tourism in puerto rico after hurricane maria

AMERICAN RESILIENCE: How Puerto Rico rebuilt its tourism industry after Hurricane Maria, from revitalizing its hotel scene to bringing hit musical 'Hamilton' to the island

• Puerto Rico was devastated by Hurricane Maria in September 2017.
• The storm destroyed buildings, knocked out electricity for months, killed an estimated 2,975 people, and left at least $80 billion in damage .
• The island's tourism industry, which accounts for 6.5% of its GDP, was decimated, with typically jam-packed areas like Old San Juan becoming "ghost towns."
• Since then, Puerto Rico tourism has seen an impressive rebound: 2019 was a record-breaking year, with 5.2 million visitor arrivals and nearly $1 billion spent on hotels and vacation rentals, per the tourism board, Discover Puerto Rico .
• The island's tourism industry recovered four times faster than New Orleans' did after Hurricane Katrina, the tourism board says.
• Visit Business Insider's homepage for more stories .

On September 20, 2017, the third-strongest hurricane ever to hit the US hammered the island of Puerto Rico.

Hurricane Maria destroyed homes and businesses , decimated roads, and toppled cell phone towers and power lines, knocking out electricity, water, and phone services. An estimated 2,975 people died , although the official death toll was only recorded as 64 for months. In the aftermath of the storm, 200,000 people — about 6% of the island's 3.5 million population — fled the island , mostly to the mainland US. Electricity wasn't fully restored for almost a year. The total cost of the damage was estimated at $80 billion.

Puerto Rico's tourism industry — which accounts for 6.5% of its GDP, per the tourism board — was devastated. The US territory has been slow to recover from the effects of the hurricane. It took nearly a year for power to be fully restored on the island, and as of August 2019, about 30,000 people were still living in homes covered by tarps rather than solid roofs.

But Puerto Rico's tourism industry has bounced back surprisingly quickly. 2019 was a record-breaking year for tourism, with 5.2 million visitor arrivals and nearly $1 billion spent on hotels and vacation rentals, according to the tourism board, Discover Puerto Rico .

"Following Hurricane Maria, Puerto Rico saw a tourism comeback unlike any other, recovering four times faster than New Orleans after Katrina," a spokesperson for Discover Puerto Rico told Business Insider. 

Puerto Rico invested heavily in tourism marketing after the hurricane, bringing in big names like Jimmy Fallon and Lin-Manuel Miranda, the creator of the hit musical "Hamilton" and who is of Puerto Rican descent.

Here's how Puerto Rico rebuilt its tourism industry after Hurricane Maria. 

Before Hurricane Maria hit the island in September 2017, Puerto Rico had just come off one of its most successful tourism years ever.

Per Discover Puerto Rico, 2016 was the peak year for tourism for the US territory , with 8.1 million trips and $8.5 million in visitor spending.

But Puerto Rico's economy was in a precarious financial position, with its government bankrupt and owing $70 billion.

Puerto Rico racked up this massive debt over the years due to an exodus of large businesses and a lack of tax revenue, which forced the government to borrow money and sell bonds to Wall Street, as Business Insider previously reported. 

Despite being a US territory, Puerto Rico has little say on federal policies that have affected it ever since it became a part of the US in 1898. 

On September 20, 2017, Hurricane Maria hit Puerto Rico, making landfall as the third-strongest hurricane ever to hit the US, with 155 mile-per-hour winds.

It was the first Category 4 cyclone to hit Puerto Rico since 1932.

Hurricane Maria came just two weeks after the eye of Hurricane Irma had passed near the island, killing four people and cutting off power to about two-thirds of the population.

The hurricane's winds ripped roofs off buildings and toppled cell phone towers and power lines, knocking out electricity to the entire island.

The island was drenched in rain that reached as much as 37 inches in some parts. Almost all of the buildings in Puerto Rico were damaged by Hurricane Maria in some way, a FEMA assessment found.

"The San Juan that we knew yesterday is no longer here," Mayor Carmen Yulin Cruz  told MSNBC the evening after the hurricane hit, adding that Puerto Rico was "looking at four to six months without electricity." It ended up being 11 months until power was fully restored . 

The hurricane killed 2,975 people, according to the official death toll, but that number has been disputed.

For months following the hurricane, the official death toll was 64, despite multiple reports disputing that number.

In November 2017, CNN surveyed 112 Puerto Rican funeral homes — nearly every single one on the island — who identified at least 499 hurricane-related deaths in the month following the storm. In December, an analysis by the New York Times based on daily mortality data from Puerto Rico's vital statistics bureau found that 1,052 more people than usual died in Puerto Rico in the 42 days following Hurricane Maria.

A  May 2018 study published in the New England Journal of Medicine estimated the actual death toll to be 4,645.

In August 2018, a study commissioned by Puerto Rico's governor adjusted the official death toll to 2,975.

Alexis R. Santos-Lozada, a demographer and assistant professor at Pennsylvania State University, said the death toll discrepancy likely came down to how government officials counted hurricane-related deaths. Deaths associated with a natural disaster can be classified as direct or indirect deaths, and officials likely counted only direct deaths, such as those due to structural collapse or flying debris, Santos-Lozada said.

A month after Hurricane Maria, tourism in Puerto Rico was virtually nonexistent, and the island was compared to a "ghost town."

"It's like a ghost town," Mike Maione, a 57-year-old tourist from New Jersey, who was staying with his wife in Old San Juan at a hotel powered by a generator, told CBS News in October 2017. "We've been here a number of times before, and the place is usually just crawling with tourists, but there's nobody here."

Thousands were still without running water. Many restaurants and shops on the island still didn't have electricity , about a third of Puerto Rico's hotels were still closed, and the beaches were closed for swimming due to potential water contamination.

More than two-and-a-half years after Hurricane Maria, Puerto Rico's recovery has been slow.

In the months following the storm, about 200,000 people — or about 6% of the population — fled the island , mostly to the mainland US, per Skift.

Power wasn't fully restored until mid-August 2018, almost a year after the hurricane.

And as of August 2019, about 30,000 people were still living without solid roofs , their homes covered by tarpaulins.

But the island's tourism industry has bounced back with surprising agility.

Puerto Rico declared itself officially open for tourism again in December 2017, just three months after the hurricane.

"Following Hurricane Maria, Puerto Rico saw a tourism comeback unlike any other, recovering four times faster than New Orleans after Katrina," a spokesperson for Discover Puerto Rico, the territory's tourism board, told Business Insider.

Several months before the hurricane, in March 2017, Puerto Rico had passed the " Act to Promote Puerto Rico as a Destination, act" setting the stage for a boost in tourism investment.

After Hurricane Maria, the island ramped up its efforts to revitalize the industry.

In January 2018, four months after the hurricane, the Puerto Rico Tourism Company flew influencers such as The Points Guy CEO Brian Kelly, who was Forbes' No. 1 travel influencer of 2017, to come visit the island and assist with recovery efforts.

Puerto Rico has it all- beaches, culture, food, nightlife, surfing, rainforests, rum and so much more and you don’t need a passport to go there! 🇵🇷❤️ A post shared by Brian Kelly (@briankelly) on Jan 7, 2018 at 8:58am PST Jan 7, 2018 at 8:58am PST

After the visit, The Points Guy, whose website brings in 10 million monthly unique visitors, published several stories promoting travel to Puerto Rico .

At that time, more than 100 Puerto Rico hotels were already accepting reservations again, more than 4,000 restaurants were open, and 107 tourist attractions were operating, according to the tourism company's executive director, José Izquierdo.

That spring, Puerto Rico launched a new destination marketing organization, Discover Puerto Rico.

Per its website, Discover Puerto Rico took over tourism advertising responsibilities that had previously been handled by the Puerto Rico Tourism Company and Meet Puerto Rico. 

Over the next several months, Discover Puerto Rico sent a multimedia team to travel around the island to take promotional photographs and videos of 78 municipalities.

It also focused on building out its social media presence and highlighting Puerto Rico's recovery effort. 

In January 2019, in partnership with Discover Puerto Rico, Jimmy Fallon came to the island to film an episode of "The Tonight Show Starring Jimmy Fallon."

In the episode, Puerto Rican singer  Bad Bunny and Fallon led a parade through the streets of Old San Juan while performing the song "MIA."

That same month, the New York Times named Puerto Rico the number one place to visit in its annual "52 Places to Go" list.

"A year and a half after Hurricane Maria slammed into this United States territory and other Caribbean islands with devastating force, Puerto Rico is on the rebound ," Mireya Navarro wrote for the New York Times. "The number of daily flights is still below normal, but tourism officials say that cruise ship traffic is healthy, hotel room occupancy is climbing back to pre-hurricane levels and many major attractions are open or partly open."

Also in January 2019, Discover Puerto Rico helped bring the hit musical "Hamilton" to the island.

The musical "Hamilton" was performed in Puerto Rico for a limited time , with creator and lead actor Lin-Manual Miranda, who is of Puerto Rican descent, reprising the titular role.

Discover Puerto Rico created "The Hamilton Experience" travel packages around the show.  The two-week-long "Hamilton" run raised almost $15 million for local arts groups, cultural organizations, and independent artists, according to Discover Puerto Rico.

After Hurricane Maria, many Puerto Rico hotels underwent months-long renovations. Since then, these hotels have reopened along with several brand new hotels on the island.

The first new hotel to open in Puerto Rico after Hurricane Maria was the Serafina Beach Hotel in May 2018, eight months after the storm.

The next month, a mountain farm lodge called El Pretexto opened outside of San Juan. In December 2018, the luxe St. Regis Bahia Beach reopened following a $60 million renovation after the hurricane.

And in October 2019, after its own multimillion-dollar renovation, Hyatt Hotels' The Resort at Coco Beach in Rio Grande reopened about 25 miles outside of San Juan near the El Yunque rainforest. 

And Puerto Rico's hotel scene continues to expand. In February 2020, just before the coronavirus pandemic hit the US, Marriott's Aloft Hotel opened in El Distrito , San Juan's entertainment district. El Conquistador, a Waldorf Astoria resort, is set to reopen in the fall of 2020 after a major renovation. A Four Seasons resort in Cayo Largo is scheduled to open  in late 2020.

There was also a surge in new vacation rentals after Hurricane Maria, as residents filled the gaps left by temporarily shuttered hotels.

Before Hurricane Maria, roughly 7,700 property managers were listing spaces on Airbnb in Puerto Rico , Airbnb CEO Brian Chesky recently said. Now, there are about 12,000.

On March 30, 2020, Chesky discussed Puerto Rico on a live-streamed video message to the company's property-manager partners, saying that Airbnb's business would bounce back after the coronavirus crisis in the same way that Puerto Rico's tourism sector rebounded after Hurricane Maria.

2019 ended up being Puerto Rico's best year ever for tourism.

The island saw 5.2 million visitor arrivals and nearly $1 billion spent on hotels and vacation rentals, per Discover Puerto Rico .

Since August 2018, the tourism board has been focusing on boosting MICE tourism , a type of tourism that brings large groups to a destination for meetings, incentives, conferences, and exhibitions, the spokesperson told Business Insider.

The MICE sector has proven to be promising in Puerto Rico, with a potential economic impact for the island of more than $320 million over the next six years, per the tourism board.

Puerto Rico's tourism sector must now overcome new obstacles with the coronavirus pandemic that has brought travel and other business on the island to a standstill.

Economist José Caraballo said the island's strict lockdown caused an estimated economic loss of between $6 billion and $12 billion , Insider reported last month.

On May 26, the island reopened its beaches, restaurants, churches, malls, and hair salons after a March shutdown, but a 10 p.m. to 5 a.m. curfew remains in effect through June 30. Puerto Rico reopens for tourism on July 15.

But in a win for the island's economic situation, in February, Puerto Rico had just reached a deal with bondholders that would write off $24 billion of its debt in exchange for paying the rest of it back 10 years sooner than previously agreed, Business Insider reported.

Despite ongoing challenges, Puerto Rico's tourism industry has shown great resilience.

Brad Dean, CEO of Discover Puerto Rico, told Forbes in September 2018 that the people of Puerto Rico have "unintentionally earned a PhD in economic recovery. They are writing the textbook ... on how to use tourism to fuel economic recovery."

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Puerto Rico Tourism Update 2024

In this Puerto Rico tourism update, we cover everything you need to know about travel to the Island of Enchantment. Below, we discuss the impact of recent hurricanes and why tourism is important for the island's recovery from both natural disasters and the COVID pandemic. We outline the current COVID rules (spoiler: there are almost none). We discuss the LGBTQIA+ safety situation (Puerto Rico is very welcoming). Plus, we lay out recommendations on what time of year is best to visit. 2024 is an incredible time to plan a trip to Puerto Rico and we’re here to help. 

For everything from safety tips to restaurant recommendations, work with a local to plan your trip . No one knows Puerto Rico like the locals do. Learn more .

• Puerto Rico and the pandemic

Hurricane Fiona Update

• How tourism helps Puerto Rico's economy
• Why you should plan a trip to Puerto Rico
• Puerto Rico hidden gems
• Visit Puerto Rico on a cruise
• LGBTQIA+ Travel
• Best time to visit Puerto Rico

What to know about Puerto Rico and the pandemic

For Americans, Puerto Rico is an easy and relatively safe place to visit . And travel feels much like it did pre-pandemic. 

Here's the latest:

There are no vaccine or testing requirements for Americans, although the CDC does recommend the COVID vaccine before travel. 

Masks are recommended on public transportation (including airports) but are not required. It’s still a good idea to pack masks and your vaccination card, just in case. 

You can always check in with a local to get an on-the-ground perspective of what life is like in Puerto Rico right now. 

Don’t the news from the 2022 hurricane season discourage you from traveling to Puerto Rico . The resilient islands bounced back quickly, especially in tourist areas, after Hurricane Fiona hit in September 2022. The San Juan Airport was fully operational within just a couple of days after Fiona made landfall. Hotels that were closed opened up quickly as well. At this point, most traveler-favorite activities are back to normal. Locals in Puerto Rico know all the details and can tailor your itinerary to make sure you get to see the best of Puerto Rico and help you support local recovery by visiting off-the-beaten-path, independently-owned places.

