When the Government Failed Puerto Rico, Local Communities Stepped Up
By Coral Natalie Negrón Almodóvar
The Earth began to shake as Tamar Hernández drove to visit her mother in Yauco, Puerto Rico, on Dec. 28, 2019. She did not feel that first tremor — she felt only the ensuing aftershocks — but she worried because her mother had an ankle injury and could not walk. Then Hernández thought, "What if something worse is coming our way?"
Her hunch was right. In the twilight hours of Jan. 7, 2020, a magnitude 6.4 earthquake struck the U.S. territory, with its epicenter near the city of Ponce on the south coast, a few miles from Hernández's hometown. Buildings trembled throughout the territory, but the southwest took the brunt of the quake, with dozens of partially or completely collapsed dwellings, including a school and a church, according to a report from El Nuevo Día. The island's primary power generation plants in the southern area of Puerto Rico failed, immediately plunging the territory into darkness.
As a survivor of Hurricane Maria's devastation in 2017, Hernández was consumed with anxiety and desperation at the prospect of having to live through another natural disaster, and watching the government mismanage the recovery again. "My father's Alzheimer's progressed since the storm, and dealing with an equal emergency was unthinkable," she said, before bursting into tears. She doubted she could maintain her economic stability after the earthquake damaged her nail business in the urban center of Yauco.
A view of a washed out road near Utuado, Puerto Rico, after a Coast Guard Air Station Borinquen MH-65 Dolphin helicopter crew dropped relief supplies to residents Tuesday, Oct. 3, 2017. The locals were stranded after Hurricane Maria by washed out roads and mudslides. U.S. Coast Guard photo by Petty Officer 3rd Class Eric D. Woodall / CC BY-NC-ND 2.0
Help did arrive, although it didn't come from the government initially. Instead, a hyperlocal response made up of disparate nonprofits and volunteers arrived and provided much needed aid, even during continuing aftershocks. Hernández said she was especially thankful for the response from one community organization, Tabernacle Followers of Jesus Christ.
Those volunteer initiatives sparked a feeling of trust in refugee camps, said Víctor Amauri, a social worker and one of the help coordinators with Solidarity Brigade of the West, which is made up of people from many organizations who provided direct response to help communities after Hurricane Maria.
"Strategizing after the hurricane and developing short- and long-term plans was our strong suit," Amauri said. "Now, it isn't straightforward to plan something for tomorrow, because everything changed. Misinformation and lack of transparency from the federal and local governments are preventing us from helping our people as they deserve."
The group leaders of the Solidarity Brigade used to meet in Mayagüez to organize community building projects. They would teach about composting and orchard keeping, and promote grassroots efforts to enhance food security and local agriculture as tools of self-sustainability.
"But in this context, we cannot think ahead," Amauri said. "We are still handling dozens of cases of families that are sleeping on the floor because, even though we are a country prone to hurricanes and, thanks to our location in between fault lines, earthquakes, the authorities never developed an emergency plan response."
A report by the Center of Investigative Journalism of Puerto Rico, the Climate Change Series Project — the culmination of years of requesting public documents — found that despite Puerto Rico's vulnerability, the territorial government had taken limited measures to tackle natural disasters. Even though investigative work in 2017 uncovered evidence that the death toll of Hurricanes Maria and Irma was much higher than the 64 victims claimed by the former governor Ricardo Rosselló — nearly 3,000 people are estimated to have died, a little less than twice as many as in Hurricane Katrina — and the territory's ability to respond to emergencies has not improved much.
The government's inefficient response has led to the formation of several citizen coalitions that know the needs of their communities. The Single Voice Movement is a conglomerate of local nonprofit and community-based organizations that already developed a two-year response plan for earthquake-affected communities. The projects developed by these entities have a vision that looks inward toward active communities capable of supporting themselves and their neighbors, said Cora Arce Rivera, executive director of Aspira de Puerto Rico.
