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Climate activism got more innovative, and showed its weight and power in 2021

There’s much more happening in climate organizing than trailing Manchin around Washington. Racial justice advocates have used key laws to stop new permits for fossil fuel infrastructure. Activists have worked to cut investor ties to fossil fuels, have infiltrated the boardroom, and have won a handful of global courtroom victories. These wins have had one big thing in common: The campaigns have found leverage in otherwise intractable, slow-moving institutions.

Many of these campaigns have relied on a mix of pressing for change from the outside and reforming financial and government bodies from within. After the 2018 midterm elections, the Sunrise Movement proved how effective raising hell can be in pushing for change. The then-new group helped to tap into a national network of young organizers to stage sit-ins and protests in the US Capitol staged weeks after the 2018 midterm election.

 Chip Somodevilla/Getty Images
Rep. Alexandria Ocasio-Cortez (D-NY) rallies young climate activists, organized by the Sunrise Movement, in front of the White House in June to demand that President Joe Biden work to make the Green New Deal into law.

Relying on a mostly digital strategy to train their recruits for in-person action, Sunrise helped sustain pressure on Democratic leaders and presidential candidates. The avalanche of pressure led to Biden releasing the most comprehensive plan any incoming president had ever had for the climate crisis — a plan that still hinges on Manchin’s vote to enact legislation for clean electricity and electric vehicles.

But raising hell often takes other, quieter forms. In the first year of the Biden administration, another long-simmering campaign to change the financial sector’s relationship with fossil fuels showed it could gain some serious ground. In the 2010s, college students provided the original model for divestment campaigns, urging their institutions to stop investing endowments in fossil fuel companies. Once seen as a long-shot campaign, the divestment movement reached a new milestone in October, after Harvard University and one of the world’s largest pension funds and others pledged to divest $40 trillion in global assets.

Other smaller campaigns have grown into a strong political force that in 2021 flexed to stop new investments in fossil fuel exploration and projects. Climate activists have applied the same balance of pressure from the outside, for example, by demanding Treasury Department regulations forcing bank disclosures on Big Oil loans. And they have balanced this pressure with takeovers from the inside, succeeding with a coup last spring when a climate- focused hedge fund, Engine No. 1, gained three seats on ExxonMobil’s board.

 Roberto Ricciuti/Redferns

Bill McKibben speaks on the opening evening of COP26 climate conference in Glasgow, Scotland, on October 31, 2021, for Pathway to Paris, a US-based organization working to realize the Paris climate agreement.

The next stage for activists is finding new pressure points that build on this momentum. Longtime climate activist Bill McKibben, a cofounder of the grassroots group 350.org, predicts one of those pressure points will be involving more older Americans to lobby financial institutions to cut ties from fossil fuel investments.

In November, McKibben launched a new group called Third Act to attract older Americans to climate activism, making the case that they owe it to the young to take action and should use their financial influence to pressure companies. Baby boomers wield a lot of power politically and financially, controlling more than half of the country’s household wealth to millennials’ 6 percent, according to federal data. They’re hard hit by climate change, too: Heat waves are the deadliest natural disaster and are especially deadly for older adults.

Some fights are more local. “There’s really a fossil fuel fight in almost every community, certainly in every region,” said Janet Redman, Greenpeace’s US climate campaign director.

Climate activists have slowed down construction by raising hell over specific projects: After years of delays, PennEast, the developers of the 116-mile pipeline project to carry natural gas from Pennsylvania into New Jersey, abandoned the project in September. Groups like Sierra Club and Greenpeace have promised to continue their fight into 2022 against 20 proposed gas export facilities poised to make the US the biggest gas exporter in the world.

Racial justice has become a galvanizing tool for slowing the expansion of fossil fuels

A key obstacle to reaching critical mass has long been environmentalism’s reputation as a “Birkenstock movement,” observes Rev. Lennox Yearwood Jr., president of the advocacy group Hip Hop Caucus. Yearwood criticizes the overly white makeup of staff and volunteers who’ve historically dominated national green groups and have been less focused on battling racism and pollution, while Black, Brown, and Indigenous people have long linked racial justice to battling back fossil fuel infrastructure.