Hurricane Irma and Maria recovery are ongoing as well, but the remaining damage from the 2017 storms isn't obvious in tourist areas. Emergency repairs have been made, but long-term infrastructure upgrades and repairs are incomplete at present. 

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Why travel now tourism supports the island's economy.

As Puerto Rico — and the rest of the world — begins to recover from the COVID pandemic, tourism dollars are more important than ever. Even more so in Puerto Rico since it has been hit by several hurricanes in recent years. 

The CEO of Discover Puerto Rico, Brad Dean, noted that tourism makes up 10% of Puerto Rico's GDP . Following Hurricane Maria in 2017, he said: "The people of Puerto Rico have shown great resiliency...they are writing the textbook on how to use tourism to fuel economic recovery."

Tourism post-Hurricane Maria helped the island recover. Now, tourism can help Puerto Rico recover from the pandemic and Hurricane Fiona. 

That's especially true if you spend your tourism dollars at local businesses and skip the touristy chains. (The local places are usually more fun, anyway.)

When you connect with a Puerto Rico local to plan your trip, more than two-thirds of the flat fee goes directly into their pocket .

The good news is that tourism is increasing. In response to that demand, airlines are increasing their flights to the islands and tourist-focused businesses are thriving. For travelers, this makes reservations key - don’t miss out on something you want to do because you didn’t reserve in advance! You can still be spontaneous and enjoy lazy beach days in between your must-do activities.

And let's be honest — we could all use a vacation

For Americans, travel to Puerto Rico is easy — and often fairly affordable. There are tons of great hostels on the island , as well as many boutique hotels . 

Plus, going to Puerto Rico means you're in for a real adventure—whether that means exploring old forts in San Juan, surfing in Rincon, sipping piña coladas in Ponce , or enjoying the white sands of Playa Flamenco.

All in all, Puerto Rico can offer a wonderful respite from the daily grind. And as the island recovers from the pandemic, your tourism dollars can make a positive impact. 

Work with a local to plan your trip to Puerto Rico .

Are piña coladas on your Puerto Rico bucket list? Get a free sample at Barranchina in San Juan. They claim to have invented the drink!

Puerto Rico is an excellent place to escape (and these hidden gems support the local economy)

The list of fun and interesting places to visit in Puerto Rico feels endless, but here are a few local favorites to add to your itinerary. 

Crab Island Rum Distillery - Visit Vieques Island to enjoy artisan rum in a locally-owned distillery. Snag a seat at the bar and let the bartender recommend which rums to try, either on their own or mixed into tasty cocktails. 

Secret Garden Art Gallery - Admire and purchase paintings, photographs, and jewelry created by local artists in Rincon. The work here is inspired by nature and includes underwater photography, driftwood sculptures, and sea glass jewelry. 

Pork Highways -  Lechón, spit-roasted marinated pork, is a traditional part of Christmas meals, but is available all year. Businesses line up along the streets of Naranjito, Trujillo Alto, and Cayey, the island’s three Pork Highways, selling lechón and other delicious dishes. 

Las Salinas de Cabo Rojo - Snap photos that will stun your Instagram followers and see six different ecosystems at “Pink Beach” aka the Salt Flats. While the flats are known for their pink color, the hues vary constantly depending on the amount of salt, bacteria, and algae in the water. Spend a night in Boquerón Village and enjoy a meal at one of the many seafood shacks that pop up along the sidewalks. 

You can even see the local side of Puerto Rico on a cruise

Ready for a cruise vacation? Puerto Rico’s ports are ready to welcome you. Most cruises in the region dock for one day on the island and offer similar shore excursions across cruise lines. If you want to get off the beaten path, ask a local Hero to plan your day for you. With a custom itinerary from a local, you can feel comfortable navigating Old San Juan at your own pace, venturing out to the beach, and opening doors to restaurants that aren't on the standard cruiser’s itinerary. 

But is Puerto Rico safe for LGBTQIA+ travelers?

Generally, yes. Puerto Rico is known as one of the safest Caribbean destinations for queer travel. The LGBTQ+ community is protected by hate crimes laws, gay marriage is allowed, and trans people can change their legal gender. 

There’s a vibrant gay scene in Puerto Rico, especially San Juan. Some of the top drag artists in the world are from Puerto Rico and there are plenty of places to catch a drag show. Winter Pride Fest takes place each December and Pride Puerto Rico is usually in May or June. 

Okay, I definitely want to visit Puerto Rico. But when’s the best time to go?

The best time to visit Puerto Rico depends on your preferences. But we can give you guidance on the weather, things to do, and other factors that might influence your decision.

Summer (July-September) - It’s hot, humid, and rainy, but July and August are popular anyway. Hurricane season begins in June and stretches into the fall, and hurricanes are most likely to hit in September. Because it’s the wet season, there are great deals to be found on hotels and more. 

Fall (October - early December) - It’s still wet and it’s still hurricane season until the end of November. However, fall is an appealing time to visit for celebrations including patron saints days, Rincón Surfing Festival, Calle Loíza Culinary Fest, and Jayuya Indigenous Festival.

Winter (December - March) - With average temperatures ranging from 70 - 83 degrees Fahrenheit and low rainfall, many consider this the best weather season in Puerto Rico . It’s high season for tourism because that balmy weather is a big draw for those of us wishing to escape cold, snowy days. Celebrations abound in winter including Día de los Reyes (Three Kings Day), Carnaval, Semana Santa, and Christmas. 

Spring (April - June) - Warmer and rainier than winter, but cooler and drier than summer, spring can be a nice time to visit. The spring flowers are gorgeous, winter crowds are gone, and while the rainy season technically begins in April it isn’t in full swing yet. It’s also harvest time for coconut, mango, shrimp, and oysters.

Ready to vacation in Puerto Rico? Chat with a local who can create a custom itinerary based on your interests and budget. 

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Vieques, the Rugged Island Off Puerto Rico, Is Making a Comeback After Hurricane Maria — And Now Is the Time to Visit

Though battered by the storms of 2017, Vieques has found a renewed sense of purpose in the process of recovery. Sara B. Franklin discovers what has been lost — and what is flourishing once again.

I sat in the passenger seat of Sylvia De Marco's jeep as we wound uphill on a road flanked by untamed foliage. It was November of 2019, and I had just arrived on Vieques after a short but breathtaking flight from San Juan . De Marco, a designer and the proprietor of the Dreamcatcher , a hotel on the main island, acted as my unofficial guide. She had recently taken over what was left of a scrappy, 50-year-old guesthouse in the forested Vieques hills — leveled during the hurricane — and rebuilt it as La Finca Victoria , which opened last February for its inaugural season.

"The word hurricane comes from the indigenous Taíno word hurakán, 'god of the storm,'" De Marco told me. Though the memory of Maria was fresh, she dispelled the notion that disasters are in any way novel to Vieques. "This island has survived so many waves of colonialism," she explained, veering to avoid one of the many horses that run wild.

Vieques has had tumultuous history; the indigenous Taíno inhabited the island for around 500 years until the Spanish arrived violently in the 15th century. France, Britain, even Denmark all vied for control of the island for the next three hundred years until it was annexed by Puerto Rico in the early 19th century. Sugarcane production expanded and, with it, plantation slavery. When The United States took Puerto Rico after the Spanish-American war, Vieques was part of the package. As U.S. entry into World War II loomed on horizon, the Navy seized control of more than half the island, further displacing farmers and local residents, and established the base that would remain active until the Navy officially left in 2003.

I first came to Vieques in January of 2014, where I stayed at La Finca in its previous incarnation: La Finca Caribe, an isolated guesthouse owned by Washington State-based proprietor Corky Parker. (Parker bought it, in 1996, from Gail Burchard, who built it in the 1980s as a women's retreat.) Vieques had once been a sleepy place known, if at all, as an off-the-beaten-path haven for hippies and those looking to escape the rat race — and more notoriously, as a site of political turmoil: in 1999, massive demonstrations erupted in protest of the naval occupation.

During that visit, the small, densely forested island — Vieques is just 21 miles wide and 5 long, with one town each on the north and south shores — was abuzz with development, visitors flocking to its black-sand beaches and bioluminescent waters. The W, by far the largest and most luxurious hotel ever built there, had recently opened. The Modernist, 13-room Hix Island House had just expanded. Construction on El Blok — a striking concrete hotel in the town of Esperanza — was under way, and everyone was excited about its forthcoming restaurant by San Juan chef Jose Enrique.

Maria came as a punch to the gut. If Puerto Rico was abandoned after the storm, Vieques — reliant upon ferries for groceries and gasoline — was doubly so. Many residents left, unable or unwilling to rebuild. When Parker returned to clean up and reopen La Finca Caribe, she found the island in terrible shape. In a moment she describes as “total desperation and heartbreak,” she bequeathed the property to De Marco, who’d become a regular and friend over the years.

The destination is still in recovery. De Marco, and those who remained, feel a deep sense of loyalty. "Until Maria, a lot of people had forgotten the potential this island has to support the community here," she told me. "By making us vulnerable, the disaster helped us wake up."

Today, the 12-room La Finca Victoria is completely transformed under De Marco's leadership — save for the giant rubber tree still shading the walkway. There are many millennial-friendly updates: vegan breakfast and daily yoga, an honor bar with locally brewed kombucha, and a boutique market stocked with homegrown herbal teas and jewelry, clothing, and artwork by Puerto Rican women. But De Marco is more interested in cultivating long-term success and sustainability than she is in being on trend.

So is Vieques native Ivan Torres Ortiz, owner of the Crab Island Rum distillery, which De Marco took me to visit. "I wanted to stay on Vieques," he explained, in a room stacked with barrels, casks, and stainless steel drums containing his first commercial batch. "But I wanted to find work in something other than construction and bioluminescence tours. Figuring out how to make rum was the easy part."

A restless 20-something, he began tinkering, building his own stills and experimenting with recipes. But the molasses pace of local bureaucracy — as well as, of course, Maria — delayed his launch. The distillery is finally open, housed inside a former U.S. Navy firehouse in a rural green valley. Ortiz offers tastings and will soon feature pop-ups with local chefs. He hopes businesses like Crab Island can help brand Vieques as being about more than just beaches. "My product will create a lot of jobs, even if indirectly." De Marco nodded in agreement as we sipped a smooth, orange-infused rum.

While Ortiz focuses on lowering unemployment, others are imagining self-sufficiency literally from the ground up. We headed uphill, past the skeletons of once-showy homes, to La Finca Conciencia , where De Marco sources produce for her inn. This organic farm is aimed at social justice through food security and reviving local growing practices. Farmer Jorge Cora greeted us at the gate, and De Marco proceeded slowly around his terraced gardens, snipping holy basil, mustard greens, and fuchsia blossoms, pinching leaves, tasting, and asking questions. My attention was divided between the tiers of MacGyvered hives, home to Vieques's unique species of honeybees, and the stunning vista of the sea beyond. The legacy of weapons testing on Vieques means farmers sometimes face contaminated soil, but Cora's work is planting the seeds for a nascent food-autonomy movement. As a downpour broke, he packed up our crate of eggplants, and we departed.

On my last evening, I drove north from Finca Victoria, past the still-shuttered W, where vines and saplings are overtaking the whitewashed walls as nature reasserts its claim. I then cut back to Esperanza, a few square blocks of modest homes and small businesses on the southern shore. I sat on a fishing pier across from El Blok . Islanders have come to appreciate this Brutalist behemoth; the building, with its massive generator, housed relief workers and displaced locals after the storm, and became a hub for emergency services. Puerto Rican-born Carlos Perez, who became executive chef at El Blok's restaurant Placita after Jose Enrique returned to San Juan, provided thousands of free meals.

El Blok was also the first hotel to reopen after Maria, welcoming guests just two months later. Since then, the property has renewed its commitment to community engagement, moving the restaurant from the rooftop to the ground floor to welcome locals. Perez is focusing on seasonal local fare: pumpkin soup, head-on langoustines, salads of greens from La Finca Conciencia.

Esperanza is a restaurant destination for visitors to Vieques; notable spots include El Quenepo , next door to El Blok, which serves small plates and craft cocktails. (They also opened a few guestrooms last year, after what the owners called a “Hurricane Maria Renovation.") I walked down the promenade to dinner at what had become my favorite restaurant, El Guayacán , situated in an unassuming two-story cement building at the end of the Esperanza strip.

Its proprietor, Marcos Vegas Arias — who ran bars in San Juan, his hometown, for more than a decade before opening his modest restaurant on Vieques in 2013 — is a born host, and moonlights as a local tour guide. He has graciously driven me all over the island, bringing me to the most secluded beaches, including the rugged and beautiful Playa Negra: a volcanic black sand beach accessible only by hiking through a shallow riverbed.

He is also one of the few restaurant chefs on the island who serve traditional Puerto Rican home cooking: stewed chicken, tostones slathered in garlicky green sauce, vinegary conch salad. El Guayacán feels both of, and for, Vieques — a beacon of purpose that has survived both literal disaster and failed disaster management. I watched an electric-orange sun sink into the Caribbean as the musicians in the restaurant sipped Medalla Lights between sets.

A few people, reunited for another tourist season, greeted one another in Spanglish — "Hola, welcome back."

A version of this story first appeared in the February 2020 issue of Travel + Leisure under the headline Viva Vieques.

In the issue's contributors page, we erroneously referred to the writer and her husband, Chris Bradley, as the owners of the Phoenicia Diner. Mike Cioffi is the owner of the restaurant, where Bradley was chef from 2016 to 2018. Franklin, Bradley, and Cioffi collaborated on the Phoenicia Diner Cookbook, to be released later this year. We regret the error.

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Puerto Rico’s progress still stalled four years after Maria

The memories of surviving Hurricane Maria still haunt people in Puerto Rico, four years after the storm wreaked havoc on the U.S. territory on Sept. 20, 2017.

