Edgar Rodríguez Vázquez’s kidneys have been shrinking since he was in his 30s. A year and a half ago, his daughter donated one of her kidneys to him. Now, at 60, he takes about a dozen pills a day, three of which weaken his immune system to keep his body from rejecting the organ.

Rodríguez Vázquez, who has not left his home in Puerto Rico for the past month, is worried. If he gets infected by the deadly COVID-19, doctors will have to reinforce his immune system. He’ll lose his kidney and go into dialysis.

But he’s also worried about Puerto Rico.

His home has seen one disaster after another, from Hurricane Maria that pummeled the island two and a half years ago, to a series of earthquakes that sent tremors across the southern part of Puerto Rico for months. As the long and slow slog of recovering and rebuilding from the hurricane continues, Puerto Rico, like the rest of the United States, is facing another existential threat – one that experts say could overwhelm the island’s still-fragile healthcare system and send its long-struggling economy into a drawn-out spiral.

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Drawing from the horrors of Hurricane Maria, which killed 3,000 people and left many parts of the island without power for months, advocates fear that Puerto Rico – especially its poorest and most vulnerable citizens – will again be left behind as the United States deals with its own crisis.

“You are seeing what’s happening in Italy. They are choosing who can be saved. We will not be far from that kind of scenario if this goes out of control in Puerto Rico,” said Gamaliel Ortiz, a pastor at the Christian Church Disciple of Christ in Bayamon, just outside of the capital city of San Juan. “That’s one of the things that creates anguish and despair in our people.”

“It’s not that they will abandon us,” Ortiz added. “It’s a fact that we are abandoned.”

As the death toll from the coronavirus pandemic climbs to the thousands in the United States and elsewhere, Puerto Rico has taken aggressive measures to keep the virus from spreading.

Gov. Wanda Vázquez has imposed one of the earliest, most restrictive and most widespread lockdowns in the United States. She has ordered most businesses to shut down, imposed curfews and instituted punishments and fines for violators. The government has restricted traffic by alternating vehicles allowed on the road each day based on license plate numbers.

But some, including Rodríguez Vázquez, fear these won’t be enough.

While many agree that the drastic measures are necessary to keep the virus from spreading, they also fear such policies will result in irreversible damages to an economy already marred by a 14-year-long recession and unpayable debt. The cash-strapped territory has been borrowing money in the form of municipal bonds to keep the government running, causing its debt to balloon to $74 billion, which it has not been able to pay.

Rodríguez Vázquez, who lives in the town of Gurabo, has seen many businesses shutter and people leave for better opportunities in the United States.

With the impending recession caused by the pandemic, he said, “More people are going to leave again. The economy is getting hit every time. I stay here because my house is paid and because of my condition. If I were younger without any health condition, I probably would’ve left also.”

Before the coronavirus pandemic began crippling the U.S. economy, the unemployment rate in Puerto Rico was at nearly 9%, compared to the nationwide rate of 3.5%. In 2018, poverty rate was 43%, compared to the nationwide rate of 11.8%.

“In a poor jurisdiction like Puerto Rico, the economic repercussions (of the lockdowns) are even more devastating than in other places because the state does not have the capacity to stimulate,” said Michael Soto-Class, president of the Center for a New Economy, a nonpartisan think tank in San Juan. “The fact that we’ve been in economic contraction for the last 12 years and with all these other problems that we’ve had makes it just that more difficult for us.”

“Economically, it’s going to be a bloodbath,” Soto-Class added.

The government of Puerto Rico will pump $787 million into the economy to help stave off an economic crisis. Washington, D.C., Puerto Rico and other U.S. territories will receive $3 billion from the stimulus bill signed last week by President Donald Trump.

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In a statement earlier this week, the secretary of public affairs in the governor's office said the government has received thousands of requests from people who qualify for $500 each in aid designated for self-employed Puerto Ricans. Officials also said they're in contact with the federal government in Washington, D.C., to make sure the island receives additional aid to mitigate the impact of the pandemic.

