A Puerto Rican boy receives asthma treatment.
Photo: AP

Puerto Rico’s still reeling from the shock of Hurricane Maria, a disaster that may have led to the death of thousands. Nearly nine months later, doctors and physicians are alerting the public to another hidden health crisis: asthma.

Now, this respiratory illness is nothing new for Puerto Ricans. In fact, Puerto Ricans (both on and off the island) suffer some of the highest asthma rates in the U.S. Children in Puerto Rico are almost twice as likely to have asthma as those on the mainland. Puerto Ricans die at higher rates from it, too—even compared to other Latinx.

In the aftermath of Maria, however, The Associated Press reports that the situation appears to be worsening. While experts Earther spoke with aren’t entirely sure of that, it’s true that increased reliance on dirty energy, a spike in mold, an increasingly ineffective healthcare system, and some basic biology have created the perfect conditions for asthma to thrive.

Dubbed “Generator Island,” Puerto Rico has seen its air quality deteriorate due to the reliance on generators across the territory. For places where electricity still doesn’t run (or where it’s inconsistent), households are forced to turn on dirty diesel- or gas-run polluting machines to switch on their lights—and perhaps even the nebulizers some use to treat asthma. It’s a catch 22.

Then there’s the mold issue. Since Maria, the number of mold spores have increased due to fallen trees and heavy rains, said University of Puerto Rico microbiology professor Benjamín Bolaños, to Earther. “The mold has recovered greatly after Maria,” he said in Spanish. “It’s broken records.”

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Mold and air pollutants are merely triggers, though—things that can cause an asthma attack among people who have the disease. Unfortunately, recent research suggests Puerto Ricans’ genetic ancestry may make them especially susceptible to asthma.

“What we showed in 20 years of research is … that Puerto Ricans are genetically predisposed to have more severe asthma and respond less to the most common use medication during an asthma attack,” said Jose Rodriguez-Santana, a pediatric pulmonary doctor in Puerto Rico, in an email to Earther. “Definitely, we have something in our genetic pool that when exposed to our environment is ‘turned on.’”

Rodriguez-Santana’s partnered with the University of California at San Francisco to conduct this research. While he’s unsure whether asthma conditions have actually worsened since the hurricane, he knows that the island’s ailing healthcare system takes a big share of the blame.

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Long before Maria, the healthcare system in Puerto Rico tended to drag patients or their parents through endless hoops, Rodriguez-Santana explained. The result is that even before disaster struck, patients might not have been receiving the best care to treat their asthma.

“Our healthcare system had a major contribution in promoting a system that does not provide the best access to good care for asthmatics and creates many barriers to control asthma,” he said.

After the hurricane in September, many clinics closed. The ones Rodriguez-Santana’s Pediatric Pneumology Center handles remained operational, but fewer patients visited in the weeks after the disaster than in previous years, he said. That was short lived.

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A couple months later, and the center’s units were full again. Rodriguez-Santana attributes this to the re-opening of daycares and schools. There, students are exposed to viral respiratory infections, the most common trigger for children, he explained. His clinics, at least, have seen more asthma cases exacerbated by these infections than exposure to generator fumes.

For Rodriguez-Santana, this is an opportunity—both to study asthma and get to the bottom of how this disease actually works. For Bolaños, it’s a teaching moment to help people on the island learn how to protect their health.

Most people can agree on one thing: This is an opportunity to remind the public that Puerto Rico is still dealing with the aftermath of a hurricane that hit nearly nine months ago to the day. That’s pretty fucked up.