There are reminders of the destruction, with thousands of homes, many of them still covered with blue tarps , yet to be fixed. Constant power outages remind Puerto Ricans that essential work to modernize the antiquated electric grid decimated by Maria has not yet begun. Deteriorating school buildings, roads, bridges and even health care facilities point to a slow reconstruction process that has not yet picked up its pace.

A new analysis by the Center for a New Economy, a Puerto Rico-based nonpartisan think tank, argues that rebuilding after the hurricane is just one of three "systemic shocks" — along with the Covid-19 pandemic and the decadelong financial crisis — that is challenging Puerto Rico.

Regarding reconstruction, some of the most important work, which includes "undertaking mitigation activities to increase resiliency and reduce the risk exposure of vulnerable populations — has not yet begun," according to the analysis.

“If a hurricane today, category one, hits the island, it will not survive. The power grid will not survive," Rep. Nydia Velázquez, D-N.Y., said during a press conference Monday hosted by the Hispanic Federation to remember the roughly 3,000 lives that were lost to Hurricane Maria.

"Puerto Ricans are experiencing blackouts almost daily and every single one of those blackouts takes them back to that unforgettable dawn of September, 2017,” said the congresswoman of Puerto Rican descent. “Thousands of houses with blue tarps. That is happening in America.”

Hurricane Maria left $90 billion in damages and Congress allocated at least $63 billion for disaster relief and recovery operations. Four years later, about 71 percent of those funds have not reached communities on the island archipelago. Puerto Rico has received about $18 billion, according to FEMA's Recovery Support Function Leadership Group .

“As we invest in upgrading and modernizing our American infrastructure system, we have to make sure that we do it everywhere, in every community," Sen. Kirsten Gillibrand, D-N.Y., said in the press conference alongside Velázquez. "That starts with ensuring that Puerto Rico’s needs are included in the build back better agenda, and that our infrastructure investments meet the greatest need."

The Fiscal Oversight and Management Board overseeing Puerto Rico’s finances has said the remaining bulk of the reconstruction aid is scheduled to be disbursed after fiscal year 2025, according to Sergio Marxuach, CNE's policy director and author of the analysis.

Created during the Obama administration under the 2016 Promesa law, the federal fiscal board is responsible for restructuring Puerto Rico’s $72 billion public debt after U.S. laws  arbitrarily excluded the U.S. territory from the federal bankruptcy code . It's resulted in tough austerity measures as Puerto Rico is trying to jump-start its economic growth. 

The precarious financial situation became more complicated as compounding crises such as a series of destructive earthquakes early in 2020 followed by the Covid-19 pandemic made life harder for the 3.2 million Puerto Ricans living in the territory.

So far, Puerto Rico has made up for about two-thirds of the loss in economic activity that resulted from the Covid-19 pandemic. But Marxuach said it is important to remain cautious about the relatively quick recovery, since it's largely attributed to a recent injection of pandemic-related federal aid.

“It is worrisome that economic growth in the short term depends mostly on receiving federal transfers that we do not control," Marxuach stated in the report. "We worry that these expenditures will have a temporary positive impact on the economy that may set back efforts to develop a medium/long-term economic strategy or plan for Puerto Rico.”

Puerto Rico is projected to receive $43.5 billion in federal assistance related to Covid-19 by fiscal year 2023, according to the Fiscal Oversight and Management Board.

Power 4 Puerto Rico , a coalition composed of stateside national organizations, is pushing for the federal government to tackle the structural factors impeding short-term and long-term recovery. They're calling for strengthening the U.S. territory's infrastructure, writing down its debt as part of the restructuring process and increasing transparency and accountability.

The coalition is urging President Joe Biden and his administration to address the issues he promised to undertake during his campaign.

According to an upcoming fact sheet written by Power 4 Puerto Rico and shown in advance to NBC News, Biden has made good on some campaign promises, including releasing previously stalled hurricane aid and reviving a White House Puerto Rico task force  to advance rebuilding efforts on the island.

But he has yet to order a review of the federal fiscal board's fiscal austerity policy, which he pledged to do, as well as support an audit of Puerto Rico's debt and ensure that recovery funds benefit local businesses .  

The federal fiscal board is promoting structural reforms for Puerto Rico in key areas such as social welfare, energy, and ease of doing business, "which it estimates will have a cumulative positive impact equal to .75% of GNP by fiscal year 2026," Marxuach said in the report.

But Marxuach points out "it's unclear, though, whether the government of Puerto Rico has the capability to implement these policies" and whether they'll have the economic impact forecasted by the board.

“We need the resources to build houses, build roads, give services, rebuild the health system,” Rafael “Tatito” Hernández, speaker of Puerto Rico's local legislature, said during the Monday press conference. "How are we going to work, if we don’t have the certainty...We don’t know if we’re going to have power in our home when we come back from work."

Follow  NBC Latino  on  Facebook ,  Twitter  and  Instagram .

Nicole Acevedo is a reporter for NBC News Digital. She reports, writes and produces stories for NBC Latino and NBCNews.com.

Puerto Ricans take recovery into their own hands 6 years after Hurricane Maria

"We help the planet which is important."

Six years after Hurricane Maria swept through Puerto Rico, flooding whole towns and leaving 80% of the island without power, some residents and businesses have taken matters into their own hands and are taking care of the island's locals.

Casa Pueblo, a 43-year-old nonprofit environmental group, is located in the town of Adjuntas and managed to keep its lights on after Hurricane Maria because it was run by solar power. The building, which had a solar power unit installed in 1999, became a community hub for people waiting weeks for the island’s grid operators to restore power.

Arturo Massol-Deyá, the organization's executive director, told ABC News that he and others in the village have been promoting solar to other parts of the island in an attempt to cut down on Puerto Rico's dependence on fossil fuel.

"That’s the new narrative, that’s the future that we are building in Adjuntas," he said.

MORE: Puerto Rico's power grid is struggling 5 years after Hurricane Maria. Here's why.

Brenda Costa Torres, an Adjuntas resident who undergoes dialysis treatment and was aided by Casa Pueblo's power, told ABC News she agreed.

She said there needs to be a focus on efforts like solar power because everyone on the island benefits from it.

"And we help the planet which is important," she said.

Economic independence has been a struggle in Puerto Rico for over a century.

The 1920 Jones Act states that "goods carried between two U.S. ports by water must be carried in a U.S. flag vessel that is American built, owned, controlled and crewed," and because of this regulation, goods in Puerto Rico cost more due to the rising transportation costs.

To counter this roadblock, Puerto Rican farmers, stores and restaurants have been increasing their farm-to-table operations.

Efren Robles, the co-founder of the family farm Frutos del Guacabo, told ABC News he has been educating people on the island about the economic benefits of growing their own food.

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"The main purpose of it is that people come and understand a little bit about what happens on a farm and how can they be a part of this local ecosystem," Robles said of his farm.

After the hurricane, Robles said he was devastated seeing farm soil and crops ruined.

About 80% of the island’s crop value was destroyed in the storm, which represented a $780 million loss in agricultural yields, according to officials.

MORE: Video A year later, Puerto Rico still recovering from Hurricane Maria

"In that moment, we knew that we had something really big going on," Robles said.

Frutos del Guacabo is a hydroponic farm, which relies on water to transfer nutrients to plants rather than soil. It was one of the first farms to start producing crops after the storm, according to Robles.

"One hundred seventy-seven days after, I will never forget that day, we decided to start producing, [and] start delivering again, whatever we had," he said. "It was the best learning experience."

Robles shares what he’s learned with other producers on the island in hopes of creating a local independent food chain from Boricua farm to Boricua table.

ABC News' Armando Garcia and Victoria Moll-Ramirez contributed to this report.

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"It's like a ghost town": Puerto Rico tourism craters in wake of Hurricane Maria

October 24, 2017 / 4:21 PM EDT / AP

SAN JUAN, Puerto Rico -- The narrow blue cobblestone streets of Old San Juan are deserted. Cigar shops are boarded up. Boutiques in bright colonial buildings are closed. 

"It's like a ghost town," said Mike Maione, a 57-year-old tourist from Flanders, New Jersey, who was staying in the heart of the colonial city with his wife at a small hotel powered by a generator. "We've been here a number of times before, and the place is usually just crawling with tourists, but there's nobody here."

Tourism, a rare thriving sector on the island in a deep economic slump, is practically nonexistent a month after Hurricane Maria swept though. And part of the recovery from the storm depends on how fast visitors reappear.

About a third of the hotels in Puerto Rico remain shuttered. Restaurants and shops are still without power. Beaches are closed for swimming because of possible water contamination .

The high season begins in December, and tourism officials are hoping to lure some visitors, but that depends on when power is fully restored and how quickly hotels and attractions can repair the catastrophic damage. 

"We want Puerto Rico to be more like New Orleans post-Katrina and Detroit post-financial crisis," said Jose Izquierdo, the executive director of Puerto Rico's government Tourism Company. Though, he hopes, on a faster timeline.

The U.S. territory usually sees more than 5 million visitors a year, and they spend close to $4 billion, creating jobs for more than 80,000 people. While that's a small portion of the overall economy, about 8 percent, money generated by visitors has been growing at the same time other sectors have shrunk during a 10-year recession.

Maria roared across the island on Sept. 20 as a Category 4 storm, killing more than 50 people and knocking out electricity to the whole island. More than a month later, only 30 percent of customers have power, though Gov. Ricardo Rossello has pledged to get that to 95 percent by Dec. 31. Roughly 70 percent of the communication network has been restored, and 70 percent of the water service is back.

The main airport recently resumed full operations. Cruise ships are beginning to sail again. The Bacardi rum distillery will reopen Nov. 1. Nearly all the island's casinos are open. Old San Juan's colonial-era buildings mostly survived intact.

"We don't want to give up entirely on the high season," said Izquierdo, who hopes business will be bolstered by Puerto Ricans coming home for the holidays, emergency federal officials working on the recovery and others coming with a sense of purpose to help rebuild. "And then post high-season, we continue to revamp the product," he said. 

But for Patti Weiss, 54, of Gilbertsville, Pennsylvania, the uncertainty was too much. She and her husband planned their Royal Caribbean cruise a year ago and regularly embark from Puerto Rico, staying through Christmas, but are leaving from Florida instead.

"I just didn't feel it was the right time to go, it was too iffy. I was still seeing pictures and the hotels lost the generators and I just couldn't do it," she said. "We were really disappointed, but I still have my house and drinking water so this is nothing compared to what they're going through down there."

Despite the uncertainties ahead, Lonely Planet on Tuesday named San Juan among its top 10 cities to visit in 2018. The decision to include San Juan was made prior to hurricane season, but Lonely Planet decided to keep the city on the list, confident that it will be ready for tourists next year.

"When people do visit, not only will they learn a lot about extensive history, they'll see the culture, but they'll also witness the resilience and ingenuity of its citizens," said Bailey Freeman, Lonely Planet's Central America and the Caribbean destination editor.

Scores of restaurants are open, but are operating under truncated hours with limited menus and many without power. Some are offering discounted meals to locals who can't cook.

Chef Ariel Rodriguez, owner of Ariel, a fine dining spot open for almost 30 years where a two-course meal is $54, said it's been nearly impossible to get ingredients. He was offering a meal of beef stew and rice for $5. For smaller eateries like gastropub Gallo Negro, it's hard to pay the cost of diesel for generators, said Chef Maria Grubb. Her 52-seat restaurant hasn't been open for weeks. 

"It's quite crushing," she said. "Rent is still due. Insurance is still due, distributors need to be paid. We have a staff of 14 people without any means of making money. That's the toughest part of all this."

The financial impact of Maria on the industry won't be clear until after the season ends, but the visible impact of the storm is more obvious. Some of the island's best-known attractions were battered, like El Yunque, a biologically diverse tropical rain forest of 45 square miles. Aerial footage shows massive defoliation, plus landslides and downed trees. One of the island's most famous resort hotels, El Conquistador in Fajardo, will be closed until the end of the year for repairs.

The expansive grounds of the Castillo San Felipe del Morro are open around the breathtaking 250-year-old Spanish fort that winds through the cliffs overlooking San Juan Bay, but the fort itself is still shut. Beaches that were slammed by lashing rain and winds may also be contaminated after sewers overflowed; environmental officials say no one should go in yet.

Even if people do come, finding a hotel will be tricky. There are roughly 100 hotels open, mostly powered by generators, but nearly all are occupied with recovery workers and it's not clear how long they're staying, though tourism officials say they expect more rooms available starting Dec. 20. Of the premier resorts, the Caribe Hilton isn't accepting reservations until New Year's. The Ritz Carlton in San Juan won't open for guests until at least April. 

Meanwhile, hospitality officials are encouraging do-gooders come to help rebuild. Local Guest, a website promoting sustainable tourism, is offering trips starting Dec. 1 for people to come stay with families in hard-hit areas to help them rebuild, said creator Carmen Portela.

"After the hurricane I have to be honest, hearts were destroyed," she said, and she tried to figure out how to help on a larger scale. "If we don't help rebuild our country then there's nothing, there's nothing."

For now, businesses that count on tourism are staying afloat through emergency workers streaming onto the island.

"We're depending on them right now," said Carmelo Perez, manager of Gul Plaza Souvenir Store.

The darkened shop sells t-shirts, shot glasses and other trinkets. Business is terribly slow, and they're praying people start coming back.

Some are. Stephan Renard, his wife Nikola Sheienssen and their son were visiting Old San Juan from Kiel, Germany, and planned to spend a day before heading off on a cruise. They had some trouble finding a hotel and were surprised by the empty streets and closed stores. But they never considered canceling.

"If everybody stays away, how can they rebuild?" Renard asked.

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They were still rebuilding 5 years after Hurricane Maria. Then Fiona hit.

Puerto Ricans have learned to fend for themselves while waiting for roads, bridges and buildings to be repaired.

Hurricane Maria cleaved Puerto Rican memory. There was one kind of life before the tempest. And an entirely different life that emerged in its wake. Un antes y un después.

