NUESTRO Investiga

Is COVID-19 molecular testing on tourists a priority in Puerto Rico?

The “Quick Guide for the Prioritization of Molecular Test (PCR) for COVID-19” does not include testing to thousands of travelers who are arriving to the island through the Luis Muñoz Marín International Airport.

We are evaluating the protocol that the Department of Health will implement for the stratification of molecular tests, due to the limitation of reagents in Puerto Rico and the world. We have consulted with the Center for Disease Control and Prevention (CDC), laboratories and infectologist to ensure that the process is validated with the health components; as well as having consensus on its implementation. In the next few days, we will generate a document with the guides, which will be consistent with those issued by the CDC. These guides will be published for the knowledge of the entire country.”

Statements for NUESTRO from Dr. Lorenzo Gonzalez Feliciano, Secretary of the Department of Health of Puerto Rico on Friday, July 17, 2020. 

Given the position of the Puerto Rico Department of Health, who since the beginning of the COVID-19 pandemic alleges a shortage of reagents worldwide to process molecular tests or PCR, which serves to confirm the presence of the disease in citizens, the agency determined to create a system to prioritize its administration, which does not include the thousands of travelers who are arriving to the island’s International Airport (SJU).

“Identifying COVID-19 cases within the population in time is extremely important in order to know how many people are infected over time. The decisions related to the performance of the various existing tests are based on the existing capacity to perform them in Puerto Rico. This ability to test can vary for various reasons. One being the decrease in available reagents to complete the test process. When the capacity to carry out tests is limited, efforts should be concentrated on areas with the highest rate of the disease,” reads the  “Quick Guide for the Prioritization of Molecular Tests (PCR) for COVID-19” introduction, a six-page document to which NUESTRO gained access to.

Although this document contemplates giving priority to three large groups, the majority of which must present any symptoms associated with the virus to access the confirmatory test, tourists who arrive on the island are not even mentioned in the DH plan.

This omission calls into question the entire strategy to identify travelers who carry the virus but arrive at the SJU airport without a negative molecular test, in violation of the Executive Order of Governor Wanda Vazquez Garced.

“After several reviews, we are working on the final documentation on the prioritization of the administration of molecular tests, given the limitation of reagents. Said protocol establishes which individuals will be given priority for their administration and, likewise, will serve as a guide for citizens, doctors and laboratories. In effect, and as a preview, we are not including tests for all travelers arriving to Puerto Rico. As we have previously mentioned, travelers must bring evidence of their molecular test, prior to arriving on the island. In the event that they do not have it, they must remain in quarantine,” said the DH secretary, Dr. Lorenzo González Feliciano.

In his written statements sent to NUESTRO, the head of the DH was emphatic in assuring that although tourists are not mentioned in the plan that he claims to be preliminary, they will have diagnostic tests like anyone else.

“Most definitely, if any traveler presents symptoms related to COVID-19 or a doctor determines that it is necessary to have the test, like any other citizen, they will have access to them, but taking into account the limitations that currently exist in Puerto Rico and U.S. We will only administer tests at the airport to those passengers who, upon arriving to the island, show symptoms. Our call continues to be that if you don’t have the test, don’t come to the island and protect yourself and your loved ones.”

For his part, the president of the Association of Clinical Laboratories, Dr. Juan M. Rexach Avilés, was pleased with the preparation of these guidelines, a document that laboratories have been demanding for months.

“We are grateful to the Department of Health for listening to the Association’s demand for clear guidelines for setting priorities facing a shortage of reagents. We understand that in the case of tourists, a sector that has raised serious concerns, the Department of Health itself will be in charge of carrying out molecular tests on anyone who tests positive for a serological test. It is essential that each tourist be evaluated and referred to the corresponding procedure to reduce the chances of infection,” said the director, who is a technologist and medical doctor.

Dr. Rexach added that the DH hired Quest Diagnostics, who have been responsible for the processing of PCR tests along with seven other reference laboratories. This contractual agreement, along with other contracts to clinical laboratories, are part of the second part of our ongoing research, which we will publish shortly.

Digital media NotiCel published this week that 80% of travelers arriving at SJU do not bring a negative molecular test with them. (Courtesy)

Is there really a shortage of reagents?

“The question should be, has DH looked at what tests are not in short supply that could be done using the instruments available in Puerto Rico? What has been done to facilitate access to these tests, not only within the DH, but also in the other laboratories, to optimize capacity throughout Puerto Rico? “, asked Dr. Daniel Colón-Ramos, who is a professor of Molecular Neuroscience at Yale University and co-founder of the CienciaPR organization.

“The Health Department could have been able to establish an integrated response in March where, in addition to endorsing the platforms that private laboratories have available, develop their own reagents that could have been used on open platforms that exist in Puerto Rico (research laboratories, etc.) or that are available to acquire. New York did something similar at the beginning of the pandemic and so far, I have not heard them say they have reagent limitations. And they did have and continue to have cases,” expressed cellular and molecular biologist, Dr. Marieli González Cotto.

At the closing of this article, NUESTRO inquires with the DH what is their plan to maximize molecular testing in Puerto Rico by using other reagents endorsed by the Food and Drug Administration of the United States (FDA). Our reporters will meet with Department of Health personnel this Monday at 2:00 p.m., to learn details about this matter.