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  <figcaption>Rev. Lennox Yearwood Jr., president of the Hip Hop Caucus, speaks about funding climate change 
legislation outside the US Capitol on October 7, 2021.

A focus on racial justice in halting fossil fuels can be a “galvanizing tool,” according to Yearwood. “It helps to get the movement focused on why they need to push back against this pipeline or project.”

This year, the Louisiana St. James Parish community, through local groups like Rise St. James, successfully delayed a permit for a $9.4 billion Formosa chemical plant planned by the Mississippi River, pending a full environmental review. Local groups argued in a brief that the pollution would harm the residents nearby and the plant would be built on Black burial grounds. “A lot of these petrochemical companies are looking to build on former plantations, almost like a digging in the eye. It’s a disregard for Indigenous, Black, or Brown communities,” Yearwood, a Louisiana native, said.

Yearwood saw a parallel to how Indigenous rights activists fought back against Enbridge’s Line 3 pipeline carrying oil from North Dakota to Minnesota, which completed its construction this year. A resistance camp has been operating there for months despite construction being over, monitoring for leaks and staying ready to assist the nearby protest of another nearby pipeline replacement, Line 5.

 Kerem Yucel/AFP via Getty Images
Police in riot gear arrest environmental activists at the Line 3 pipeline pumping station near Itasca State Park in Minnesota on June 7, 2021.

Tara Houska, attorney and Indigenous activist, told NPR in June that these fights represented “an incredible groundswell of young people in particular and Indigenous, Black, BIPOC folks who are out risking personal freedom and their bodies on the line to stop this horrible project from exacerbating climate crisis and disrespecting tribal sovereignty yet again in the history of this country.”

Working through the legal, financial, and political system is slow, frustrating work. There are usually more losses than victories. Activists have found success through these traditional lanes, but this kind of change doesn’t necessarily move fast enough.

A “climate emergency” movement wants action to jolt the US out of apathy

Swedish teen Greta Thunberg has become the most famous voice of a growing climate emergency movement. Her goal is to draw attention to the irrationality of acting as if everything is fine when there is assured destruction ahead from climate change. “In an emergency, someone needs to say that we’re heading towards the cliff,” she said in a December 2021 interview with the Washington Post Magazine. “And everyone is just following, saying like, ‘Well, no one else is turning around, so I won’t either.’”

 Matteo Rossetti/Mondadori Portfolio via Getty Images
Climate activist Greta Thunberg delivers a speech during a Fridays for Future demonstration in Milan, Italy, on October 1, 2021.

Margaret Klein Salamon and the Climate Emergency Fund she leads are supporting organizers who match this rhetoric. She sees the strategies of groups like Extinction Rebellion, Friday for Future school strikers, and the Sunrise Movement as distinct “from the gradualist, institutionalized environmental and climate movement that has been dominant for decades. The climate emergency movement says what do we need to achieve to avoid an apocalypse.”

The kind of activism that fits this vision, Salamon argues, is more aggressive direct action that could run the gamut from hunger strikes to blockades of streets and pipelines to workplace strikes. Though not common in the US, Extinction Rebellion has staged blockades of pipelines and Amazon warehouses in the UK.

Salamon wonders what that looks like if more US activists adopted similar strategies. That would mean more worker strikes, like what Amazon’s tech workforce did in 2019 for a climate protest.

In November, several Sunrise Movement members participated in the first US climate hunger strike: Kidus Girma was one of the four who gave up food for two weeks and sat outside the White House to draw attention to Biden’s continued fossil fuel leasing, posing the question whether Democrats like Biden and Manchin really do care about his life. His goal wasn’t to win over Manchin: “I’m speaking to Americans and people around the world about what kind of world do we want to create,” Girma said in an interview with Vox.