Before the storm, the Caribbean island archipelago was teetering economically and unraveling politically. In the five years since, there have been ongoing blackouts, protests, earthquakes and a global pandemic. Puerto Ricans have moved from powerlessness to precarity.

As the anniversary approached, The Washington Post went back to visit those who opened up their homes then , to show us their lives now. Hurricane Fiona — which hit Puerto Rico on Sunday, destroying homes, roads and bridges and knocking out electricity — was still days away. But even before that, much of the post-Maria recovery work had just begun.

In the mountains of Utuado, teacher Maria Ortiz Viruet was already experiencing blackouts several days a week when Fiona struck — each flicker of a lightbulb filling her with anxiety.

Deeper into the lush central forest, Syndia Maria Sotomayor no longer needed a zip line to get supplies across a river. A temporary steel bridge was built after Hurricane Maria to replace the one that washed away; it still straddles the waterway. But Fiona destroyed a different bridge connecting two parts of the town not far away.

That bridge was also meant as a stopgap solution while a permanent structure was built. But Puerto Rico’s transportation secretary, Eileen Vélez Vega, said Monday that construction on the new, taller bridge isn’t slated to begin until 2024. Video a day earlier showed muddy water washing over the surface of the temporary crossing, the metal breaking apart and drifting into the current.

In the town of Yabucoa, a baseball stadium destroyed by Hurricane Maria has been demolished, but before Fiona it remained a pile of dirt as officials waited patiently for Federal Emergency Management Agency money to rebuild what had been a pillar of the community.

The people of Puerto Rico have adapted. Bregaron, the expression goes, meaning they struggled and survived. And they found ways to ensure that the lesson Hurricane Maria taught is heeded: Do not depend on any government to help.

Maria Ortiz Viruet, Caonillas, Utuado

After the 2017 storm, Maria Ortiz Viruet’s classroom was empty for months. Families moved out, and children weren’t allowed back until the small town’s electricity was restored. Her 18-year-old son, Jesús Mejías Ortiz, worried whether he’d finish high school.

The Ortiz family was without power for nine months. And in this part of Puerto Rico, no electricity means no running water. Maria had to use the creek near her house to wash clothes and bottle water. Life as they knew it was replaced with the surreal routines of another century.

Her wooden house was not severely damaged, but it took Maria months to feel safe inside again. Some of her neighbors fared far worse. One family’s home toppled off a cliff entirely. Maria stayed at her mother’s cement abode a hundred feet away while the town recovered.

The power often goes out at Maria’s home, even when a hurricane isn’t approaching. Steep voltage variations sparked by the frequent interruptions kill their appliances. She’s not alone. Blackouts remain a staple of life in the U.S. territory despite efforts to fix Puerto Rico’s infrastructure .

Students returned to Maria’s school, but in limited numbers. Amid an ongoing exodus, the island’s population has steadily gotten older and smaller. Declining enrollment and political scandals led to closures and pressures to reduce staff. In the last two years, officials moved Maria from the only school she ever knew to a different campus nearly an hour away. She retired early, two years shy of her 30th year as a teacher, in 2020.

The 58-year-old spends her time tending to her elderly mother, cultivating coffee, plantains and other fruits on the land her father left her and participating in political meetings. But when dark clouds gather from over Lake Caonillas, she shudders at what they could bring.

“Every time the weather takes a turn, it triggers my anxiety and we all look at each other and say, ‘The power will go out soon,’” Maria said. “Then I start to feel unwell.”

Jesús, her son, graduated and lives at home while he studies to be an electrician. He wants to know how to restore power to his community. LUMA Energy, the private consortium contracted after Maria to distribute electricity across the island, offered him a job. But he declined, in part because of a lingering sense of betrayal over the local and federal governments’ slow and haphazard handling of the recovery.

As hard as it has been, he won’t leave his island. He is intent on forging a future in Puerto Rico despite the anemic job market.

“Hurricane Maria changed my life,” he said. “There is a clear difference between the person I was then and the one I am today. I learned to value things more. ... But Puerto Rico is the same or worse than where it was five years ago.”

In their rural, mountainous community, every rainfall portends impending darkness. Before Fiona, some streets still had concrete traffic barriers to protect drivers from steering into damaged parts of the roadway left unrepaired. The neighbor’s house that was pushed down the mountain is nearly invisible beneath tropical overgrowth.

Rafael Surillo Ruiz, Yabucoa

Yabucoa’s once pockmarked streets have been repaved. Palm trees sheared by the storm grew anew and adorned the coastline. But there are few other visible signs of progress. The town’s city hall is still destroyed. FEMA allocated $26 million to repair Yabucoa’s stadium — but so far, the only work completed with federal funds is the demolition of the existing structure.

It was here that Hurricane Maria first roared onto shore, disfiguring its picturesque valley and verdant highlands. Vast stretches of land were left an ugly brown as the storm’s unforgiving winds ripped trees and homes from the ground. Yabucoa is one of Puerto Rico’s lowest-income communities, and after the hurricane, 6,000 people left to rebuild lives in the States.

Change here has been happening at a snail’s pace — emblematic of the delays and corruption that have marred the post-Maria years. FEMA has set aside an estimated $28 billion in recovery funds to Puerto Rico to repair infrastructure. But only a fraction of the money has been disbursed by the federal agency. In all, about a fifth of the money slated for major public projects has been released to local governments to begin work. The same is true for other federal agencies with funds for the U.S. territory’s recuperation.

“We are not ready to face another tempest like Maria,” said Yabucoa Mayor Rafael Surillo Ruiz, days before Fiona struck. Behind his conference table was a whiteboard. The letters “F-E-M-A” were written in red, and nearby, a series of blue question marks, echoing the doubts and frustrations brought on by the slow pace of recovery. Damaged roofs and streets that would have been relatively easy to fix if repaired quickly have turned into major reconstruction projects amid the wait for funds. He equated it to the magical realism of a Gabriel García Márquez novel. “This is Macondo.”

On Monday, Rafael said Hurricane Fiona’s destruction confirmed what he suspected. Heavy rainfall triggered severe flooding that left two neighborhoods underwater. More than 200 families had to be rescued and lost everything inside their homes, he said. Bridges collapsed, and the roadwork that had been completed dissolved under the weight and speed of floodwaters.

“If you were to ask me what my top concern is right now, it’s not repairing a bridge,” he said. “It’s how we repair the hearts of those devastated families.”

Rafael carries the weight of all the lives lost due to Maria. Across Puerto Rico, nearly 3,000 people died during the storm and in its aftermath during the power outage — one of the longest in U.S. history. It’s hard to say how many died in his town, but the mayor can name a handful of neighbors. Each barrio now has a federally funded community center equipped with a generator, communal kitchen and cistern — but they will only help meet a fraction of the town’s needs after a storm.

“The biggest lesson I’ve learned, as a city administrator, is that I can’t depend on others to help me lift up this community. Government agencies arrived too late, some two to three months later, and others never arrived,” he said. “I have the assurance of knowing that if something happens, I have community members empowered to do what’s needed.”

Syndia Maria Sotomayor, Río Abajo, Utuado

Hurricane Maria’s rains triggered ruthless flooding throughout Puerto Rico’s mountainous regions. Rivers rose 30, 40 and 50 feet, washing away roads and bridges that cut off entire communities. The day the Río Grande de Arecibo toppled the cement bridge connecting Río Abajo to the rest of Puerto Rico, the community became known as “el campamento de los olvidados.”

They were the “forgotten ones” — a metaphor reflecting the abandonment many Puerto Ricans felt in the weeks after Hurricane Maria engulfed the island archipelago.

Syndia Maria Sotomayor’s family was one of many in Río Abajo who, after Maria, depended on a zip line to ferry groceries, supplies and themselves across a raging river in a crude basket. Their house and farm were on one side. The main road to town was on the other.

In the days after that storm, she and her four sons packed bottles of water, solar-powered lights and animal feed into a wooden cart fashioned with two-by-fours nailed together. It flew just above the river using a pulley system Syndia’s husband, Daniel, devised. They used the contraption to cross the wide, muddy river to get to work, school, the bank and anywhere else they needed to keep their farm running and family safe.

The Sotomayors depend on no one but themselves and their ingenuity to get by deep in the heart of rural Utuado and most days — living as close to being off the grid as one gets in Puerto Rico. But the island’s financial crisis, exacerbated by Maria, nonetheless has put a strain on their daily lives. The price of a gallon of milk is the same as one hour’s work at minimum wage. The median income here is lower than that of Mississippi, the poorest state in the United States.

The family has adjusted, consuming the milk their goats provide and supplementing their diets with the vegetables they grow.

Six months after the bridge collapsed, FEMA completed construction of a temporary steel bridge. It remains unclear when a permanent crossing will be constructed. The current one has already rusted from exposure to the endless rain and humidity of the tropics.

The family took down their zip line, hoping never to use it again.

As the muddy waters of the Río Grande de Arecibo rose on Sunday, Syndia kept a careful eye on the bridge nearby. It was still standing 24 hours after Fiona hit, but with more rain expected Tuesday, the Sotomayors weren’t taking any chances.

Their Hurricane Maria zip line was ready, just in case.

• Caribbean and Bahamas

8 Things To Know About Visiting Puerto Rico After Hurricane Maria

We recently traveled to puerto rico to see how the island is recovering from last year’s hurricanes. here’s what we learned..

In typical years, Puerto Rico is an easy getaway for U.S. tourists thanks many direct flights from major cities and the fact that no passport is required to visit. But Hurricanes Irma and Maria left three-quarters of residents without power and destroyed numerous hotels and restaurants, hurting the tourism industry, which contributes $4 billion dollars to the economy each year.On a recent visit, the island seemed to be operating usual as far as tourists are concerned. Sunny blue skies over San Juan shone down on vibrant green fields around Castillo San Cristobal, where visitors took selfies and ate shaved ice. Hotels around the city were booked and restaurants were buzzing — someone who hadn't watched the news last fall might never have guessed a category 5 hurricane hit the island five months ago.Outside of San Juan reality was more sobering. Popular islands Vieques and Culebra were practically empty and many restaurants were shuttered. The eateries and hotels that were open were running on generators (as was much of San Juan). Some areas of El Yunque National Forest were open, though many areas were closed. Roads and street lights across the island were still under repair.Yet, this is exactly why you should visit."Restaurants cannot open without visitors, but visitors will not come without restaurants," said Denisse De Leon of Jak Water Sports in Vieques.There are enough places open to have an enjoyable stay wherever you go in Puerto Rico, and visiting the best way to help. Here's what you need to know before you go.

1. Visiting is the Best Thing You Can Do

Before leaving for Puerto Rico, a few friends asked if visiting was insensitive. They thought having tourists around might put extra burden on people trying to rebuild. Actually, it's the opposite. Without tourism dollars, hotels, restaurants, and other businesses — especially those that are smaller — cannot afford to rebuild.

"The best way to support is to actually visit us," says Carla Campos, Acting Executive Director for the Puerto Rico Tourism Company. "Tourism is vital for the island's economy so we're encouraging people to come and stay at our hotels, explore our local restaurants, and shop at our stores."

2. Don't Expect San Juan to Feel Desperate for Visitors

In late February 2018, staying in San Juan felt no different than months before the hurricanes. All attractions and museums were open, restaurants were operating as usual, and many hotels were at capacity. The only area where damage was visible was on the walking trail along the perimeter of the city, and even this was minor — a few small trees down and a bit of debris not yet cleared.

3. Venturing Out of Old San Juan Is Worth the Uber Fare

While Old San Juan's picturesque streets and multiple forts draw 3.7 million tourists per year, there's much to be seen outside of the old city, too. The Santurce neighborhood is where locals hangout on weekends, specifically at the Plaza de Mercado. Here, from Thursday through Saturday nights you'll find crowds of young people drinking and dancing late into the night.

At restaurants like La Cueva del Mar (which was recommended by every person I spoke to in San Juan and definitely lived up to the hype), you'll get a feel for what life in San Juan is actually like for residents, and probably find yourself in some candid conversations about hurricane relief efforts.

Very few locals live in the old city, but those in Santurce were happy to talk about hurricanes past and how they've differed, as well as vent their frustration about current relief funding.

Pinky's , a breakfast spot for smoothies and huge stacks of pancakes, is a favorite among the Army Corps of Engineers, their presence a reminder that though San Juan is operating like normal on the surface, there's still work to be done.

4. Parts of El Yunque National Forest are Open for Visitors, with More Opening All the Time

"I just cried," says forest research ecologist Grizelle Gonzalez, of how El Yunque , the only tropical rainforest in the United States, looked after Hurricane Maria. "All the leaves were completely stripped. There was no green."

To a non-expert eye, El Yunque, which accounts for about 25 percent of Puerto Rico's tourism and is the second most popular attraction in the country next to Old San Juan, seems to be doing pretty well. The forest looked lush and vibrant, but Gonzalez told me to look up. Lower elevations recover faster, but as you look into the mountains the trees are less covered with leaves, with some still completely bare near the top. Plenty of rain in the months since has helped recovery move faster than after previous hurricanes, but the initial devastation was worse.

Immediately after Hurricane Hugo in 1989, tree mortality in the forest was at 10 percent, and 15 years later the mortality is still greater than the recovery. In comparison, mortality is already 20 to 30 percent after Maria. The forest canopy is still open, which is one of the most obvious signs of defoliation, and Gonzalez says it could take 50 to 100 years for the forest to completely recover because there are so many endemic, slow growing species.

"It's important for people to be informed," she says, urging patience during the recovery period. "It's important to have perspective. The Army Corps of Engineers calculated 3.6 million cubic feet of debris from the hurricane, and 60 percent of that was vegetation."

Some park facilities will also need to be rebuilt. This is where tourism helps, and some areas of the park are open. The Angelito Trail, a 0.7-mile walk, is open to the public, as is road 191 to the viewing point for La Coca Falls. More than 100 special use permits have been granted for tour groups to come back to the park, even as much of it remains closed due to landslides and road repair.