A group of students from Aspira's Inc. Alternative School in the municipality of Mayaguez ready to go to the town of Cabo Rojo and receive farming instruction. Francisco Acevedo.
Aspira's alternative school in the western town of Mayagüez allows teenagers, most of them school dropouts, to explore the significance of agriculture. The students are learning to cultivate tropical root and tuber crops that can germinate in unfavorable conditions. They are particularly resistant to damage by high wind hurricanes and typhoons, Aspira's agronomist Francisco Acevedo said.
José Esteban López Maldonado, a student at the elite Residential Center of Educational Opportunities in Mayagüez, runs a similar project in the small mountainside municipality of Adjuntas. In 2016, he managed to acquire one of the hundreds of schools closed by the local Department of Education and transformed it into a coworking space where people can learn about hydroponic cultivation, coffee planting, and greenhouses. USDA Rural Development, which offers loans and grants to economic development projects, has offered López help to improve the infrastructure of the school, but local authorities have not been able to provide him a proof of ownership so he can take advantage of the program, he said.
José Esteban in Ponce, Puerto Rico, presenting his new initiative to distribute coffee Caturra, produced in his farm Lírica. Coral Negrón
The island also faces a bankruptcy crisis and austerity measures imposed by the federal Financial Oversight and Management Board. José Caraballo-Cueto, an economist and assistant professor at the University of Puerto Rico, said the bureaucracy around government processes exemplifies how the island is the perfect prey for disaster capitalism. "Restoration doesn't have the impact it deserves on the local economy because the biggest beneficiaries are not locals," Caraballo said. "A private law firm is even handling the cases of lack of proof of ownership post-Hurricane María."
In Puerto Rico, almost 92 percent of houses were damaged by the hurricane, according to a report from the American Bar Association. More than 95 percent of those tenants, about 1.1 million people, applied for the Federal Emergency Management Agency's Individuals and Households Program in 2018, but a FEMA spokesman told NBC News that 335,748 claims were denied because they couldn't provide a deed proving ownership of their homes.
Situations such as this one eroded Puerto Ricans' belief in local and federal institutions, which have promoted new governance models, said Arturo Massol Deyá, the executive director of 40-year-old environmental nonprofit Casa Pueblo.
In 150 locations across the island territory, Casa Pueblo ensured that, after Maria, those with the most urgent need for electricity received solar panels, including hospitals, small bodegas, and the homes of aging residents who required dialysis. In the recent earthquakes, the solar power systems proved to be more resilient than the Puerto Rican Electric Power Authority's electricity grid, which failed again.
In the wake of Hurricane Maria, Massol Deyá acknowledges that people wanted to be helped by their fellow townspeople. "They discovered soon that the true meaning of 'just recovery' is that the resources end up providing services that change the reality of constant vulnerability," he said.
"Energy is the ability to do work," Massol Deyá said. "We are putting the opportunity in the hands of the people; we want them to acquire the power to govern themselves and enjoy their production. It is the maximum self-decolonization scenario because the top-down model has collapsed. … it is not effective."
An upcoming Casa Pueblo project, in collaboration with professors at the University of Michigan, will be to use biomass from coffee production to generate energy. The energy produced will be used to power the coffee plantation to improve the harvest. The technique, Massol said, helps to reduce carbon dioxide emissions. Meanwhile, it will generate employment and provide a more sustainable life for the residents of Adjuntas.
Arturo Massol, executive director of Casa Pueblo de Adjuntas. Omar Alfonso
All these grassroots actions are becoming the backbone of survival in Puerto Rico. For the time being, however, the lives of those residing in earthquake zones are stagnant, said Edward Santiago-Pacheco, a U.S. Army veteran and father of a newborn girl.
He lost his newly purchased house in Yauco in the 6.4 magnitude earthquake and has not heard back from the insurance company, the bank, or any local government agency.