Just as divestment campaigns and battles against pipelines had many detractors before they gained momentum, observers now question whether tactics like hunger strikes are too polarizing to be useful in the United States. “You want a range of tactics all working toward the same goal, but it also can end up splintering and causing fissures within the movement,” said University of Maryland sociologist Dana Fisher, who studies environmental protest movements. “You end up with these camps within the climate movement: the sellouts who are willing to put on a suit and go inside, versus those outside, yelling about a capitalist system.”

 Kevin Dietsch/Getty Images

Climate activists set off smoke after scaling the US Chamber of Commerce building in Washington, DC, on October 14, 2021. Extinction Rebellion led the rally, claiming the business lobbying group denies climate change and puts corporate profit ahead of the health and well-being of the planet.

“In the end, it’s not going to stop an oil and gas lease or to shift this huge oil tanker that is the United States away from all of its reliance on fossil fuels in the kind of time that’s needed,” said Fisher.

Fisher’s skepticism stems from concern that a blockade or hunger strike won’t win the next election, while targeted voter outreach might. She fears that the more radical the tactic, the more divided the public becomes on addressing climate change. Instead of seeing Democratic politicians trying to appeal to climate voters, they could consider it a liability should it become too polarizing.

Even a strong climate movement could splinter over tactics like property destruction

The lightning rod that sociologists like Fisher worry most about is the use of property destruction and perhaps even violence.

The climate movement has closely followed the tenets of nonviolent protest. Leaders regularly cite inspiration from the civil rights-era nonviolence, and the sit-ins and mass protests mirror similar strategies. But it isn’t a given any movement will remain that way.

 Jeff J Mitchell/Getty Images
Students take part in a Fridays for Future climate strike demonstration in Glasgow, Scotland, on September 24, 2021.

Already a few prominent scholars have argued that protesters should target property and fossil fuel infrastructure to deliver a global wake-up call. Swedish ecologist Andreas Malm makes this provocative argument in his 2021 book How to Blow Up a Pipeline.

He argues that the nonviolent tenets of the climate movement have failed to produce the results needed. He makes the case for an escalation, by destroying physical fossil fuel infrastructure to reinforce that humans can control their own fate. “[P]eople tend to perceive fossil fuel infrastructure as a fact of nature, something beyond our control, something that we cannot put a stop to,” he said in an interview with Vox Conversations. “Therefore, those disasters that are destroying our lives are something that we can just try to live with, to adapt to as best as we can.”

There’s plenty of apprehension among climate activists in opening this can of worms. Property destruction is hugely controversial, and violence is the most polarizing tactic that could truly splinter the climate movement’s delicate balance of insider and outsider tactics.

While Malm narrows his argument to targeting property and pipelines — he does not support harming people — science fiction author Kim Stanley Robinson took the thought experiment even further in his 2020 novel, The Ministry for the Future.

In this imagined near future of climate catastrophe, ecoterrorists bomb power plants, down jets, and target executives to bring about political and economic change. Robinson isn’t advocating for this world in his book, but rather making the case we can still avoid it. In an interview in November 2020 with then-Vox editor and podcast host Ezra Klein, Robinson explained why he considered that the status quo on climate may spur violent advocacy as “in that matrix of decisions we need to make. What methods are going to work to get us to a better place 30 years out?”

The questions Robinson considers in his novel are similar to what the climate movement has to contend with: What happens if the political system fails? What happens if there is never a critical mass for true change? What if entrenched special interests delay meaningful action until it is too late? His novel looks at what happens then as the powerless take drastic action to force a revolution.

“Revolution has often been physical and violent, and then sometimes revolutions have been invisible and peaceful,” the author told Klein. “So one would hope for the peaceful revolutions. … You have to think about revolutions of the past and what they could be now.”

Should the climate movement refine strategies or radically shift?

There’s another fundamental split in philosophies over what it will take to ensure a lasting revolution on climate change.