"Some closed areas have dozens of landslides," says Forest Supervisor Sharon Wallace. "Everyone is working as fast and as hard as they can."

She estimates full recovery will take more than a year. In the meantime, tourists are encouraged to visit open areas and check the park website and twitter feed , as information is changing all the time.

The forest service is putting together volunteer opportunities for tourists and locals to help with debris removal, painting, giving conservation information to the public, and more. Information about these opportunities will be released on the website as it becomes available. Some cruise lines are also offering volunteer excursions for passengers.

5. The Bioluminescent Bay Glows Lightly, If Not Brightly

Mosquito Bay and its bioluminescent waters have been a huge draw for tourism to the tiny island of Vieques. After the hurricanes, tourism stopped completely, partly because Vieques was harder to reach from San Juan, and partly because the bioluminescence of the bay was destroyed. Residents, who mostly work in hospitality or providing island tours, have suffered. "It has been very, very hard," said De Leon of Jak Water Sports tours. "We need people to come and see all of Puerto Rico, not just San Juan."

She and her husband have been running their business for 18 years, and have seen the bay recover from multiple hurricanes. The warmer the weather the faster the recovery, so they estimate that by the end of April 2018 it should be mostly back to normal. Flagellates, which make the bay glow, can be found around the world, but Mosquito Bay has a concentration of 700,000 per gallon of water, making it the brightest bay in the world. If hurricanes keep coming, this might not always be the case.

"Vieques and the bay are very unique. We want people to know that these places exist, but we cannot control them," says De Leon. "These places are here now, but we don't know if they will be here in the future."

6. Your Beach Vacation Can Still be Beachy

The islands of Vieques and Culebra, home to Puerto Rico's best beaches , were some of the hardest hit areas. That said, the beaches are still beautiful and now is a great time to visit because you'll have lots of sand to yourself. According to Rosa, Culebra has not seen the tourism San Juan has over the last few months, so the beaches are relatively empty compared to peak tourism years. Flamenco Beach, a Blue Flag beach , is cleared and just as gorgeous as ever, as are Media Luna and Navio Beach in Vieques.

Rincon, on the west side of the island, is a popular surf town operating as usual, including numerous spots open for surfing lessons.

7. The Best Way to See the Island is to Rent a Car

Within San Juan, taxis and Ubers are affordable, but if you're planning to visit anywhere outside of the city, renting a car is the most convenient way to travel. Not only can you manage your own time and not have to worry about bus schedules, but you can make beach and food stops along the way. Most major American rental car brands have kiosks inside the airport, and Avis, Enterprise, and Hertz have locations closer to the city center as well.

Because it's part of the United States, all road signage will be familiar, but be careful at intersections outside of San Juan, even just a few miles away. Many street lights were damaged during the hurricanes and are still not working, so some busy intersections are treated more like four-way stops. This can result in a lot of honking and a tense and confusing few minutes, so drive slowly and pay attention. Once on the highway, roads are easy.

8. Patience is Key

Be patient when planning, and stay open to adventure. Much of the country is still running on generators, so showers might not always be as hot as you would like, and air conditioning might not be as cool. An Airbnb where I stayed in San Juan lost water for a few hours, but it was repaired quickly. Cell and Internet service work well in San Juan, but are spotty elsewhere around the island, which can lead to slow response times from tour operators and hotels outside of the city.

Plan your trip ahead of time, be patient and open to things not being 100-percent perfect, and know that your tourism dollars will help Puerto Rico recover faster — meaning your next trip will be even better.

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FEMA Reaches Historic $30 Billion Milestone for the Recovery of Puerto Rico

These funds represent over 10,600 projects that will address damages after the passage of Hurricane María

San Juan, Puerto Rico – Highways, parks, hospitals, educational institutions, water and electricity infrastructure. These are just some of the areas included in projects amounting to $30 billion in allocations from the Federal Emergency Management Agency (FEMA). The assistance is destined for the reconstruction of Puerto Rico after the passage of Hurricane María, to address these and other social and essential service facilities.

Over 10,600 projects cover various categories under Public Assistance funds to address infrastructure whose renovations will benefit the entire island.

“We celebrate the $30 billion milestone because this translates into an unprecedented and comprehensive reconstruction for this and future generations. Through these funds, Puerto Rico will experience a resilient recovery, so essential in planning for future atmospheric events,” explained Federal Disaster Recovery Coordinator José G. Baquero.

One of the main development drivers of the country is the University of Puerto Rico. With over $750 million to optimize their structures, the university’s campuses will continue to train world-class professionals and promote important academic research; and the Río Piedras Botanical Garden will provide rest and recreational areas for its visitors, while serving as a living laboratory to study tropical plants and various bird species.

Another outstanding project in post-secondary education is the Puerto Rico Conservatory of Music, which is already under construction. Due to its historical value, the facilities of this specialized public university had a damage assessment that addressed the reconstruction of a 19th century building, to which FEMA allocated over $1.5 million.

Meanwhile, due to its importance for recreational and socioeconomic development, Las Cascadas Park in Aguadilla had close to $1 million to reopen its doors. The over 40-year-old park is one of the economic engines of the municipality. On the other hand, the Roberto Clemente Walker Stadium in Carolina is already receiving the public, following the allocation of nearly $18.4 million from the agency. This reconstruction not only benefits professional baseball and the home of the Gigantes , but also welcomes over 100 teams of preparatory tournaments for children’s leagues.

Within road infrastructure, the Abra Honda Low Water Crossing in the municipality of San Sebastián is a project under construction that will benefit the community and that is focused on mitigating risks during future events. The Guajataca River washed away the previous road during Hurricane María and the agency allocated close to $5.2 million to rebuild it; mitigation measures will raise the road with a single-span bridge above flood level in the area. The bridge will provide a direct route from the Guacio neighborhood to most of the jobs, hospitals and supermarkets located in the urban center of San Sebastián.

Both the island’s roads and bridges, as well as water and electricity services are the main resources to begin emergency response work. With that in mind, one of the agency’s newly assigned projects includes the dredging of the Carraízo Reservoir. At about $88.7 million, the funds for the Puerto Rico Aqueduct and Sewer Authority will allow the removal of some 2.6 million cubic yards of sediment from the reservoir. The project —which included an environmental assessment in compliance with the National Environmental Policy Act— will provide a larger water reserve for some 492,000 consumers in the municipalities of Caguas, Gurabo, Juncos, Las Piedras, San Juan, San Lorenzo and parts of Trujillo Alto. Carraízo provides around 90 million gallons of water daily to its customers.

Additionally, among the $9.5 billion for the generation, transmission and distribution of the island’s electric system under the Puerto Rico Electric Power Authority (PREPA), $16.3 million stand out for permanent repairs to the Mayagüez Hydro-Gas Plant. The work for this generation plant includes the repair of units 1A and 1B of the gas turbine, and the replacement of the control water pump, among other tasks.

The Central Office for Recovery, Reconstruction and Resiliency (COR3) is an ally in the efforts of moving forward permanent work once the municipalities, government agencies and non-profit organizations receive the obligations from FEMA, which today amount to $30 billion. Given this, COR3 Executive Director Manuel A. Laboy Rivera thanked the commitment of the Biden-Harris Administration with Puerto Rico, by supporting key initiatives that have allowed the start of thousands of permanent works.

“Since the Governor Pedro Pierluisi Administration began, at COR3 we have focused our efforts on executing specific initiatives with the endorsement of FEMA. As a result of these efforts, the subrecipients have revealed through their Quarterly Progress Reports a substantial increase in the execution of permanent works when comparing the periods of December 2021. Aware of the importance of expediting disbursements, we implemented affirmative changes that allowed us to reimburse or advance some $513 million, in the first quarter of this year, exceeding the total payments made in the years 2020 and 2021”, said COR3’s executive director

For more information about Puerto Rico’s recovery from Hurricane María, visit fema.gov/disaster/4339 y recovery.pr . Follow us on social media at Facebook.com/FEMAPuertoRico , Facebook.com/COR3pr and Twitter @COR3pr .

SAN JUAN, Puerto Rico (February 11, 2021) – With over $750 million allocated by FEMA, the University of Puerto Rico will continue to optimize the structures at its campuses throughout the island. Photo FEMA/Eduardo Martínez

Guaynabo, PUERTO RICO (June 28, 2022) – FEMA allocated nearly $88.7 million to dredge the Carraízo Reservoir. The dredging will entail the removal of some 2.6 million cubic yards of sediment.  Photo FEMA/Eduardo Martinez

CAROLINA, Puerto Rico (March 26, 2021) –FEMA approved an obligation of approximately $18.4 million to the Roberto Clemente Stadium for permanent repairs to this sports facility managed by the Municipality of Carolina. Photo FEMA/Eduardo Martínez

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Months After Hurricane Maria, Puerto Rico Still Struggling

The new death toll from the worst natural disaster to affect the island is a reminder of the longest blackout in U.S. history.

Nearly a year after Hurricane Maria wreaked havoc in Puerto Rico, Ricardo Rosselló, the island’s governor, raised the storm’s official death toll from 64 to 2,975. The figure comes from a new study by the Milken Institute School of Public Health at George Washington University. Rosselló commissioned the study and acknowledged this week that he made mistakes. On Wednesday, President Donald Trump said the federal government did a “fantastic job” in responding to the storm.

But in February, Yamary Morales Torres, 41, told me, “The fishermen here are suffering,” as she stood in her yard overlooking the pounding surf on Puerto Rico’s southeastern coast. Setting out before daybreak, Yamary and 14 other fishermen in her neighborhood have to prepare their boats and fishing gear in the dark. In addition, “there’s no place to refrigerate the fish we catch, so we need to sell them immediately.”

On September 20, 2017, Hurricane Maria struck land not far from Playa El Negro in Yabucoa, where Yamary and her extended family live. The storm knocked out power to the entire island, a United States territory that is home to 3.3 million citizens. Five months later this neighborhood of only 14 homes—all damaged and flooded by the storm—still had no electricity and no sense of when it would be restored.

A third-generation fisherman, Yamary lives with her elderly parents in their dilapidated concrete home. The house next door was all but leveled in the storm. Her twin sister, Yasmin, lives two houses down, next door to a brother and his family. They all had to evacuate before the storm, but with no other options the family returned to their lifelong homes. “Life is very sad now,” Yamary says. “But I’m not leaving. I’m staying right here.”

That spirit of resilience is helping Puerto Rico rebuild from the massive destruction left in the storm’s path . Power and water were restored within weeks to the island’s major urban areas, but with spring approaching, more than 100,000 residents—all in rural, poor areas much like Playa El Negro—remained in the dark. It’s going to take more than determination by the island’s residents to fully recover, if that’s even possible.

The strongest storm to hit Puerto Rico in 89 years, Hurricane Maria battered the island with tornado-­force winds. Massive rains brought catastrophic flooding, washing out bridges and inundating entire neighborhoods. The island’s infrastructure, already shaky after years of neglect, was devastated.

With no power, running water was cut off for much of the population. Communications to and from Puerto Rico were nearly impossible for days. Airports were shut down, delaying recovery efforts, since supplies had to be airlifted or shipped in. And the Federal Emergency Management Agency, charged with disaster relief, was already stretched thin after historic storms earlier last summer in Texas and Florida.

For Hungry Minds

The result was the longest major power outage in U.S. history, and many communities on the island were left without running water for months. Toilets couldn’t flush; there was no water for showers, baths, or washing clothes. People had to rely on bottled water, but supplies were limited. Useless electric stoves had to be replaced with propane ones. Without refrigeration, food rotted and vital medicines spoiled. Only those with gas-powered generators could ward off darkness after dusk—for a few brief hours. Forget about air conditioners to relieve the sweltering heat. All the modern conveniences we take for granted were left behind.

On February 19 the power finally came back on for a neighborhood on the outskirts of Morovis, a small town in the island’s central highlands. When the lights turned on in her house, Marysol Rivera Rivas, 51, jumped up and down, hugged her neighbors, and hoisted a can of beer. “There’s the last clothes I have to wash by hand,” she exclaimed, pointing to a line of laundry flapping in the wind in her yard. “This is the first time in five months we’re able to celebrate. We’re alive now!”

Even after power and water are restored across the island, people will still be dealing with the storm’s effects. “The storm takes away the foundations of society. Everything you thought gave you certainty is gone,” says psychologist Domingo Marqués, 39, an associate professor at Albizu University in San Juan. “You see people anxious, depressed, scared.” Marqués estimates that 30 to 50 percent of the population is experiencing post-traumatic stress disorder, depression, or anxiety.

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Still, Marqués is guardedly optimistic. “We saw a lot of resiliency. We’re not going anywhere. We’re rebuilding,” he says. “We’ll be OK. But we shouldn’t try to get back to normal, because things will never be normal again.”