"It is hard to overcome this when you just brought a new life into this world," Santiago-Pacheco said. "FEMA only provided money for two months of rent for temporary housing, but I still must pay my house mortgage. The worst part is that the local government is using our pain in favor of their political propaganda."
On Feb. 10, the Solidarity Brigade learned about Hernández's and Santiago-Pacheco's cases and reached out to them, Amauri said. However, thousands need similar help.
"Two of our members are sociologists (Roberto Vélez and Jacqueline Villegas), and they developed a census to identify all necessities and help people the best possible way. But we need the government to publish relevant information that can help us organize our strategy," he added.
Casa Pueblo's installation of solar panels in a hardware store in Adjuntas. Arturo Massol
Coral Natalie Negrón Almodóvar is a Puerto Rican data journalist, a current grantee of the Center for Cooperative Media at Montclair State University, and Patti Birch for Data Journalism Fellow at the Committee to Protect Journalists.
Reposted with permission from YES! Magazine.
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By Ana Maldonado-Contreras
- Your gut is home to trillions of bacteria that are vital for keeping you healthy.
- Some of these microbes help to regulate the immune system.
- New research, which has not yet been peer-reviewed, shows the presence of certain bacteria in the gut may reveal which people are more vulnerable to a more severe case of COVID-19.
You may not know it, but you have an army of microbes living inside of you that are essential for fighting off threats, including the virus that causes COVID-19.
How Do Resident Bacteria Keep You Healthy?<p>Our immune defense is part of a complex biological response against harmful pathogens, such as viruses or bacteria. However, because our bodies are inhabited by trillions of mostly beneficial bacteria, virus and fungi, activation of our immune response is tightly regulated to distinguish between harmful and helpful microbes.</p><p>Our bacteria are spectacular companions diligently helping prime our immune system defenses to combat infections. A seminal study found that mice treated with antibiotics that eliminate bacteria in the gut exhibited an impaired immune response. These animals had low counts of virus-fighting white blood cells, weak antibody responses and poor production of a protein that is vital for <a href="https://doi.org/10.1073/pnas.1019378108" target="_blank">combating viral infection and modulating the immune response</a>.</p><p><a href="https://doi.org/10.1371/journal.pone.0184976" target="_blank" rel="noopener noreferrer">In another study</a>, mice were fed <em>Lactobacillus</em> bacteria, commonly used as probiotic in fermented food. These microbes reduced the severity of influenza infection. The <em>Lactobacillus</em>-treated mice did not lose weight and had only mild lung damage compared with untreated mice. Similarly, others have found that treatment of mice with <em>Lactobacillus</em> protects against different <a href="https://doi.org/10.1038/srep04638" target="_blank" rel="noopener noreferrer">subtypes of</a> <a href="https://doi.org/10.1038/s41598-017-17487-8" target="_blank" rel="noopener noreferrer">influenza</a> <a href="https://doi.org/10.1371/journal.ppat.1008072" target="_blank" rel="noopener noreferrer">virus</a> and human respiratory syncytial virus – the <a href="https://doi.org/10.1038/s41598-019-39602-7" target="_blank" rel="noopener noreferrer">major cause of viral bronchiolitis and pneumonia in children</a>.</p>
Chronic Disease and Microbes<p>Patients with chronic illnesses including Type 2 diabetes, obesity and cardiovascular disease exhibit a hyperactive immune system that fails to recognize a harmless stimulus and is linked to an altered gut microbiome.</p><p>In these chronic diseases, the gut microbiome lacks bacteria that activate <a href="https://doi.org/10.1126/science.1198469" target="_blank" rel="noopener noreferrer">immune cells</a> that block the response against harmless bacteria in our guts. Such alteration of the gut microbiome is also observed in <a href="https://doi.org/10.1073/pnas.1002601107" target="_blank" rel="noopener noreferrer">babies delivered by cesarean section</a>, individuals consuming a poor <a href="https://doi.org/10.1038/nature12820" target="_blank" rel="noopener noreferrer">diet</a> and the <a href="https://doi.org/10.1038/nature11053" target="_blank" rel="noopener noreferrer">elderly</a>.