A global pandemic has affected millions of lives and countries, yet Puerto Rico may be one of the few facing two pandemics. Why? Because in addition to the coronavirus disease (“COVID-19”) it is also dealing with “second-class” citizenship treatment. La Isla Del Encanto (The Enchanted Island), also known as Puerto Rico, is still dealing with multiple crises it has endured within the past few years as a result of Hurricane Maria and its ongoing struggle of constitutional identity. The island of enchantment may lose that very enchantment, because of the detrimental effect of its constitutional status, which has been magnified by the COVID-19 pandemic.

The coronavirus pandemic has swept the globe, shutting businesses, killing the vulnerable and crippling economies. Puerto Rico has taken one of the country’s hardest economic hits. Among Puerto Rico’s greatest economic challenges are chronically high poverty, especially among children, and low labor-force participation. However, there have been positive effects on Puerto Rico during the pandemic due to its demographic isolation. Puerto Rico’s demographic isolation and urban infrastructure has been an imperial strength because of the difficulty individuals face when trying to get around the island, lessening the potential spread of the virus. The island’s lack of public transportation and urban sprawl, issues affecting the islanders for decades, are now working in their favor. Puerto Rico imposed some of the most widespread restrictions yet seen in the United States. The majority of businesses were closed for over two weeks and placed a 9:00 p.m. overnight curfew. The only exception to the closure order was supermarkets; restaurants offering carryout or delivery; pharmacies; medical equipment stores; and gas station and banks. Violators of the lockdown resulted in a fine of up to $5,000 or up to six months in jail.

Despite those facts, the island’s legal status continues to place a barrier on the island development and resources during catastrophic events. There continues to be significant uncertainty about the coronavirus because the territory has lagged behind the United States in testing and tracing cases. The main concern Puerto Rico has is how the lack of testing creates uncertainty in an island that already has limited medical resources and funds. Further, accurate and transparent communication and evidence-based information, on behalf of the country’s leaders, is imperative when trying to handle a pandemic. However, the Secretary of Health of Puerto Rico resigned on March 13, 2020 after the island confirmed the first three COVID-19 cases. In total, Puerto Rico went through three health secretaries during the month of March 2020. The administrative changes were a barrier to the accurate information about the effect of the pandemic in Puerto Rico. Such mismanagement is a result of the long-lasting debate of what Puerto Rico’s legal status should be changed or enhanced to.

In addition to the lack of information on the pandemic, Puerto Rico faces health care challenges. Demographically, the island has a larger population of adults aged 65 or older compared to the United States (21% vs 16.5%). The older Puerto Rican population is characterized by a high frequency of chronic conditions associated with increased risk for COVID-19, including hypertension (73.0%), diabetes (34.9%), heart disease (14.8%), and obesity (25.4%). The compounding effects of wealth inequality, low levels of education, and a high prevalence of underlying risk factors among older adults threaten an already unstable economic structure stumbling from federal funding shortfalls in entitlement programs and health care. Collectively, these factors, directly or indirectly, affect population health through access to health-promoting goods and services.

Despite all the challenges Puerto Ricans face, they remain to demonstrate their resilience and continuing efforts to uphold their traditions, values and culture. Puerto Rico needs transparency and preventive measures to reinforce the efforts of the Puerto Rican healthcare system while educating the community and promoting overall physical and mental well-being. Puerto Rico deserves a well-defined legal status and autonomy it has been lacking after decades of being controlled by a country that participated in its very economic collapse.