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5 years after Maria, reconstruction drags on in Puerto Rico

Jetsabel Osorio leans against a doorway in her hurricane-battered home, in Loiza, Puerto Rico, Thursday, Sept. 15, 2022. Nearly five years have gone by since Hurricane Maria struck Puerto Rico, no one has offered her family a plastic tarp or zinc panels to replace the roof that the Category 4 storm ripped off the two-story home tucked in an impoverished corner in the north coastal town of Loiza. (AP Photo/Alejandro Granadillo)

Aerial view of Jetsabel Osorio’s home and her neighborhood in Loiza, Puerto Rico, Thursday, Sept. 15, 2022. Thousands of homes, roads and recreational areas have yet to be fixed or rebuilt since Hurricane Maria struck the U.S. territory nearly five years ago. (AP Photo/Alejandro Granadillo)

A utility pole with loose cables towers over the home of Jetsabel Osorio in Loiza, Puerto Rico, Thursday, Sept. 15, 2022. Nearly five years have gone by since Hurricane Maria struck Puerto Rico. Crews only recently started to rebuild the power grid with more than $9 billion of federal funds as island-wide blackouts and daily power outages persist. (AP Photo/Alejandro Granadillo)

Virmisa Rivera poses for a photo in her home that was damaged by Hurricane Maria nearly five years ago, in Loiza, Puerto Rico, Thursday, Sept. 15, 2022. She said FEMA gave her money to rent a house while they repaired her roof, but no crews came by. Her boyfriend attempted to install zinc panels, but they don’t protect from heavy rain. (AP Photo/Alejandro Granadillo)

Virmisa Rivera holds an envelope with the amount of money she was given to repair her hurricane-damaged home in Loiza, Puerto Rico, Thursday, Sept. 15, 2022. She said FEMA also gave her $1,600 to rent a house while they repaired her roof, but no crews came by. The government said it would move her to a new home in another neighborhood since they can’t repair hers because it’s in a flood zone. (AP Photo/Alejandro Granadillo)

Virmisa Rivera stands outside or home damaged by Hurricane Maria nearly five years ago, in Loiza, Puerto Rico, Thursday, Sept. 15, 2022. “My house is falling apart,” she said, adding that the government said it would move her to a new home in another neighborhood since they can’t repair hers because it’s in a flood zone. But Rivera worries she will die if she moves: She takes medication day and uses an oxygen tank. Her family lives next door, which gives her security since she now lives alone. (AP Photo/Alejandro Granadillo)

Nearly five years after Hurricane Maria struck Puerto Rico, pieces of blue roof tarp litter the ground in Loiza, Puerto Rico, Thursday, Sept. 15, 2022. The government has completed only 21% of more than 5,500 post-hurricane projects. In addition, more than 3,600 homes still have a tattered blue tarp serving as a makeshift roof. (AP Photo/Alejandro Granadillo)

Jetsabel Osorio secures a door of her home damaged by Hurricane Maria nearly five years ago, in Loiza, Puerto Rico, Thursday, Sept. 15, 2022. Some Puerto Ricans have opted to rebuild themselves instead of waiting for government help they feel will never come. Osorio said her family bought a tarp and zinc panels out of their own pocket and set up a new roof over their second floor. (AP Photo/Alejandro Granadillo)

A trailer message board cautions drivers with a message that reads in Spanish: “Strong swells and currents”, at the entrance of Loiza, Puerto Rico, Thursday, Sept. 15, 2022. Nearly five years ago Hurricane Maria damaged or destroyed hundreds of thousands of homes and killed an estimated 2,975 people in its sweltering aftermath after razing the island’s power grid. (AP Photo/Alejandro Granadillo)

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LOÍZA, Puerto Rico (AP) — Jetsabel Osorio Chévere looked up with a sad smile as she leaned against her battered home.

Nearly five years have gone by since Hurricane Maria struck Puerto Rico, and no one has offered her family a plastic tarp or zinc panels to replace the roof that the Category 4 storm ripped off the two-story home in an impoverished corner in the north coast town of Loiza.

“No one comes here to help,” the 19-year-old said.

It’s a familiar lament in a U.S. territory of 3.2 million people where thousands of homes, roads and recreational areas have yet to be fixed or rebuilt since Maria struck in September 2017. The government has completed only 21% of more than 5,500 official post-hurricane projects, and seven of the island’s 78 municipalities report that not a single project has begun. Only five municipalities report that half of the projects slated for their region have been completed, according to an Associated Press review of government data.

And with Hurricane Fiona forecast to hit Puerto Rico on Sunday with torrential rains, more than 3,600 homes still have a tattered blue tarp serving as a makeshift roof.

“That is unacceptable,” said Cristina Miranda, executive director of local nonprofit League of Cities. “Five years later, uncertainty still prevails.”

Puerto Rico’s governor and Deanne Criswell, head of the U.S. Federal Emergency Management Agency who recently visited the island, stressed that post-hurricane work is underway, but many wonder how much longer it will take and worry another devastating storm will hit in the meantime.

Criswell said officials focused on recovery and emergency repairs for the first three years after Maria. Reconstruction has now started, she noted, but will take time because authorities want to ensure the structures being built are robust enough to withstand stronger hurricanes projected as a result of climate change.

“We recognize the concern that recovery may seem like it’s not moving fast enough five years later,” she said. “Hurricane Maria was a catastrophic event that caused damages that are really complex.”

The hurricane damaged or destroyed hundreds of thousands of homes and caused an estimated 2,975 deaths after razing the island’s power grid. Crews only recently started to rebuild the grid with more than $9 billion of federal funds. Island-wide blackouts and daily power outages persist, damaging appliances and forcing those with chronic health conditions to find temporary solutions to keep their medications cold.

The slow pace has frustrated many on an island emerging from the biggest municipal bankruptcy in U.S. history.

Some Puerto Ricans have opted to rebuild themselves instead of waiting for government help they feel will never come.

Osorio, the 19-year-old from Loiza, said her family bought a tarp and zinc panels out of their own pockets and set up a new roof over their second floor. But it leaks, so now she lives with her father and grandfather on the first floor.

Meanwhile, in the island’s central region, community leaders who accused the government of ignoring rural areas formed a nonprofit, vowing to never go through what they experienced after Maria. They’ve built their own well, opened a community center in an abandoned school and used their own equipment to repair a key road. They also opened a medical clinic in April and certified nearly 150 people in emergency response courses.

“That’s what we’re seeking, to not depend on anyone,” said Francisco Valentín with the Primary Health Services and Socioeconomic Development Corporation. “We’ve had to organize ourselves because there’s no other option.”

Municipal officials also have grown tired of waiting for help.

In the southern coastal town of Peñuelas, Mayor Gregory Gonsález said he sought permission to hire special brigades to repair roads, ditches and other infrastructure, with work starting in mid-September.

It is one of five municipalities that has not seen a single post-hurricane project completed, with a pier, medical center, government office and a road still awaiting reconstruction. Gonsález said that few companies make bids because they lack employees, or they quote a price higher than that authorized by federal officials as inflation drives up the cost of materials.

It’s a frustration shared by Josian Santiago, mayor of the central mountain town of Comerío. He said it’s urgent that crews repair the main road that connects his town to the capital of San Juan because landslides are closing it down with increasing frequency. Tropical Storm Earl was blamed for causing eight landslides on Sept. 6, just hours before it became a hurricane.

“It’s a terrible risk,” Santiago said, adding that engineers recently told him it could take another two years to repair. “Two years?! How much longer do we have to wait?!”

Reminders of how much time has passed since Hurricane Maria hit are scattered across Puerto Rico.

Faded red plastic tassels tied around wooden electrical posts that still lean as much as 60 degrees flapped in the wind as Tropical Storm Earl dumped heavy rain across the island in early September.

Norma López, a 56-year-old homemaker, has a post leaning just feet away from her balcony in Loiza, and it exasperates her every time she sees it.

“It’s still there. About to fall,” said López, who lost her roof to Hurricane Hugo in 1989 and again to Maria. “I’m here trying to survive.”

Sixty-five-year-old Virmisa Rivera, who lives nearby, said her roof leaks every time it rains, and the laminated walls near her bedroom are permanently soaked.

She said FEMA gave her $1,600 to rent a house while it repaired her roof, but no crews came by. Her boyfriend, who recently died, attempted to install zinc panels, but they don’t protect from heavy rain.

“My house is falling apart,” she said, adding that the government said it would move her to a new home in another neighborhood since it can’t repair hers because it’s in a flood zone.

But Rivera worries she will die if she moves: She takes 19 pills a day and uses an oxygen tank daily. Her family lives next door, which gives her security since she now lives alone.

Family also is the reason Osorio, the 19-year-old, would like to see a roof for the second floor. It’s where her mother raised her and her sister before dying. Osorio was 12, so her younger sister was sent to live with an aunt.

Plywood panels now cover the windows of the second floor that her mother built by hand with cinderblocks. It’s where she taught Osorio how to make candles and cloth wipes for babies that they used to sell, sitting side-by-side while Osorio talked about her school day.

“This is my mother’s,” Osorio said as she motioned to the second floor, “and that’s where I plan to live.”

Puerto Rico hotels, tourism industry spared by Fiona, officials say

Three weeks after Hurricane Fiona made landfall in Puerto Rico , tourism officials there are pledging solidarity with those affected by the storm's heavy winds and rain, while also striving to make it clear that the island's biggest hotels, resorts, airports, cruise ports and tourist attractions are open, functioning and safe.

It's a delicate duo of messages to share, no doubt. After all, the storm caused massive damage in parts of the U.S. territory, damaging homes and infrastructure, and knocking out power and water to many.

"I don't want to candy coat it or understate it," Brad Dean, CEO of the island's official tourism organization, Discover Puerto Rico, said of the storm's lasting effects.

At the same time, he's quick to draw a distinction between Fiona and Hurricane Maria, the category five storm that made landfall nearly five years earlier to the day, prompting a recovery that continues today.

"We're blessed," Dean said of the tourism industry's state following Fiona. "Much of the tourism industry in Puerto Rico was spared."

He's leaning on that distinction as he voices empathy for those facing a long road ahead because of Fiona, while simultaneously hoping to ensure those considering trips to Puerto Rico — or with trips already planned — stay the course and visit.

Puerto Rico again faces recovery

Any conversation about vacations, beaches and tourism is secondary to a discussion about the human impact of Hurricane Fiona.

Particularly in the western and southern parts of Puerto Rico, people face a significant storm recovery; a mode with which so many are all too familiar after the last half-decade following the devastation caused by Maria in September 2017.

As of last week, workers had restored power to 93% of the island, and water service to 98%, according to numbers shared by Puerto Rico Governor Pedro Pierluisi.

In a territory of 3.2 million people, though, that meant hundreds of thousands of people still did not have electricity and tens of thousands were without running water.

"Right now, Puerto Rico is in a full recovery mode," Pierluisi said last Monday, on the day President Joe Biden visited the island to tour the damage.

Wind and flood damage fueled by Fiona also temporarily paused, complicated or expanded the scope of projects already in the works due to Maria, leading the federal government to widen a disaster declaration and pledge additional funds to assist in the rebuilding efforts.

What makes a storm's aftermath all the more costly, though, is when the ramifications extend far beyond that of the wind and the rain. And it's on that front, tourism officials hope to avoid longer-term consequences from this storm.

Tourism industry relatively untouched

The widespread devastation from Hurricane Maria did a lot more than destroy businesses, homes and the power grid. The immediate devastation and suffering brought on by the storm were compounded when another reality set in: Given all the damage to hotels, attractions and the destruction of San Juan Airport (SJU), tourists — with all the money they bring in and jobs they support — could not easily visit.

That meant Puerto Rico was without one its major economic drivers.

Three weeks after Fiona's landfall, though, Dean is cautiously optimistic that the aftermath of this storm will be different.

"This has turned out to be a setback, but not a reset," he told TPG.

Flights were able to begin taking off and landing again at San Juan Airport and others across the territory shortly after the storm.

Furthermore, Puerto Rico's cruise ports are back open and, according to the storm updates page on Discover Puerto Rico's website, "Most hotels, restaurants, golf courses and venues are operating normally."

Specifically, Dean said major hotels and resorts are back on the power grid, even in outlying parts of Puerto Rico.

The organization's site also mentions the island's beaches and national parks, along with destinations like Old San Juan, La Placita de Santurce, Carabali Rainforest Park, Castillo San Cristobal and others are back open for business.

"When you step back and look at the impact [of Fiona]" Dean said, comparing the storm's broader effects to those seen five years ago with Maria, "The only comparison is that they both happened in the month of September."

Discover Puerto Rico has been sharing photos of properties, date-stamped to show the current state of operations, like this image of the Embassy Suites by Hilton Dorado Del Mar Beach Resort taken on Sept. 26, 2022. The hope is that images will help make clear that resorts are, in fact, able to take guests now.

But he also acknowledged that in the wake of a major storm, would-be visitors might need a bit more convincing to come; and he's ready to make his pitch.

Tourism officials: Puerto Rico is safe to visit

Dean's confidence that Puerto Rico is "truly ready to welcome tourists back," as he said to TPG, stems from the fact that a majority of tourists arrive and branch out from the San Juan metropolitan area on their trips.

Sure, hotels are open; but what might visitors notice as far as damage off-property?

"If you're arriving into the San Juan metro area, you won't even realize that we had a natural disaster weather event in the last few weeks," he said. "If you were to drive out into the outlying areas, you'll see where there has been some flood damage."

He noted, though, that even some of those locations are beginning to see businesses reopen.

The message seems to be spreading, with cruise lines affirming their schedules for this fall, Dean said, and no major meetings or conferences for the upcoming months canceled.

Certainly, if you're considering or planning a visit, you'll want to double-check with your specific resort on its operating status to be safe.

However, that continued momentum comes as a relief after the long-lasting economic ramifications stemming from Maria. The island saw record tourism numbers in 2021 and has been on pace to break that record this year.

Dean sees it as a sign that the island has come a long way over the last five years.

"As I look back now," he said, "I'm realizing how much progress the island has made not just in our ability to prepare, but to respond."

Bottom line

Puerto Rico again faces a significant road to recovery following Hurricane Fiona, particularly in the southern and western parts of the island.

As that recovery ramps up though, officials want tourists to understand that they should be able to take their trips as planned. In fact, tourism officials hope they will.

In the meantime, there are many ways to help storm victims affected by both Fiona and Ian , in both Puerto Rico and Florida. With so many looking for ways they can assist in the aftermath of the storm — and there are many ways you can help — one such way, Dean points out, is to visit the island and spend money.

"There's no better way to help the people in Puerto Rico than to schedule or continue a vacation," he said. "There's no need to worry about whether Puerto Rico's ready."

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The facts: Hurricane Maria's effect on Puerto Rico

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On the morning of Wednesday, September 20, 2017, Hurricane Maria struck Puerto Rico with sustained winds of 155 mph, uprooting trees, downing weather stations and mobile phone towers, and ripping wooden and tin roofs off homes. Electricity was cut off to 100 per cent of the island, and access to clean water and food became limited for most. The powerful Category 4 storm devastated the island and plunged all of its 3.4 million residents into a desperate humanitarian crisis.