</p><p>In the U.S., 117 million individuals – about half the adult population – <a href="https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines/guidelines/" target="_blank" rel="noopener noreferrer">suffer from Type 2 diabetes, obesity, cardiovascular disease or a combination of them</a>. That suggests that half of American adults carry a faulty microbiome army.</p><p>Research in my laboratory focuses on identifying gut bacteria that are critical for creating a balanced immune system, which fights life-threatening bacterial and viral infections, while tolerating the beneficial bacteria in and on us.</p><p>Given that diet affects the diversity of bacteria in the gut, <a href="https://www.umassmed.edu/nutrition/melody-trial-info/" target="_blank" rel="noopener noreferrer">my lab studies show how diet can be used</a> as a therapy for chronic diseases. Using different foods, people can shift their gut microbiome to one that boosts a healthy immune response.</p><p>A fraction of patients infected with SARS-CoV-2, the virus that causes COVID-19 disease, develop severe complications that require hospitalization in intensive care units. What do many of those patients have in common? <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm" target="_blank" rel="noopener noreferrer">Old age</a> and chronic diet-related diseases like obesity, Type 2 diabetes and cardiovascular disease.</p><p><a href="http://doi.org/10.1016/j.jada.2008.12.019" target="_blank" rel="noopener noreferrer">Black and Latinx people are disproportionately affected by obesity, Type 2 diabetes and cardiovascular disease</a>, all of which are linked to poor nutrition. Thus, it is not a coincidence that <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6933e1.htm" target="_blank" rel="noopener noreferrer">these groups have suffered more deaths from COVID-19</a> compared with whites. This is the case not only in the U.S. but also <a href="https://www.washingtonpost.com/world/europe/blacks-in-britain-are-four-times-as-likely-to-die-of-coronavirus-as-whites-data-show/2020/05/07/2dc76710-9067-11ea-9322-a29e75effc93_story.html" target="_blank" rel="noopener noreferrer">in Britain</a>.</p>
Discovering Microbes That Predict COVID-19 Severity<p>The COVID-19 pandemic has inspired me to shift my research and explore the role of the gut microbiome in the overly aggressive immune response against SARS-CoV-2 infection.</p><p>My colleagues and I have hypothesized that critically ill SARS-CoV-2 patients with conditions like obesity, Type 2 diabetes and cardiovascular disease exhibit an altered gut microbiome that aggravates <a href="https://theconversation.com/exercise-may-help-reduce-risk-of-deadly-covid-19-complication-ards-136922" target="_blank" rel="noopener noreferrer">acute respiratory distress syndrome</a>.</p><p>Acute respiratory distress syndrome, a life-threatening lung injury, in SARS-CoV-2 patients is thought to develop from a <a href="http://doi.org/10.1016/j.cytogfr.2020.05.003" target="_blank" rel="noopener noreferrer">fatal overreaction of the immune response</a> called a <a href="https://theconversation.com/blocking-the-deadly-cytokine-storm-is-a-vital-weapon-for-treating-covid-19-137690" target="_blank" rel="noopener noreferrer">cytokine storm</a> <a href="http://doi.org/10.1016/S2213-2600(20)30216-2" target="_blank" rel="noopener noreferrer">that causes an uncontrolled flood</a> <a href="http://doi.org/10.1016/S2213-2600(20)30216-2" target="_blank" rel="noopener noreferrer">of immune cells into the lungs</a>. In these patients, their own uncontrolled inflammatory immune response, rather than the virus itself, causes the <a href="http://doi.org/10.1007/s00134-020-05991-x" target="_blank" rel="noopener noreferrer">severe lung injury and multiorgan failures</a> that lead to death.</p><p>Several studies <a href="https://doi.org/10.1016/j.trsl.2020.08.004" target="_blank" rel="noopener noreferrer">described in one recent review</a> have identified an altered gut microbiome in patients with COVID-19. However, identification of specific bacteria within the microbiome that could predict COVID-19 severity is lacking.