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Why Puerto Rico is doing so much better against COVID-19 than the rest of the U.S.

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Pop quiz: Which U.S. state has vaccinated the largest share of its eligible population against COVID-19 — and has America’s lowest rate of new coronavirus cases as a result?

Sorry, that was a trick question. The answer isn’t a state at all. It’s Puerto Rico.

While the press gives places such as California and Connecticut glowing reviews for containing the hypercontagious Delta variant, the unincorporated island territory is actually now doing a better job than either of them — not to mention every single other U.S. state — at inoculating its residents and keeping its COVID infection rate low.

What accounts for this striking gap between Puerto Rico and the mainland? According to experts, the U.S. has fallen behind the Caribbean commonwealth for the same reason it has plummeted to 41st in the world for vaccinations: because politics and polarization continue to warp U.S. COVID policy in ways that other societies simply haven’t had to contend with.

A man takes a selfie as he receives the Johnson and Johnson Covid-19 vaccine at a mass vaccination event at the Puerto Rico Convention Center in San Juan, Puerto Rico on March 31, 2021. (Ricardo Arduengo/AFP via Getty Images)

A man takes a selfie as he receives the COVID-19 vaccine at a mass vaccination event in San Juan, Puerto Rico, on March 31. (Ricardo Arduengo/AFP via Getty Images)

And the fact that this effect is still showing up in Puerto Rico — one of the few places that’s part of America but not part of its political vortex — only underscores how dramatic it is.

Consider the numbers. For every 100,000 residents, Puerto Rico is currently reporting just six new COVID cases per day. That’s less than half as many as the lowest U.S. state on that list, Connecticut (which is reporting 14/100,000), and nearly a sixth of the nationwide average (34/100,000).

Vaccinations are a similar story. Several Northeastern states have administered at least one vaccine dose to more than 85 percent of their eligible populations: Vermont (88 percent), Massachusetts (88 percent), Connecticut (87 percent) and Rhode Island (86 percent).

Puerto Rico is about to hit 90 percent — 15 points higher than the national average.

To be sure, Puerto Rico has endured COVID waves just like every other corner of the country. But the biggest of them — which occurred this spring — peaked at 34 cases per 100,000 residents per day. In comparison, the Delta wave that just slammed Florida — the state that’s closest to Puerto Rico in terms of latitude, climate and seasonality — hit 138 cases per 100,000 residents per day. As for daily deaths, Puerto Rico topped out at a rate of 0.47/100,000, while Florida, where just 77 percent of the population has received at least one dose of a vaccine, soared to nearly four times that level (1.75/100,000).

People attend the first mass vaccination event to get inoculated with the Johnson and Johnson Covid-19 vaccine at the Puerto Rico Convention Center in San Juan, Puerto Rico on March 31, 2021. (Ricardo Arduengo/AFP via Getty Images)

The first mass COVID vaccination event at the Puerto Rico Convention Center in San Juan, Puerto Rico, on March 31. (Ricardo Arduengo/AFP via Getty Images)

Throughout the pandemic, Puerto Rico has reported 6,337 COVID cases and 93 COVID deaths per 100,000 residents. In Florida, the corresponding numbers — 16,603 and 252, respectively — are more than two and a half times as high.

Puerto Rico’s relative “remoteness” has also probably helped to keep its surges in check. The six U.S. states or territories with smaller or similar cumulative case loads (per capita) are all geographically isolated: American Samoa, the Northern Mariana Islands, Vermont, Hawaii, the U.S. Virgin Islands and Maine. Meanwhile, Alaska, Oregon and Utah have also recorded slightly fewer deaths per capita than Puerto Rico, suggesting that it doesn’t hurt to be a little off the beaten path.

Yet now that vaccines are widely available, new daily COVID cases in several of these farther-flung places have surged much higher than in Puerto Rico: nearly twice as high in Oregon and Hawaii; more than five times as high in Alaska. Daily deaths have been higher in Oregon, Hawaii and Alaska too. This means there’s more than just geography at work.

Vaccination rates are probably the biggest difference. The full vaccination rate for Puerto Rico (66 percent of the total population) is significantly higher than Hawaii’s (58 percent), Oregon’s (61 percent) or Alaska’s (51 percent). It’s also significantly higher than the national average (56 percent).

A woman arrives to be inoculated with the Moderna Covid-19 vaccine at a Puerto Rico National Guard vaccination center, during a priority Covid-19 vaccination program for the residents of the island of Vieques, Puerto Rico on March 10, 2021. (Ricardo Arduengo/AFP via Getty Images)

A woman arrives to be inoculated at a Puerto Rico National Guard vaccination center in Vieques, Puerto Rico, on March 10. (Ricardo Arduengo/AFP via Getty Images)

By nearly every metric that correlates with vaccine uptake — at least on the mainland — this shouldn’t be the case. Puerto Rico’s poverty rate is 43.5 percent, or more than twice as high as the rate in the poorest U.S. state, Mississippi — where just 43 percent of residents have been fully vaccinated. Likewise, nearly 99 percent of Puerto Rico’s population is Hispanic; nationwide, the vaccination rate among Hispanic Americans is just 49 percent.

And unlike every highly vaccinated U.S. state, Puerto Rico isn’t really a progressive haven. One of the two major islandwide elected officials is a registered Republican; the governor belongs to the territory’s more conservative party; and the legislature has enacted restrictions on abortion and expressions of gender identity in recent years.

But that’s the difference: because Puerto Rican politics doesn’t map neatly onto that in the U.S., the island has largely avoided politicizing and polarizing the pandemic the way the U.S. has. Puerto Ricans can’t vote in U.S. presidential elections, so they don’t tend to identify with Democrats or Republicans (or let that identity define who they are). Politics there revolves more around the island’s status, and the possibility of statehood, than around the latest U.S. culture war. And right-wing media — with its skeptical attitude toward vaccines, masks, public health officials and even the seriousness of the coronavirus itself — doesn’t hold nearly as much sway in Puerto Rico as it does in the states. 

“Not everybody [in Puerto Rico] is aware of political issues between Republicans and Democrats in the continental U.S.,” David Capó Ramos, former senior epidemiologist in Puerto Rico’s Health Department, recently told the Miami Herald.

Puerto Rico's new governor Pedro Pierluisi holds press conference in San Juan, Puerto Rico on August 06, 2019. (Alejandro Granadillo/Anadolu Agency via Getty Images)

Puerto Rican Gov. Pedro Pierluisi at a press conference in San Juan, Puerto Rico, in 2019. (Alejandro Granadillo/Anadolu Agency via Getty Images)

As a result, there has been less vaccine resistance in Puerto Rico than in even the wealthiest, bluest U.S. states, and Gov. Pedro Pierluisi has had more leeway than most U.S. governors to implement public health policy — including widespread vaccine mandates that have further boosted the inoculation rate. In July, Puerto Rico became one of the first places in the U.S. to reinstate its indoor mask requirements regardless of vaccination status. In August, Pierluisi ordered businesses such as restaurants, nail salons, barbershops, casinos and gyms to operate at half capacity unless they require proof of vaccination (or a negative test) from customers; the same requirements apply to employees as well. First responders, school personnel, health care workers and government workers must all be vaccinated or submit to weekly testing. And after midnight, alcohol sales and social activities such as concerts, weddings, birthdays and anniversaries must stop, and businesses such as restaurants and theaters must close.

“I believe the mandates work,” Pierluisi recently explained. “I want to be very careful because I don’t want to revert.”

For now, at least, Pierluisi’s strategy seems to be serving Puerto Rico well — and Puerto Ricans seem to be on board. If only the rest of America could follow their lead.


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