Puerto Rico, officially the Commonwealth of Puerto Rico, is an island territory of the United States, located in the northeast Caribbean Sea. It’s known for its white-sand beaches, the historic city of Old San Juan, and El Yunque National Forest. The archipelago had already been facing a recession for over a decade before Maria hit. Almost half its residents lived below the poverty line — by far the highest poverty rate of any U.S. state or territory — and the unemployment rate was more than double the national level.

The effects of the hurricane — the worst storm to strike the island in over 80 years — caused as much as £73.4 billion in damages. About 80 per cent of the island’s crop value was wiped out by Maria, representing a £607 million loss in agricultural yields — a devastating blow to an island with high poverty and already-fragile food security.

Around 130,000 Puerto Ricans, who are U.S. citizens, have left home between July 2017 and July 2018 — many as a direct result of Maria’s devastation. Most Puerto Ricans, though, are committed to staying to recover, no matter how long it takes. But three years after the storm, they still need a lot of support with essentials and with the hard, long-term work of recovery.

Read more about Mercy Corps' initial response to Hurricane Maria ▸

Thanks to generous support from a variety of corporate partners including Bacardi, BlackRock, Google.org, the Miami Foundation and Walmart, Mercy Corps is continuing to support families in Puerto Rico to recover from the aftermath of Hurricane Maria and prepare for future disasters.

Three years into Hurricane Maria recovery, here’s what’s happening with Puerto Rico now.

What is Puerto Rico like in 2020?

What effect is covid-19 having on puerto rico, how did hurricane maria affect puerto rico.

• Who was most affected by the hurricane in Puerto Rico?

How has Puerto Rico recovered after Hurricane Maria?

How are people in puerto rico preparing for hurricane season this year, how is mercy corps helping.

Three years after Hurricane Maria, thousands of Puerto Rico’s residents are still recovering from the storm, even as the peak of the 2020 hurricane season begins. Although power has been restored and access to clean water has greatly improved, Puerto Ricans are still recovering from the destruction and trauma of the hurricane.

Day-long power outages still happen from time to time, especially in rural areas. Some homes still have tarps instead of roofs. Collapsed utility poles and uprooted trees are common. The continued challenges have driven hundreds of thousands of Puerto Ricans from the island entirely.

More disasters have hit Puerto Rico since Hurricane Maria, prolonging the island’s recovery. On January 7, 2020, a 6.4 magnitude earthquake struck Puerto Rico. One person was killed, hundreds were left seeking temporary shelter and some 250,000 people lacked access to clean water. Puerto Rico’s Governor declared a state of emergency and activated Puerto Rico’s National Guard.

Additionally, predictions from the National Oceanic and Atmospheric Administration , 2020 will have an above-normal Atlantic hurricane season — a season that has already affected communities across Puerto Rico. On July 30, 2020, Tropical Storm Isaias knocked out power and caused flooding on the island. Heavy rains in communities, already weakened by the earthquake and subsequent aftershock, caused homes to collapse. The storm also left some 150,000 without water and cut power to more than 400,000 homes, businesses and hospitals. “Everyone is in a constant state of emergency,” said Marieli Grant, a Mercy Corps team member based in San Juan.

The pandemic is yet another crisis for Puerto Rico. The Centers for Disease Control and Prevention has warned that the risk for transmission of COVID-19 is high and is advising against any non-essential travel to the island. The threat of infection is slowing the recovery of tourism-based companies and creating new challenges for future disasters. A recent spike in confirmed cases caused many Puerto Ricans to be wary of seeking shelter during Tropical Storm Isaias.

As Puerto Rico continues its recovery from the devastation of Hurricane Maria, the pandemic presents a new crisis for communities across the island. The toll of COVID-19 on public health has intensified since June 2020. As of mid August 2020, new reported cases have climbed to an average of more than 600 per day .

Hurricane Maria forced many children in Puerto Rico to deal with the consequences of a sustained break in their education, along with the stress of recovering from a natural disaster. Now, COVID-19 is causing a new strain for the island’s education system. As of July 2020, schools in Puerto Rico will be offering only virtual classes to keep students safe, delaying in-person classes until September.

The pandemic has also dealt a devastating blow to Puerto Rico’s economy, which has been already battered by hurricanes and earthquakes over the past few years. Tourism has traditionally been an important source of income for small- and mid-sized businesses, but lockdowns and the threat of infection have caused an almost total drop-off to the industry. The Centers for Disease Control and Prevention currently advises against any non-essential travel to Puerto Rico, stating that the risk of COVID-19 transmission is high.

To help micro and small businesses overcome the economic effects of COVID-19, our teams are providing technical training and financial support. The programme provides webinars on how to build a resilient business and how to strengthen marketing strategies to increase sales. Of the participating micro businesses, 10 will be selected to receive a cash transfer to help grow their business.

As an above-normal hurricane season looms this year, COVID-19 poses a terrible threat to the people of Puerto Rico.

“The Caribbean faces the nightmare scenario of a major hurricane hitting in the middle of an uncontained pandemic. Skyrocketing demand for health supplies has stretched supply chains. Difficulty accessing items like hygiene products and medical supplies will hurt much needed preparations for hurricane response. In the event of a major storm, supply chains would almost certainly be further limited by hurricane damage. This will threaten the lives of people who need medical care and equipment to fight COVID-19, and the lives of people with injuries and health crises caused or made worse by a hurricane.” -  Erynn Carter, Mercy Corps’ Senior Director for Humanitarian Response

The health and safety of community members is our highest priority, which is why we’re partnering with local organisations to distribute food to families. To ensure communities are prepared for the event of a disaster, our teams are working with community centres on adapting their emergency plans for COVID-19. We’re also working to help keep people safe from infection, providing cash grants for local awareness campaigns on how to stop the spread of the virus. Tailored for their specific communities, the campaigns include a sing-along video for children to follow when they wash their hands as well as social media posts that promote social distancing and good hygiene practices.

The effects of the storm have undoubtedly been felt most by the people themselves. The storm left thousands of families without homes and destroyed some communities entirely. In August 2018, the Puerto Rican government raised the official death toll to an estimated 2,975 people — 46 times higher than the original count of 64 deaths, released in December 2017.

For months after the initial disaster, most families and businesses remained without power, mobile phone reception was limited, and clean water, food, medicine and fuel were all in very short supply. According to the New England Journal of Medicine , households went 84 days without power, 68 days without water, and 41 days without phone reception, on average.

Unable to meet their basic needs, hundreds of thousands of Puerto Ricans left altogether in the immediate aftermath, and the lasting effects of the damage are expected to drive an additional 80,000 people off the island by 2024 .

Today, many homes remain completely abandoned. As of July 2020, tens of thousands of homes in Puerto Rico remain uninhabitable by modern standards . There are still many families living under the shelter of temporary blue tarps. Others are just beginning the slow process of reconstruction, as rebuilding materials are expensive and have been in short supply.

While most people have regained access to basic essentials at this point, the road to recovery is long, and many residents still need help.

"Many families are traumatised and lack proper resources to prepare for the next hurricane season" - Karla Peña, Director for Mercy Corps in Puerto Rico

Who was most affected by Hurricane Maria?

The storm disproportionately affected Puerto Rico’s poorest residents, who have fewer resources on hand to help them recover and rebuild. Many of these people live in more rural communities and the hard-to-reach areas of the mountains. They were the last to regain access to water or see their electricity restored.

Mercy Corps is focused on providing assistance to these vulnerable and underserved populations, who are most likely to be missed in broader relief efforts. This includes the elderly — many of whom depend on welfare or social security — along with people with disabilities and those living in remote rural areas, like the mountain towns of Las Marias and Maricao .

Children and young people are particularly vulnerable to the psychological impacts of disaster like Hurricane Maria. Research shows nearly half of Puerto Rican children’s homes were damaged by the storm, while 30 per cent feared for their lives or the lives of their loved ones, and around one quarter helped rescue others. It will take time and support for Puerto Rico’s children to fully overcome what they experienced during Hurricane Maria.

Many young people depend on the resources they find at school to help them overcome crisis-induced stress, but Hurricane Maria disrupted the lives of some 350,000 public school students. It took nearly five weeks before the first public schools began to reopen after the storm, though most were still operating without power.

While the pandemic is keeping schools from offering in-person classes, the majority of Puerto Rico’s public schools have reopened since Hurricane Maria. Some schools have been converted into community centres and shelters, requiring students to relocate and find alternate routes to resume their studies. And economic trouble exacerbated by the storm has forced the closure of 265 more — roughly a quarter of all of the island's public schools, affecting an estimated 60,000 students.

Many students have left the island since Maria hit, and the student population is expected to continue declining as more families flee high unemployment and poor public services made worse by storm damage. Those who remain will continue dealing with the consequences of a sustained break in their education, along with the stress of recovering from a natural disaster.

Three years have passed since Hurricane Maria tore through Puerto Rico. While clear evidence of the storm remains, life for many on the Caribbean island has gradually returned to a semblance of normal.

Basic infrastructure, like the power grid and water systems, have been restored to most of the population — but the repairs have been slow. It wasn’t until August 2018 — nearly a year after the storm — that Puerto Rico Electric Power Authority (PREPA) announced that 100 per cent of customers have power restored. People living in Yabucoa, the first town to be struck by the storm, were some of the last to see the lights come back on. The blackout was the largest blackout in U.S. history .

Access to clean water has greatly improved, though service can be intermittent and there’s still some question of quality. For months after the storm, even where water service had been restored, most communities still had a "boil water" advisory in place, and people were purchasing bottled water to get the clean water they needed.

Many people lost their livelihoods in the storm and the local economy was devastated, making rebuilding a slow, expensive process. Small- to medium-size businesses — which employ one out of every three workers in Puerto Rico — and farms were especially hard hit, suffering from destruction and decreased tourism. Despite many businesses and roads reopening since Hurricane Maria struck, thousands of small businesses remain closed.

Still, Puerto Ricans worked hard to restore their shops as quickly as possible. Hundreds of farmers, fisherfolk and beekeepers have since jumpstarted their livelihoods with training and supplies from Mercy Corps, which has restored incomes and helped boost recovery of Puerto Rico’s economy and market system.

The National Oceanic and Atmospheric Administration is expecting a above-normal Atlantic hurricane season this year — but that still means an estimated 13 to 19 named storms, of which six to ten could become hurricanes. Ensuring people have emergency plans in place is critical to boosting preparedness for future disasters.

Local community centres have become important gathering points where people who have lost their homes seek shelter, receive aid and participate in community events. Thanks to funding from Walmart and The Miami Foundation, we are transforming these centres into resilience hubs that help communities to recover and be better equipped for the next crisis.

The hubs include solar panels that provide access to a basic source of energy that functions off the electrical grid. This will enable community members to keep medications that require refrigeration cold, charge their phones to stay in communication with family members, and access water — even if the power goes out.

We are supplying the hubs with disaster response kits, including two-way radios, flashlights, chainsaws, lighters and more, and facilitating search-and-rescue trainings and the development of community action plans, so community members know what to do to stay safe in the event of an emergency.

Where resilience hubs have additional land, we are also constructing small gardens, so community members can grow their own fresh vegetables to eat, or sell to offset the operational costs of running the community centres.

In the event of a disaster hitting Puerto Rico during the pandemic, we’re working closely with 17 community centres to adapt their emergency plans to keep people safe from infection. We’re providing training on how to maintain their water storage, energy equipment and community gardens in case of disaster, including how to ensure safe health and hygiene strategies in the event of an interruption to the water supply.

In the immediate aftermath of the hurricane, we partnered with World Central Kitchen, a nonprofit founded by celebrity chef José Andrés, to  deliver more than 25,000 meals to hard-hit communities .

Together with local organisations, we distributed nearly £233,000 in emergency cash so people could buy what they needed most — items like water, food and other essential supplies. Cash is a fast and flexible way to help people after crisis and supports local markets as they recover from the effects of Hurricane Maria.

Get the quick facts about the value of cash aid ▸

We also distributed 5,000 solar lanterns and 2,500 water filters to help thousands of families survive the storm’s immediate aftermath. Having solar lights and water filters, combined with training in their proper use, means that families are also better prepared for future storms.

While addressing immediate needs, we have also been working with people to rebuild their agricultural livelihoods. We’ve supported hundreds of farmers, fisherfolk and beekeepers with supplies and training to learn new techniques and recover their enterprises for the long-term.

Additionally, with financial support from Bacardi, Google.org and other partners, Mercy Corps has launched an economic recovery programme focused on bringing tourists back to the island. We're providing businesses with tailored support that will help them build their businesses back stronger. That support includes cash grants, technical assistance and business training.

Tourist areas also require rehabilitation. Improving those sites, along with building and promoting businesses, will bring in much-needed income. We’re partnering with government associations and local organisations to let people know that their favourite restaurants, bars, activity centres and beaches are open for business again.

“Local economies are the best engine for strong, long-term recovery after disasters,” says Jeronimo Candela, Director of Mercy Corps in Puerto Rico. “Small business owners have worked hard to reopen their shops as quickly as possible after the storm and are eager to have people explore the various attractions the island has to offer. Puerto Rico is open for business.”