“When you have lots of different tactics going at once, you have lots of entry points for people becoming engaged in the issue,” said David Meyer, a social scientist at the University of California Irvine who studies climate protest movements. This kind of decentralization helps with one of the biggest challenges facing any social movement: the need to innovate or risk failure. “Movements that don’t diversify their tactics evaporate or get crushed,” Meyer added. “If you don’t innovate tactics, it gets boring and authorities find ways of dealing with you.”


 Francisco Seco/AP

A man looks up as police and fire personnel move in to remove Greenpeace activists after they scaled European Union headquarters in Brussels, Belgium, and unfurled a large banner during a demonstration outside an EU summit meeting on global warming on December 12, 2019.

The US is still tinkering around the edges of how to transition away from fossil fuels, instead of moving at the much faster pace necessary to meet global climate goals. Changing this course requires new strategies. Some believe the key is in growing the climate movement to a critical mass of the population, which will usher in political change through advocacy and turnout in elections. Others think more targeted youth strikes and pipeline protests are the key to jolting the US from its inertia.

But growth of a movement for growth’s sake does not necessarily win political victory in a system that is structurally biased against change. Polling from the Yale program on Climate Change Communication shows consistently that a supermajority of adult Americans, 70 percent, are at least somewhat concerned about climate change. The most engaged group are those who describe themselves as “very worried” is smaller than that, though this subset has grown in the past five years from 22 to 35 percent of the population.

What’s less clear is how even a large subset of “alarmed” voters translates into political power. At the national level, politicians don’t reflect these popular beliefs. Congress disproportionately represents climate change deniers and fossil fuel interests — a major reason Congress has yet to pass a single bill that would target carbon pollution across the economy. Now, even as a minority in Congress, Republicans have continued to threaten climate legislation through the Senate filibuster, forcing Democrats to rely on the budget reconciliation process that still hinges on Manchin’s vote.

 Drew Angerer/Getty Images

From left, Sen. Sheldon Whitehouse (D-RI), Senate Majority Leader Chuck Schumer, and Sen. Martin Heinrich (D-NM) at a rally held by the League of Conservation Voters and Climate Action Campaign to urge the passage of Build Back Better legislation on September 13, 2021.

Putting a single number on how big a movement has to grow to deliver systemic change is hard, to say the least, but Harvard political scientist Erica Chenoweth has gotten a lot of attention for research that settled on a number after examining 323 violent and nonviolent protests globally between 1900 and 2006. Chenoweth’s research concluded that a movement is effective enough to change the system if it hits a critical mass of 3.5 percent of the population.

It sounds so simple, and newer groups like the UK’s Extinction Rebellion have rallied around that figure. But other researchers question how much of Chenoweth’s work really applies to climate change, since she was studying sometimes-violent regime change in other countries. And there’s another catch: That 3.5 percent has to be incredibly devoted to the cause, willing to march in streets, even at one’s own risk of arrest. These distinctions matter for how to decide when a movement has truly hit critical mass, explained Fisher, the University of Maryland sociologist.

“Who cares about climate change at this point? Well, just about everybody, except for people who consider themselves strong Republicans,” Fisher said. “We do not have 3.5 percent of the population that’s willing to engage in risky confrontational activism, for sure. I’m not sure that we have 3.5 percent of population that’s willing to do more than vote.”

There isn’t much time for the climate movement to figure out what formula of activism will succeed. The next few years will have the highest stakes yet.

The Biden administration and the Kremlin are scheduled to discuss the US response to Russian military action in Geneva, Switzerland, on Monday, and a larger conversation between NATO member countries and Russia is set for Wednesday in Brussels, Belgium. Further talks about Russia’s actions and proposed security demands are also set to take place in Vienna, Austria, with member nations of the Organization for Security and Cooperation in Europe.

After a virtual meeting Friday of foreign ministers from its member states, NATO promised a coherent response to protect Ukrainian sovereignty, and Secretary-General Jens Stoltenberg insisted in a statement Friday that the alliance is committed to a diplomatic approach with Russia.

“Russia’s aggressive actions seriously undermine the security order in Europe,” he said. “NATO remains committed to our dual-track approach to Russia: strong deterrence and defense, combined with meaningful dialogue.”