</p><p>To address this question, my colleagues and I recruited COVID-19 hospitalized patients with severe and moderate symptoms. We collected stool and saliva samples to determine whether bacteria within the gut and oral microbiome could predict COVID-19 severity. The identification of microbiome markers that can predict the clinical outcomes of COVID-19 disease is key to help prioritize patients needing urgent treatment.</p><p><a href="https://doi.org/10.1101/2021.01.05.20249061" target="_blank" rel="noopener noreferrer">We demonstrated</a>, in a paper which has not yet been peer reviewed, that the composition of the gut microbiome is the strongest predictor of COVID-19 severity compared to patient's clinical characteristics commonly used to do so. Specifically, we identified that the presence of a bacterium in the stool – called <em>Enterococcus faecalis</em>– was a robust predictor of COVID-19 severity. Not surprisingly, <em>Enterococcus faecalis</em> has been associated with <a href="https://doi.org/10.1053/j.gastro.2011.05.035" target="_blank" rel="noopener noreferrer">chronic</a> <a href="https://doi.org/10.1016/S0002-9440(10)61172-8" target="_blank" rel="noopener noreferrer">inflammation</a>.</p><p><em>Enterococcus faecalis</em> collected from feces can be grown outside of the body in clinical laboratories. Thus, an <em>E. faecalis</em> test might be a cost-effective, rapid and relatively easy way to identify patients who are likely to require more supportive care and therapeutic interventions to improve their chances of survival.</p><p>But it is not yet clear from our research what is the contribution of the altered microbiome in the immune response to SARS-CoV-2 infection. A recent study has shown that <a href="https://doi.org/10.1101/2020.12.11.416180" target="_blank" rel="noopener noreferrer">SARS-CoV-2 infection triggers an imbalance in immune cells</a> called <a href="https://doi.org/10.1111/imr.12170" target="_blank" rel="noopener noreferrer">T regulatory cells that are critical to immune balance</a>.</p><p>Bacteria from the gut microbiome are responsible for the <a href="https://doi.org/10.7554/eLife.30916.001" target="_blank" rel="noopener noreferrer">proper activation</a> <a href="https://doi.org/10.1126/science.1198469" target="_blank" rel="noopener noreferrer">of those T-regulatory</a> <a href="https://doi.org/10.1038/nri.2016.36" target="_blank" rel="noopener noreferrer">cells</a>. Thus, researchers like me need to take repeated patient stool, saliva and blood samples over a longer time frame to learn how the altered microbiome observed in COVID-19 patients can modulate COVID-19 disease severity, perhaps by altering the development of the T-regulatory cells.</p><p>As a Latina scientist investigating interactions between diet, microbiome and immunity, I must stress the importance of better policies to improve access to healthy foods, which lead to a healthier microbiome. It is also important to design culturally sensitive dietary interventions for Black and Latinx communities. While a good-quality diet might not prevent SARS-CoV-2 infection, it can treat the underlying conditions related to its severity.</p><p><em><a href="https://theconversation.com/profiles/ana-maldonado-contreras-1152969" target="_blank">Ana Maldonado-Contreras</a> is an assistant professor of Microbiology and Physiological Systems at the University of Massachusetts Medical School.</em></p><p><em>Disclosure statement: Ana Maldonado-Contreras receives funding from The Helmsley Charitable Trust and her work has been supported by the American Gastroenterological Association. She received The Charles A. King Trust Postdoctoral Research Fellowship. She is also member of the Diversity Committee of the American Gastroenterological Association.</em></p><p><em style="">Reposted with permission from <a href="https://theconversation.com/a-healthy-microbiome-builds-a-strong-immune-system-that-could-help-defeat-covid-19-145668" target="_blank" rel="noopener noreferrer" style="">The Conversation</a>. </em></p>
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