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Like the rest of the United States, the territory of 3.2 million people has struggled to ramp up testing and isolate people who may have had contact with somebody who tested positive of COVID-19. Twelve people have died and 316 have tested positive, according to the governor’s COVID-19 medical task force.

Puerto Rico has had a longstanding shortage of doctors and nurses. Victor Ramos, president of the Puerto Rico Surgeons and Physicians Association, said the island has seen an exodus of medical professionals who moved to the United States for better opportunities. Because Puerto Rico is an island, transferring patients to hospitals in the United States won’t be an option, Ramos said.

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Puerto Rico’s health department and the Washington, D.C.-based Puerto Rico Federal Affairs Administration did not respond to requests for comment. Resident Commissioner Jenniffer Aydin González Colón, a nonvoting member of Congress who represents Puerto Rico, and the head of the governor's COVID-19 medical task force, also did not respond.

Juan Carlos Reyes, a member of the task force, told Univision Puerto Rico that the number of positive cases will keep rising.

“It’s not rocket science. We’re starting to see more positive tests because we’re doing more tests,” Reyes said.

Puerto Rico's political woes have hampered the government's response to the pandemic.

Rafael Rodríguez Mercado, Puerto Rico’s former health secretary, resigned on March 13 amid criticisms over the government’s slow response to the pandemic. The interim secretary, Concepción Quiñones de Longo, resigned less than two weeks later.

The third and current secretary, Lorenzo González, recently fired an employee amid a scandal over 500 coronavirus tests that were reportedly lost, according to media reports.

Juan Oscar Morales, head of the health commission of Puerto Rico’s House of Representatives, said in an interview with Univision Puerto Rico that some shipments of coronavirus test kits did not arrive at their intended destinations. Morales did not respond to a request for comment. Members of the COVID-19 task force denied to Univision claims that hospitals aren't receiving shipments of tests and supplies.

Tensions have also flared between the government and the police force. Puerto Rico has closed several police stations, as officers accused the government of exposing police officers to COVID-19, the Associated Press reported. More than 150 officers are under quarantine.

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All of these come less than a year after Puerto Rico's former governor resigned amid mass protests. The secretary of state, who would've been the successor, also resigned because of controversy over hundreds of private messages exchanged with the governor and other high-ranking officials. Vázquez, the former justice secretary and the third in line, became governor.

Puerto Rico still rebuilding after Hurricane Maria

Coronavirus is also hitting Puerto Rico as many of the island's towns are still recovering from the damages from Hurricane Maria. In many rural areas, houses have yet to be rebuilt, as millions of dollars in aid from the federal government remain in bureaucratic limbo, according to residents and community leaders.

In the town of Toa Baja, just west of San Juan, some of the street lights are still out. The government center is contaminated with fungi from flooding, which forced town officials to set up temporary offices in a volleyball court, Mayor Betito Márquez said.

Márquez said officials began preparing for the pandemic long before governors in Puerto Rico and elsewhere issued stay-at-home orders. They began holding orientations with citizens, local doctors and schools in early March as they watched the growing death toll in other countries.

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Officials are also looking into turning a Comfort Inn into an isolation area for coronavirus cases if necessary, Márquez said. Workers disinfected public streets and common areas and drove around town with megaphones to remind citizens to stay home.

“That’s what we’ve learned from Hurricane Maria,” Márquez said. “Take these dangers or threats with expediency or as fast as we can … We need to take crucial action, so we don’t end up (like how we were) after Maria.”

Still, Márquez acknowledged that his town and Puerto Rico’s healthcare system is ill-equipped. He also said test kits are not yet available in Toa Baja.

“This pandemic, it came to us so fast. We have a shortage of medical equipment and medical resources, and as the world is competing for the same resources, it is harder to be prepared for this pandemic,” he said.

Márquez acknowledged the damage the lockdowns will do to his town’s economy, which is reliant on small businesses. He said the aid from the federal government in Washington, D.C., may not be enough.

But, he said, “more important than saving the economy is saving lives. That’s the focus right now.”

Alan Gomez contributed to this story.