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On January 30, 2020, the World Health Organization officially declared COVID-19 a public health emergency of international concern. As of May 15, 2020, 188 countries and regions have reported more than 4 5 COVID-19 confirmed cases and 313000 deaths. Countries have implemented public health prevention measures, including physical distancing, isolation, and quarantine. Currently, governments and public health authorities are identifying which indicators are most useful for evaluating prevention measures. Public health emergency (PHE) dynamics require immediate intervention to reduce possible morbidity and mortality. Public health decision-makers face massive challenges during and after emergency scenarios, including how to effectively collect comprehensive systematic data. Given the traditional challenges facing public health authorities, the lack of accurate data can promote detrimental decisions. The scarcity of reliable information is even more salient in developing countries because of limited infrastructure. Since 2016, Puerto Rico, a territory of the United States, has faced four PHEs, including the COVID-19 pandemic. Despite the lessons learned from these PHEs, and the concomitant physical, emotional, and financial consequences, the governmental data-collection infrastructure is inadequate for making evidenced-based decisions. Throughout the emergencies, public health decisions in Puerto Rico were often made without data that was scientific or reliable. An example of this data is the diverse conclusions regarding the death rates fromHurricaneMaria (2017) reached by various groups conducting epidemiological studies that used dissimilar methodologies.

Syndromic Surveillance in Puerto Rico During the COVID-19 Response: An Alternative Approach to Scarce Molecular Testing