From 10 dangerous scenario's that World Health Organization (WHO) plans to fight this year, nine are known to Puerto Rico.
The WHO warning warns of immediate attention because of all the identified challenges only Ebola and other pathogens with equal or greater danger have not arrived on the island.
The other nine threats are or can be a common part of the local health system, from dengue to environmental pollution, the possibility of a flu pandemic and the increasingly dangerous antibacterial resistance, among others.
Environmental pollution and climate change lead the list of threats due to their effects on health.
In this context, Puerto Rico, because it is a tropical island with an hurricane season that warns the population every year for six months (June to November), can not escape. These two factors anticipate more active seasons, as warmer waters in the Atlantic lead to the formation of storms and hurricanes.
The tropical location of Puerto Rico connects it directly with one of the threats identified by the WHO, the dengue virus that has been transmitted by the mosquito bite Aedes aegypti. It is an endemic disease on the island, that is, cases are reported throughout the year.
A possible flu pandemic is also one of the dangers to public health worldwide this year. The situation is not strange for Puerto Rico, where the development of epidemics and outbreaks of this highly contagious respiratory virus is frequent.
Non-communicable or chronic diseases, resistance to antibiotics, HIV and resistance to vaccination are other health challenges identified by the WHO, as well as vulnerable and vulnerable environments and weak primary health care.
"There are 10 issues that give the most in Puerto Rico. You have to work on it intensively"The doctor said Víctor Ramos, president of College of Surgeons.
According to the pediatrician, the health indicators of Puerto Rico are currently below those of other countries without an integrated health system.
"The (health) efforts that are being made are not organized, so the initiatives have consequences for some, not all. With climate change, for example, it is important to create the law that regulates, with the exclusion of actions that directly affect, such as burning and burning of coal"He said.
WHO data warn that nine out of ten people are currently bombarded with contaminated air. Moreover, the mortality rate of diseases such as cancer, stroke and cardiovascular and pulmonary diseases is partly linked to environmental pollution. It is expected that climate change will lead to 250,000 deaths from malnutrition, malaria, diarrhea and heat stress between 2030 and 2050.
"Hospital visits are increased by heat waves," Dr. Rafael Méndez Tejeda, a climatologist and professor at the University of Puerto Rico in Carolina, pointed out that heart attacks also tend to increase as a result of the temperature rise.
According to the professor, the greenhouse effect also causes moisture in buildings, which promotes the development of fungi and aggravates airway diseases.
The WHO anticipates the development of an influenza pandemic, although it is unknown when exactly this will happen and how serious it would be. In Puerto Rico, during the 2017-2018 season, 10 fatalities were reported as a result of this virus. Already in the season 2018-2019 there are three confirmed fatalities and several more in research. Meanwhile, 21,028 cases and 1,019 hospitalizations had been registered until 2 February.
To the doctor Miguel Colón, former president of the Infectious Diseases Society, he worries about the subreport that usually occurs in cases of flu, as 66% of the rapid laboratory tests show "false negatives".
"There are many people who have not been treated and continue with the symptoms for five and six weeks. We must treat these cases by the clinic (symptoms) not only the results of the test (fast)"He said, by inducing vaccination as prevention of the virus.
He acknowledged, however, that vaccination does not offer "100%" protection against this disease.
Antibiotics resistance is another health threat that causes medical care.
"I see it every day, many multiresistant organisms (antibiotics), we have to be very careful, for example, for colds there are no antibiotics," said Colón.
Dr. Angeles Rodriguez, ex-epidemiologist of the state, agreed to punish his abuse.
"We do not have many new antibiotics, with new mechanisms of action, and there are already bacteria that are resistant to everything that exists," he complained.
Rodriguez said that this situation is particularly dangerous in cases such as tuberculosis, because if a person with a multiresistant infection does not isolate himself in time, he can transmit the disease to others and cause an outbreak that they could not fight.
He added that the excessive use of antibiotics in agriculture, livestock and poultry should be regulated because they are part of the food chain and can also affect people.
As far as resistance to vaccination is concerned, WHO points to various possible factors, such as access problems and lack of confidence in vaccines.
The pediatrician Fernando Ysern warned that although vaccination against childhood on the island is "quite high" in other countries, including the United States, there are areas where outbreaks of measles and other diseases that have been practically eradicated have been identified in groups of people who oppose and they do not vaccinate their children for religious beliefs, in addition to other factors. He added that a local challenge is that "as medical plans do not pay well for vaccines, not many pediatricians and GPs vaccinate."
An investigation is urgent
According to the WHO, 40% of the world's population threatens to become infected with dengue, a disease that causes about 390 million people annually ill. In addition, the WHO emphasizes that dengue is increasingly spreading to less tropical countries, such as Nepal, where traditionally there were no cases.
Although dengue in Puerto Rico is endemic, Dr. Ramos warned that it is urgently necessary to conduct a study into the reasons that led to a significant reduction in cases after Hurricane Maria.
"At the moment there is a big outbreak of dengue in the Dominican Republic and Jamaica and for some reason the virus does not circulate much in Puerto Rico since the hurricane. You have to do a serious study to know what happens"Said Ramos.
As far as HIV is concerned, the WHO recognizes that significant progress has been made, but the epidemic continues with nearly a million people dying each year from HIV and AIDS. The WHO urged access to treatment for risk populations, such as sex workers, prisoners and transgender.
Dr. Rodriguez agreed and emphasized the success of treatment in patients in government clinics, where more than 90% of patients with HIV were suppressed.
"These are generally serious threats, but most are preventable with good public health, active and passive monitoring and education."He decided.