Puerto Rico will begin to vaccinate all residents 16 and older against the coronavirus as of Monday, announced Gov. Pedro Pierluisi, a development that comes as the U.S. territory tightens public health measures in response to a new rise in COVID-19 cases.

“Every Puerto Rican deserves access to health and together, we will defeat this virus,” said Pierluisi Wednesday evening at his first State of the Government address, which largely focused on how Puerto Rico will address the pandemic.

The new policy follows President Joe Biden’s plan to make the COVID-19 vaccine available to all American adults by April 19. Close to a quarter of Puerto Rico’s population of 3.2 million has received at least one shot, and officials believe the island could reach herd immunity by the end of summer.

But a spike in cases and hospitalizations has concerned health experts and public officials. Thirty-eight towns, including San Juan, are experiencing what the government calls a “high” level of transmission, which means they will not be able to open schools for in-person classes. That figure that has more than doubled since last week, when only 14 towns fell under the classification.

In response to the new wave of infections, Pierluisi has issued stricter measures against the coronavirus that will kick in Friday. A midnight curfew was bumped to 10 p.m., and businesses will close at 9 p.m. The maximum occupation for restaurants and other establishments will remain at 50%.

“It is necessary to take certain measures in order to avoid further spread,” states the executive order from the Governor announcing the measures. “This will allow the recovery of the affected economic sector to continue while safeguarding the health and safety of the entire population.”

As of April 8, Puerto Rico has had over 100,000 confirmed coronavirus cases and over 2,100 deaths.

An independent group of scientists that advises Pierluisi warned that by the month’s end, Puerto Rico could see over 1,600 coronavirus cases and more than 16 deaths a day.

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“These conservative estimates, which account for the protective effects of vaccines, would be the worst numbers seen throughout the pandemic,” the Scientific Coalition of Puerto Rico said in a written statement.

During his address, Pierluisi announced that the Department of Health will boost efforts to ensure that travelers are keeping quarantine and following rules in place to curb infections. In recent weeks, the island has dealt with an influx of tourists that openly disregard safety measures, infuriating residents and prompting the government to crack down on misbehaving visitors. The Centers for Disease Control and Prevention recommends people avoid all travel to Puerto Rico.

Pierluisi also said that the agency would establish a genomic surveillance program to track viral mutations. At least four variations of the coronavirus have been identified on the island, including the highly contagious UK (B.1.1.7) variant.

The recent spike is likely caused by a combination of factors, according to Dr. Iris Cardona, who heads the Puerto Rico Health Department’s vaccination program. The arrival of variants, the influx of travelers, the continuation of community transmission, and the relaxation of public health norms as vaccinations progress could all be contributing to the spread.

The top health official also noted that transmission among family members was high during the month of March, citing an analysis from the island’s municipal contact tracing system, which found that 56% of clusters were linked to family interactions. While the number of hospitalizations is not as high as what Puerto Rico experienced late last year, officials are still concerned.

“If the numbers do not remain low and continue to increase, the probability of the arrival of new variants also increases, and so does the probability that one of these variants will become the dominant virus, which could affect the effectiveness of existing treatments and the effectiveness of the vaccines,” she said.

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