage Foundation’s Center for Data Analysis. He is on Twitter: @salimfurth.

Puerto Rico’s governor, Alejandro García Padilla, recently spent a week in Washington begging for an indirect bailout. The governor wants Congress to give Puerto Rico access to chapter 9 bankruptcy laws, which currently don’t apply to the U.S. territory. But Puerto Rico’s problems run deeper than its$70 billion debt.

The island has already defaulted on some of its debt and diverted funds from some debts with weaker legal obligations to make other payments. Partial default may be inevitable, but resistance to business and labor reforms may be part of the reason Congress has yet to act on Puerto Rico’s requests for help. Lawmakers might also not be pleased by a Caribbean Business report Thursday that Puerto Rico may try to maneuver on federal loans to the island’s public water and sewer authority (Prasa):

“Right off the bat, Prasa will no longer set aside money to service about $1.1 billion of its junior debt, most of which is guaranteed by the central government and includes federal loans made by the U.S. Department of Agriculture’s (USDA) Rural Development, which is owed $390 million, and the Environmental Protection Agency (EPA), owed $550 million.”

The story quotes the water authority’s executive president, Alberto Lázaro, saying of the suspended set-asides, “That doesn’t mean we aren’t going to pay.”

Because the debt is “junior,” the federal government’s claim on repayment is weak. Legally, “senior” bondholders and operation costs must be paid first. Because the loans are backed by Puerto Rico’s government, the cash-strapped utility can dump its obligations onto the governor.

But the commonwealth is $60 million behind in payments on its water bills so is unlikely to make good on its guarantee of the Prasa debt.

It’s not clear why the USDA and EPA lent large sums to Puerto Rico’s water utility at disadvantageous terms. Like other creditors, the federal government counted on the bankruptcy rules that apply in Puerto Rico at the time they lent funds. If Prasa cannot pay its debts, its creditors have a right to take over operations and implement reforms at the utility. That would be unpleasant for the bureaucrats who have managed Prasa, but it is likely to result in better service for Puerto Ricans.

Granting Puerto Rico access to the chapter 9 bankruptcy regulations would short-circuit possibilities for reform. Rather than giving Puerto Rico a path to growth, it could keep in place the bureaucrats who managed Prasa and other public corporations into default.

RELATED IN THINK TANK:

Where’s the Long-Term Plan for Puerto Rico’s Fiscal Crisis?

Benefits to Sticking With the Framework for Puerto Rico’s Debt

Read the whole story

· · · ·

1 in 5 Puerto Ricans will be infected with Zika Virus, warns expert

1 in 5 Puerto Ricans will be infected with Zika Virus, warns expert
Wednesday March 2nd, 2016 at 12:18 PM

Health | Mail Online

More than one in five people living in Puerto Rico will become infected with Zika virus, experts today warned.

As the virus sweeps through the Americas, Puerto Rico has become America's front line in the battle against the disease.

Home to 3.5 million US citizens, the territory has a tropical landscape that provides an ideal breeding ground for the Aedes mosquito that spreads Zika.

Officials have barred local blood donations, ramped up efforts to eradicate the Aedes aegypti mosquito and are trying to monitor every pregnant woman on the island due to fears the virus increases the risk of birth defects.

Tuesday, March 1, 2016

This is the first time in four years that we heard some intelligent words from AGP | Eradicate the mosquitoes (of all kinds, types and persuasions), instead of creating the breeding grounds for them, that's another solution. And another boost and significant savings for the island 's finances.

This is the first time in four years that we heard some intelligent words from AGP. It means that he is not completely hopeless "bag of stones hibaro" as some of his political opponents paint him. Or, even more believably, that he finally went to the "Walgreen's" (the ones that still are left), bought some wax sticks, cleaned up his ears and started to listen to some good advisers:

"Favors legalizing marijuana

He recalled that there were only 2015 584 murders, "the lowest amount in nearly 30 years" and similar declines in the incidence of other crimes Type I take this opportunity to thank the Police Superintendent Jose kettles, by advances in public safety. The same made by highlighting achievements in Justice, referring to the head of that agency, Cesar Miranda, and prior to Education Secretary Rafael Roman.

He criticized the lack of word and character, referring to the lack of support for his initiative proposed by legislators of the popular majority. Meanwhile, freed from pressures of a candidate in an election year, he favored the legalization of marijuana and asked the senator Miguel Pereira project is approved for possession of limited portions of the drug is decriminalized. On the opposition to these initiatives, he condemned "the hypocrisy of many sectors in the country" and called for a health approach to address the problem of drug addiction on the island."

Marijuana legalization might be a blessing for Puerto Rico, an economic stimulus and catalyst that could help to turn the things around, bring more taxes and help to renegotiate the bond payments.

No free ride, cabrones! No 50% haircut! No one will give it to you. America is loving but not stupid and is stern when it has and should be. Pay what you borrowed, and with interest, just like any one else, no special treatment for your seductive Spanish eyes. But if you can generate some extra income, and that easily, and with all these potential effects; hey, why not? It would be even better if marijuana growth and sales become the local government monopoly, with quality controls. Puerto Rico could make a mark with its progressive, smart and efficient drug policies (including the comprehensive treatment programs - that's your medical tourism, the addition and adjunct to the regular one) and turn it from the huge problem plaguing the island into the solution for the Caribbeans and the Americas. This will be one of the steps in turning Puerto Rico into the Switzerland of the Caribbeans.

As for Zika, no reason to carry the habitual image and the role of eternal victim, including of the circumstances, in the hope of more give-out pennies of public funds. Eradicate the mosquitoes (of all kinds, types and persuasions), instead of creating the breeding grounds for them, that's another solution. And another boost and significant savings for the island 's finances.

M.N.

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Steps for Fixing Puerto Rico’s Fiscal Problems by Grupo CNE
Tuesday March 1st, 2016 at 3:51 PM

CNE – Centro Para Una Nueva Economía – Center For A New Economy

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» Puerto Rico governor calls for legalizing marijuana | Fox News
01/03/16 08:23 from Mike Nova's Shared Newslinks
mikenova shared this story . Puerto Rico governor calls for legalizing marijuana Associated Press Facebook 288 Twitter 0 Email Print SAN JUAN, Puerto Rico – Puerto Rico's governor has called for the legalization of marijuana...

» The Right Solution for Puerto Rico
01/03/16 08:22 from Mike Nova's Shared Newslinks
mikenova shared this story from The Daily Signal. Finally, support from Congress for something other than a federal bailout for Puerto Rico or letting the commonwealth break its contracts and constitutional obligations. The Republican St...

» Puerto Rico governor calls for legalizing marijuana
29/02/16 18:21 from Mike Nova's Shared Newslinks
mikenova shared this story from World. Puerto Rico’s governor has called for the legalization of marijuana during his last public address as leader of the U.S. territory.

Thursday, March 3, 2016

Wednesday, March 2, 2016

Tuesday, March 1, 2016

Steps for Fixing Puerto Rico’s Fiscal Problems by Grupo CNE Tuesday March 1st, 2016 at 3:51 PM

Steps for Fixing Puerto Rico’s Fiscal Problems by Grupo CNE
Tuesday March 1st, 2016 at 3:51 PM