But should NATO’s present tack — and next week’s talks — fail to deter Russia from action against Ukraine, Stoltenberg has signaled that NATO is prepared to pursue more aggressive options. Although Ukraine is not a member of NATO and thus the alliance is under no obligation to step in should Russia attack, Stoltenberg’s statements to the press show that he views Russia’s aggression in Ukraine as destabilizing to European security; and that should that security be threatened, there will be consequences for Russia.

“We have troops, we have forces,” Stoltenberg told reporters Friday, although he declined to discuss details. “We have the readiness. We have the plans to be able to defend, protect all allies, and we are constantly adapting, and also actually investing more now than we had done for many years in modernizing our military capabilities to make sure that we preserve peace in Europe.”

US Secretary of State Antony Blinken also warned that the US was “prepared to respond forcefully to further Russian aggression,” although it’s unclear exactly what form that response might take.

Sanctions are a well-trod path in the US- Russia foreign policy space, and other nations, including the United Kingdom, have indicated their willingness to increase economic pressure on Russia should upcoming talks fail to reach a diplomatic outcome.

Senior US officials told CNN’s Natasha Bertrand that the US is preparing economic blocks on Russia that would severely curtail the country’s ability to import goods like smartphones, aircraft, and car parts — damaging the Russian economy and putting it in the company of pariah nations like North Korea and Syria, which have similar severe trade restrictions.

As Alex Ward explained for Vox last year, previous sanctions have targeted mostly businesses, institutions, and individuals. But large-scale trade sanctions, which are reportedly now under consideration, would impact Russia on an entirely different level, preventing the import of common goods and technology from the US and partner nations.

The UK is also preparing to impose “high impact measures targeting the Russian financial sector and individuals” should Russia invade Ukraine, Reuters reported Thursday, and the European Union agreed in December to work in tandem with the US and UK to impose sanctions of its own.

Still, Russia has thus far presented an unmoving stance, with Deputy Foreign Minister Sergei Ryabkov telling Russian state media agency RIA that the Kremlin “will not make any concessions under pressure and in the course of threats that are constantly being formed by the Western participants of the upcoming talks.”

Russia continues to deny that it’s planning to invade Ukraine and insists that Ukraine, NATO, and the West are the aggressors in the present conflict, a stance that’s reflected in the security demands Russia sent out last month to NATO and US leadership. Among other things, Russia seeks to prevent Ukraine specifically, as well as other former Soviet republics like Georgia, from entering NATO — a stipulation that NATO leadership says absolutely won’t fly.

Blinken also said Sunday that key Russian demands from its draft documents last month are off the table, though reporting from NBC on Friday suggests that the US is considering a reduction of forces in Eastern Europe.

The Biden administration has denied that any cuts to troop deployments are being considered, but Blinken didn’t reject host Jake Tapper’s suggestion that repositioning heavy weaponry in Poland, moving missiles, or making changes to military exercises could be bargaining chips when he appeared on CNN’s State of the Union Sunday.

In Monday’s talks, the Biden administration will likely reassure Russia that it doesn’t plan to build missile systems in Ukraine, though it has defended US missile systems’ positioning in Romania and Poland. The administration has also promised NATO officials it won’t make unilateral decisions for the alliance, a diplomat from a NATO member state told Politico.

However, there could be room to negotiate over military drills on both sides, the escalation of which has contributed to increased tensions. NATO regularly conducts training exercises in the Baltic region and includes non- NATO states like Sweden and Finland in those exercises, which Russia sees as a threat; Russia, meanwhile, has been conducting larger and more frequent drills closer to NATO countries, and both nations have increased the frequency of nuclear-capable bomber sorties near Ukraine.

Russia-Western relations are at their lowest point in decades

The relationship between Russia and the West has been particularly contentious over the past few months, as the Ukraine crisis reaches a tipping point. Furthermore, Moscow’s support of Belarusian strongman Alexander Lukashenko in his quest to anger the EU by shuttling Middle Eastern migrants to his country’s border with Poland, and the recent deployment of Russian troops in Kazakhstan, have only inflamed tensions as Russia seems intent on cementing its sphere of influence in former Soviet states.

