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Yale's Colón-Ramos Energizes His Native Puerto Rico's Response to COVID-19

June 19, 2020
by Robert Forman

When the COVID-19 pandemic swept into the western hemisphere, Puerto Rico was especially vulnerable. In 2017, Hurricane Maria had battered the archipelago’s health system, infrastructure, and much more, while taking approximately 3,000 lives. Several earthquakes since then have added to the destruction, and the government of the U.S. territory has been in disarray both fiscally and politically since long before Maria.

For years, Daniel Colón-Ramos, PhD, Dorys McConnell Duberg Professor of Neuroscience and Cell Biology, and a native of Puerto Rico, has done what he can from New Haven and through periodic visits to his homeland to be sure Puerto Rico has every possible resource in times of need. When COVID-19 arrived, he knew this would be another such time, especially when he saw that Puerto Rico’s ability to test for the SARS-CoV-2 virus was abysmally low.

“As a trustee of the Science and Technology Trust of Puerto Rico, and in collaboration with my colleague, Dr. Giovanna Guerrero-Medina of the Yale Ciencia Institute, I helped convene a group of scientists, which got together with the clinical reference labs in Puerto Rico and started discussing the barriers they were facing to getting molecular testing going.” Some included initial missteps at the U.S. Centers for Disease Control and Prevention (CDC) that slowed testing throughout the United States, including at Yale. But Puerto Rico’s own Department of Health was also an impediment. Through his relationships with Puerto Rico’s scientific community, Colón-Ramos knew that Puerto Rico could be more self-sufficient in testing than the department realized.

Says Colón-Ramos, “They were sending samples to labs in the U.S. because they said Puerto Rico didn’t have the capacity to conduct testing. I knew that was wrong.” Colón-Ramos also saw that labs in Puerto Rico that were eager to start testing were not receiving positive controls—samples of actual virus—which are an essential part of calibrating tests to ensure their accuracy. When positive controls began arriving in Puerto Rico from the CDC, Colón-Ramos says, “the samples that were sent were stuck in the Department of Health, so the clinical diagnostic labs didn’t have access to them for weeks.”

Valuable help from Yale colleagues

So, Colón-Ramos turned to colleagues at Yale. Through the resourcefulness of a team led by Marie-Louise Landry, MD, professor of laboratory medicine and of medicine (infectious diseases), and director of Yale’s Clinical Virology Laboratory, Yale had overcome the early problems at the CDC as well as other obstacles, and developed its own test for its patients and health care workers. “Yale was one of the first academic centers, if not the first, to obtain an emergency use authorization from the Food and Drug Administration to conduct tests," says Colón-Ramos. "Giovanna and I reached out to two Yale faculty members, Drs. Marietta Vazquez and Richard Torres, who connected me with Dr. Landry. We tapped into that institutional resourcefulness—and the generosity and commitment of my colleagues—to get reagents that at the time were scarce, like positive controls from confirmed patients that enabled the clinical reference labs in Puerto Rico to set up their own tests.”

Colón-Ramos says the result for the population of Puerto Rico was profound. “Puerto Rico is conducting close to 3,000 tests every day. It has been practically doubling the number of tests on a weekly basis, conducting close to 200,000 molecular tests, which put it, today, among the places that have tested the greatest number of their populations, per capita.” Numerous local media appearances, in which Colón-Ramos and Guerrero-Medina talked about the importance of developing local infrastructure against the pandemic, helped raise public pressure on these issues, to the point of a trending hashtag calling for more testing in Puerto Rico.

These messages were supplemented by Ciencia Puerto Rico, a nonprofit that Colón Ramos founded and Guerrero-Medina directs that provides a space for Puerto Rico’s worldwide scientific community to contribute to the development of the archipelago. Through the organization, Puerto Rican scientists have published more 70 articles in press outlets and appeared in more than 50 television, radio, podcast, and social media interviews on a number of topics, including accurate information on which COVID tests were valuable to Puerto Ricans and which weren’t. That was a subject of confusion early in the pandemic. “We gave a presentation to journalists on the difference between PCR [virus] and serological [antibody] tests,” says Guerrero-Medina, “and we had a conversation about the importance of differentiating between them in their reporting.”

A PhD candidate at the University of Puerto Rico’s Medical Science Campus has also carried CienciaPR’s banner for the good of her native island. Fabiola Cruz Lopez, MPH, has participated in the Yale Ciencia Academy, an NIH-funded affiliated program at Yale led by Guerrero-Medina that, over the past five years, has provided professional development and leadership training to 194 PhD candidates from Yale and elsewhere. Cruz’s experience in molecular epidemiology, supplemented by her Yale Ciencia training and a recent internship in the lab of Dr. Nathan Grubaugh at Yale School of Public Health, guided her in the formation of an innovative contact tracing program for Puerto Rico, even before the CDC had released its guidelines for the U.S. “Fabiola created a collaboration with a mayor in a rural town in the middle of Puerto Rico,” Colón-Ramos explains. The town, Villalba, was where Cruz grew up. “They set up the most successful contact tracing program in the country. She got it to work there, and then more and more mayors started joining. She has now been hired by the Department of Health to lead the efforts for contact tracing in all of Puerto Rico.” This and other work by Colón-Ramos and CienciaPR may give the health infrastructure of Puerto Rico the strength to ward off a second wave of the virus.

Lasting gains

Colón-Ramos says he is optimistic that the interventions that he, Guerrero-Medina, and their colleagues at CienciaPR have made will have staying power, far beyond the COVID pandemic. As a tropical archipelago, Puerto Rico is home on a regular basis to other viral outbreaks, such as Zika, Dengue, and Chikungunya. And its politically awkward relationship with the mainland United States has made reining in those diseases challenging. “By the time they get attention from the CDC stateside, they can ravage Puerto Rico for months, if not years,” says Colón-Ramos. "It’s not until the mosquitoes are in Florida that you start getting any sort of attention.”

Now that Puerto Rico has a better sense of its own scientific capabilities, and its strategic relationships with research centers and colleagues such as those at Yale, he says, the archipelago can build upon scientific knowledge to help its inhabitants, and—for that matter—also contribute to global knowledge. “If science were to take a look at infectious diseases earlier, when they hit places like Puerto Rico, humanity benefits. By the time it gets to Florida, you would know a lot about it.” And that is a plus for everyone.

Submitted by Robert Forman on June 19, 2020