The public consensus among Western officials, including Blinken, is that while next week’s talks offer possibilities, the seriousness with which Russia is approaching them is unclear at best, as is the Kremlin’s commitment to any reciprocity.

After Russia annexed Crimea in 2014, Ukraine and Russia agreed to — but never fully implemented — a peace agreement called the Minsk Agreement. Since then, continued conflict in eastern Ukraine has killed more than 14,000 people, as Vox’s Jen Kirby wrote in December, and helped push Ukraine, particularly under the leadership of President Volodymyr Zelensky, toward the West and NATO. Putin sees in that shift the potential for Ukraine to join the alliance — and therefore, a threat to Moscow.

Short of a full invasion of Ukraine, however, Putin’s desire to wield his power and remind the West that he still has leverage in the region could be another reason behind the troop buildup, and a tactic to get the US and NATO to negotiate with him.

But the path forward is murky for Western powers and alliances. For example, it’s still unclear how tighter sanctions against Russia might play out, given that previous measures in response to Russian aggression in Ukraine have done little to deter Putin.

Additionally, while the new sanctions proposals would represent a major escalation in Western efforts to deter Putin, it’s quite a gamble to imagine that those measures alone would be enough to deflect what appears to be significant, entrenched military buildup under the direction of an authoritarian leader whose motivations are arguably much more existential than merely the acquisition of territory.

As Alexander Motyl, an expert in Soviet and post-Soviet politics at Rutgers University Newark, told Kirby, “The problem is we don’t know what Putin wants, and this is really the bottom line.”

Any consequences for Russia’s actions are difficult to determine and implement, since Putin
remains inscrutable, Motyl argued. “Is he testing? Is he invading? Is he teaching the Ukrainians a lesson? We don’t know. And so it’s hard to do anything, because we don’t know what [Putin] wants, and we don’t know how far he’s willing to go.”

At the advice of public health officials, the Puerto Rican government reacted quickly to the onset of omicron by reviving and strengthening restrictions that had previously been in place.

The governor has delayed the start of public schools by two weeks and recommended private schools do the same. He has made booster shots mandatory for employees in the health and education sectors, and all schoolchildren age 5 and older must have their first dose by January 10.

 Ricardo Arduengo/AFP via Getty Images
Drivers wait in line at a drive-through testing center operated by the Puerto Rico Health Department at the Hiram Bithorn Stadium parking lot in San Juan, Puerto Rico, on December 18, 2021.

Those attending mass events now have to provide not only proof of vaccination, but also a negative Covid-19 test taken within 48 hours of the event. All establishments serving food and drink have to require vaccination or a negative test for entry, and capacity at those places is limited to 50 percent or 250 people maximum. All passengers on flights to Puerto Rico also have to show a negative test. And businesses must close between midnight and 5 am and are not allowed to sell alcohol during those hours.

Major events on the island have consequently been canceled or changed to a virtual event, including the Miss World pageant and a 10,000-person New Year’s celebration.

For some Puerto Ricans, those measures don’t go far enough. Some have raised concern about the governor’s decision to delay the start of school rather than what they see as the safer option: moving back to remote instruction. Others see the governor’s actions as wise. But overall, there is notable fatigue over Covid-19 prevention protocols among young people.

The highest incidence of cases during the recent spike has been among people ages 15 to 39, said Victor Ramos, president of Puerto Rico’s College of Physicians, which is advising the governor on pandemic strategy. The virus has been spreading in their workplaces, their schools and universities, holiday celebrations, and large events — and they have been bringing it home to older, more vulnerable populations.

Two years into the pandemic, it’s difficult to convince those young people to stay home, especially when, due to widespread vaccination, the typical case of Covid-19 in Puerto Rico hasn’t resulted in symptoms more serious than those of a cold. Many also believe that with Covid-19 becoming endemic, it’s only a matter of time before they get the virus, so they might as well get it over with. The trouble with that strategy, however, is they still could spread it to people who are at higher risk for hospitalization.

“The symptoms have been really mild for folks that have gotten it, and that also plays into how serious people think it is,” Levis said. “People are also just tired.”

Meanwhile, public health officials are warning Puerto Ricans that two doses of the vaccine is not enough. Less than 40 percent of the population has received a booster. But problematically, not everyone is eligible for a booster shot yet, since it hasn’t been six months since their last shot or three months since they got the Johnson & Johnson vaccine.

Although the symptoms of Covid-19 are typically milder for the vaccinated, omicron is more transmissible, even among people who have had two shots. The combination of vaccinated people lowering their guard and the fact that most people in Puerto Rico have not received a booster shot has created an opening for omicron to spread. The result is a growing number of cases, currently at nearly 400 percent more than last winter’s peak, as well as a nearly 600 percent increase in hospitalizations in the last two weeks at a time when the island’s public health infrastructure is struggling.

Despite being thrown the curveball of omicron, Puerto Rico’s government has responded exactly as public health officials have advised, and they are confident that the new measures will get the pandemic under control again. The same can’t be said of other states and territories in the US, which have largely eschewed a return to pandemic lockdowns.

Health care workers in masks and gowns stand outside a line
 of cars and write information from the passengers on clipboards. Ricardo Arduengo/AFP via Getty Images
Workers register people to be tested for Covid-19 at the Hiram Bithorn Stadium parking lot in San Juan on December 18.

Puerto Rico’s health care system is under strain

Hospital staffing shortages are currently proving to be the biggest strain on health care resources across the US, and Puerto Rico is no exception.

“We have the beds,” Ramos said. “The problem we have is personnel. They are tired, they have to stay home because they are contagious, and some are on vacation because of the holidays.”

That means the quality of the complex and resource-intensive care Covid-19 patients require might not be as high as it could be. And that non-Covid-19 patients, especially those who already had limited access to physicians, may face delays in care, which could create long-term health issues that will outlast the pandemic.

There was already a mass exodus of doctors from Puerto Rico after Hurricane Maria hit the island in 2017, in part due to low wages and issues with insurance reimbursement that made it impossible for them to pay their offices and staff. By the following year, the medical specialist workforce had shrunk by 15 percent, meaning that there were only about 9,500 staff to serve the entire population of 3.2 million, as Catherine Kim reported for Vox.

The numbers had recovered somewhat by the time the pandemic emerged. But many medical staff have had to stay home and quarantine when they test positive for Covid-19.

The Centers for Disease Control and Prevention recently changed its recommendation for people to quarantine for five days instead of 10 if fever-free for 24 hours without the use of fever-reducing medication and other symptoms have improved. Though controversial, that guidance could allow asymptomatic health care workers to return to work much sooner, helping alleviate staffing shortages and the availability and quality of medical care for all.

But burnout is also an issue. Many health care workers have left direct care of Covid-19 patients in favor of less risky jobs, such as vaccination and lab work, Ramos said.

All of this has meant that the capacity to address not only Covid-19, but also other patients presenting with urgent medical issues nevertheless remains a challenge. According to the federal government, 72 of the island’s 78 municipalities are medically underserved and have “unmet health care needs.”

Aggravating that issue is the fact that many physicians on the island have reduced their on-site services, and patients with Covid-19 risk factors are afraid to access care in person for fear of contracting the virus. That has led to an explosion of need in the mental health sector and rising incidences of chronic diseases, like diabetes and hypertension, Levis said.

“It drives home the imperative that if Covid is endemic and we’re going to be seeing these surges pop up, we need to make sure that we have alternate ways of communicating with patients,” Levis said.

Unless those longstanding challenges in Puerto Rico’s health care system are addressed, in addition to the immediate personnel shortage, any future waves of the pandemic will continue to pose a risk to the health of Covid-19 patients and anyone else seeking care.

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