• Introduction
• Conclusions
• Article Information

The 2015 study included 380 participants and the 2019 study included 532 participants.

a Significantly different at P  < .05. Differences assessed using χ 2 test.

eTable 1. Sociodemographic Characteristics of Adult Participants of the 2015 PRADLAD Study and the 2019 PROSPECT Study, Excluding 87 Repeat Participants

eTable 2. Self-reported Health Conditions of Adult Participants of the 2015 PRADLAD Study and the 2019 PROSPECT Study

eTable 3. Age-Standardized Prevalence and Age-Standardized Means of Lifestyle and Psychosocial Risk Factors and Health Indicators of Adult Participants of the 2015 PRADLAD Study and the 2019 PROSPECT Study

eTable 4. Lifestyle and Psychosocial Risk Factors and Health Indicators of Adult Participants of the 2015 PRADLAD Study and the 2019 PROSPECT Study

eTable 5. Age-Standardized Prevalence and Age-Standardized Means of Lifestyle and Psychosocial Risk Factors and Health Indicators of Adult Participants of the 2015 PRADLAD Study and Again in the Subsequent 2019 PROSPECT Study

eTable 6. Sociodemographic Characteristics of Adult Participants in the 2015 PRADLAD Study in Puerto Rico by Participation Status in the Subsequent PROSPECT Study

eTable 7. Lifestyle and Psychosocial Risk Factors and Health Indicators of Adult Participants in the 2015 PRADLAD Study in Puerto Rico by Participation Status in the Subsequent PROSPECT Study

eTable 8. Sociodemographic Characteristics of Adult Participants of the PRADLAD Study in 2019 and of PROSPECT Participants in 2019 Recruited Through Other Strategies (Not PRADLAD)

eFigure 1. Flowchart of 2015 PRADLAD Participants Who Were Recontacted and Eligible to Participate in the 2019 PROSPECT Study

eFigure 2. Flowchart of Recruitment of 2019 PROSPECT Participants as of March 16, 2020

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Mattei J , Tamez M , O’Neill J, et al. Chronic Diseases and Associated Risk Factors Among Adults in Puerto Rico After Hurricane Maria. JAMA Netw Open. 2022;5(1):e2139986. doi:10.1001/jamanetworkopen.2021.39986

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Chronic Diseases and Associated Risk Factors Among Adults in Puerto Rico After Hurricane Maria

• 1 Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
• 2 Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
• 3 FDI Clinical Research of Puerto Rico, San Juan
• 4 McLaren Health Care, Graduate Medical Education, Grand Blanc, Michigan
• 5 College of Fine Arts, Humanities and Social Sciences, University of Massachusetts, Lowell
• 6 Department of Biomedical and Nutritional Sciences and Center for Population Health, University of Massachusetts, Lowell
• 7 Department of Biochemistry, University of Puerto Rico Medical Sciences Campus, San Juan

Question   What was the prevalence of chronic diseases and their associated risk factors among adults living in Puerto Rico before and after Hurricane Maria?

Findings   This cross-sectional study using data from 825 participants in 2 studies conducted in 2015 and 2019 found statistically significantly higher prevalence of unhealthy lifestyle behaviors and multiple chronic conditions among adults in Puerto Rico after Hurricane Maria. Higher social support, lower depressive symptoms, and lower perceived stress were observed after the hurricane.

Meaning   These findings suggest that as public health emergencies upsurge, continuous efforts will be necessary to sustain healthy behaviors, positive emotional health, and low rates of chronic diseases.

Importance   As public health emergencies become more prevalent, it is crucial to identify adverse physical and mental health conditions that may be triggered by natural disasters. There is a lack of data on whether Hurricane Maria in 2017 influenced the disease burden of adults in Puerto Rico.

Objective   To estimate the prevalence of chronic diseases and their associated risk factors among adults living in Puerto Rico before and after Hurricane Maria in 2017.

Design, Setting, and Participants   This cross-sectional study used data from 2 previous cross-sectional studies, including the pre–Hurricane Maria Puerto Rico Assessment on Diet, Lifestyles and Disease (PRADLAD) study, conducted in 2015, and the post–Hurricane Maria Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic Disease Trends (PROSPECT), conducted in 2019. Participants included adults aged 30 to 75 years residing in Puerto Rico. Data were analyzed from April to October 2020.

Exposures   Self-reported data were obtained on sociodemographic, lifestyle, and psychosocial factors and medically diagnosed conditions using validated questionnaires. Anthropometrics were measured in triplicate.

Main Outcomes and Measures   Data were obtained using similar protocols in both studies. Characteristics were contrasted for all participants across studies and for 87 PRADLAD participants who returned to PROSPECT.

Results   A total of 825 participants from both cohorts were included, with 380 PRADLAD participants and 532 PROSPECT participants. In the 2019 PROSPECT study, the mean (SD) age was 53.7 (10.8) years, and 363 participants (68.2%) were assigned female at birth and 169 participants (31.8%) were assigned male at birth. In the 2019 cohort, 360 participants (67.7%) had college education or higher, 205 participants (38.5%) reported annual income greater than $20 001, and 263 participants (49.5%) were employed. Most sociodemographic variables were similar between studies, except for higher income and employment after the hurricane. In the main analysis, participants in 2019, compared with participants in 2015, had higher abdominal obesity (389 participants [73.2%] vs 233 participants [61.3%]), sedentarism (236 participants [44.4%] vs 136 participants [35.8%]), binge drinking (95 participants [17.9%] vs 46 participants [12.1%]), and social support (mean [SD] score, 26.9 [7.2] vs 24.7 [7.1]) but lower depressive symptoms (169 participants [31.7%] vs 200 participants [52.6%]) and perceived stress (mean [SD] score, 19.3 [9.5] vs 21.7 [7.7]). In 2019, compared with 2015, there were higher rates of hypertension (252 participants [47.3%] vs 149 participants [39.2%]), arthritis (172 participants [32.3%] vs 97 participants [25.6%]), high cholesterol (194 participants [36.4%] vs 90 participants [23.8%]), high triglycerides (123 participants [23.1%] vs 56 participants [14.7%]), eye disease (94 participants [17.6%] vs 48 participants [12.7%]), fatty liver disease (68 participants [12.8%] vs 29 participants [7.5%]), and osteoporosis (74 participants [13.9%] vs 20 participants [5.2%]). Secondary analysis for the 87 returning participants showed similar results.

Conclusions and Relevance   In this cross-sectional study, a higher prevalence of unhealthy behaviors and chronic conditions was noted among adults in Puerto Rico after Hurricane Maria, warranting long-term studies. Psychosocial factors were better, but still need attention. As natural disasters intensify, efforts should focus on continuous surveillance of health outcomes and promoting healthy behaviors, positive emotional health, and disease control, particularly in populations with higher risk for poor health.

In September 2017, the US territory of Puerto Rico was hit coast-to-coast by the exceptionally destructive category-4 Hurricane Maria. 1 The damages to the infrastructure were massive and widespread, leaving residents without transport, power, or communication. There were severe limitations in access to basic needs, such as food, potable water, and health services, and an excessive death toll was reported. 2 - 4

Exposures to natural disasters have been associated with adverse mental and physical health. For example, 1 year after Hurricane Katrina in New Orleans, Louisiana, which made landfall in 2005, more than half of a sample of individuals who had evacuated the area met the criteria for posttraumatic stress disorder (PTSD) and most had depression and anxiety. 5 Twelve years later, 1 in 6 mothers with low income who endured the hurricane still had symptoms indicative of PTSD, and psychological distress remained high. 6 Data from patients with acute myocardial infarction found a more than a 3-fold increase in admissions for subsequent attacks during the 6 years after Hurricane Katrina; these were accompanied by higher rates of psychiatric comorbidities, smoking, lack of health insurance, and unemployment, compared with rates before Hurricane Katrina. 7 Just 2 years after the 2011 earthquake in East Japan, the proportion of individuals with overweight, diabetes, hypertension, dyslipidemia, liver dysfunction, atrial fibrillation, and gastrointestinal diseases increased. 8 , 9 Unhealthy lifestyle behaviors after disasters may mediate the direct adverse health consequences of disasters. For example, poor dietary intake was noted after the 2011 earthquake in Japan, 9 and analysis of data from 10 natural disasters has found that 22% to 40% of individuals coped with postdisaster emotions by drinking alcohol. 10

Despite this evidence, little is known about the role of Hurricane Maria on the prevalence of chronic diseases and their risk factors. Some small studies have suggested associations with adverse health outcomes. An online survey among residents of Puerto Rico who were displaced to Florida or other regions of Puerto Rico reported a high prevalence of PTSD and generalized anxiety disorder. 11 Another survey found that 7.2% of youths reported clinically significant symptoms of PTSD 5 to 8 months after Hurricane Maria. 12 Still, there are scarce data on behavioral and psychosocial risk factors of chronic conditions before vs after Hurricane Maria in Puerto Rico. This gap is concerning, as the adult population of Puerto Rico already had high rates of multiple chronic conditions and emotional distress in the years before Maria. 13 - 15 In 2016, the Behavioral Risk Factor Surveillance System (BRFSS) reported a prevalence of 61.8% for overweight or obesity, 41.7% for physical inactivity, 23.8% for arthritis, 18.2% for depression, 15.3% for diabetes, 12.5% for binge drinking, 10.6% for tobacco use, and 7.8% for coronary heart disease. 13 In response, this study aimed to estimate the prevalence of chronic diseases and their associated risk factors among adults living in Puerto Rico before and after Hurricane Maria, using data from 2 studies conducted in 2015 and 2019.

This cross-sectional study was approved by the institutional review boards of Harvard T.H. Chan School of Public Health, Ponce Health Sciences University, and University of Massachusetts, Lowell. All participants provided written informed consent. We followed the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) reporting guideline for cross-sectional studies.

We used data from 2 studies conducted in Puerto Rico. The first study was the Puerto Rico Assessment on Diet, Lifestyles and Disease (PRADLAD) study. 14 , 16 Conducted in 2015, PRADLAD was a cross-sectional survey of a convenience sample of adults recruited at 3 partner clinics in the San Juan metropolitan area of Puerto Rico; the metropolitan area comprises nearly two-thirds of the population. Individuals who expressed interest were screened for eligibility based on the following criteria: current residence in Puerto Rico for at least 10 months of the previous year, aged 30 to 75 years (when chronic disease risk factors typically start to emerge), and able to answer questions without assistance.

The second study was Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic Disease Trends (PROSPECT), an ongoing prospective, population-based cohort study initiated in March 2019, recruiting adults living in all of Puerto Rico. 17 Our analysis used baseline cross-sectional data only. Recruitment in PROSPECT was conducted using a multistaged approach by enumerating potentially eligible households using 2010 Census block frames with socioeconomic and demographic data then randomly inviting 1 participant per qualified household and by advertising at communitywide events and locations. Additionally, PRADLAD participants were invited. Eligibility criteria include aged 30 to 75 years, living in Puerto Rico at the time of enrollment and at least the previous year, not planning to move outside the island within 3 years, living in a stable dwelling, and able to answer questions without assistance. Eligible individuals were invited to a baseline in-person visit at 1 of 55 islandwide partner clinics to answer multiple questionnaires, obtain clinical measurements, and collect biological samples.

Trained research assistants conducted all data collection in Spanish (English was available on request). Data collection procedures were similar for both studies. Information was obtained on age, assigned sex at birth, ethnicity, educational attainment, household income, marital status, work history, migration history, area of residence, household composition, health insurance status, and self-rated health. Ethnicity was included as a variable in this study because out-migration from Puerto Rico after Hurricane Maria was significant and sustained, according to the census data; thus, including this variable could indicate who was leaving the island. Participants were asked to self-report whether a health professional had diagnosed each of a comprehensive list of conditions and whether they currently had the condition.

Questions were included to assess food insufficiency and receiving the Puerto Rico Nutrition Assistance Program (NAP) or the Women and Infant and Children (WIC) food assistance program within the past 6 months. Detailed data on alcohol intake and smoking habits were assessed. The Paffenbarger questionnaire of the Harvard Alumni Activity Survey was used to assess the number of hours spent per day at various activity levels that were then multiplied by predefined weighting factors to derive a physical activity score; a lower score indicates more sedentary time using modified cutoffs for this population. 18 , 19 Information on the amount of sleep (hours per day) and quality of sleep (insomnia and nonrestorative sleep) was assessed with a questionnaire previously used among residents of Puerto Rico. 20 , 21 The research assistant measured waist and hip circumference twice following standardized protocols; the mean measure was used.

Perceived stress during the previous month was measured with a perceived stress scale that has shown good internal consistency in English- and Spanish-speaking Hispanic individuals. 22 , 23 Depressive symptoms were captured using the Center for Epidemiologic Studies Depression Scale (CES-D), which had Cronbach α of 0.90 in a sample of older adults in Puerto Rico. 24 - 26 Social support was assessed using the Interpersonal Support Evaluation List–12-item, which has demonstrated internal consistency, reliability, and convergent validity across languages and Hispanic ethnicities, including Puerto Rican individuals. 27 - 29

From the original 380 PRADLAD participants, 358 consented to be contacted for future studies, of whom 338 were invited to be screened for PROSPECT (eFigure 1 in the Supplement ). After exclusions owing to no response (110 participants [33%]), no interest (26 participants [8%]), or unavailable contact information (51 participants [15%]), 151 PRADLAD participants were screened for PROSPECT. Of these, 90 were found to be eligible, comprising a 69% response rate. After excluding 3 participants with unreliable interviews, 87 PRADLAD participants completed the PROSPECT baseline interview.

PROSPECT participants were recruited from 3 sources: the returning PRADLAD participants (87 participants), household enumeration (23 participants), and communitywide strategies (422 participants) (eFigure 2 in the Supplement ). We report fewer individuals recruited through enumeration than through community strategies because enumeration requires more time to implement. However, response rates were similar for both approaches. Through these efforts, a total of 532 participants had completed the baseline PROSPECT interview as of March 16, 2020, the date at which the study paused owing to the COVID-19 pandemic. While PROSPECT resumed in August 2020, the cutoff date was adopted in this study to remove potential behavioral and psychosocial changes during the pandemic.

Differences in characteristics between PRADLAD and PROSPECT participants were assessed using χ 2 tests for categorical variables and t tests for continuous variables. Analysis was conducted for the complete study population of PRADLAD (380 participants) and the sample of PROSPECT (532 participants), and for the subset of 87 participants who were enrolled in both PRADLAD and PROSPECT (hereafter referred to as returning participants ). In supplemental analysis, general linear models were used to estimate age-standardized characteristics using the age-adjustment weights of the 2010 mainland US population to consider potential differences in age distribution between studies. Additionally, we compared characteristics for PRADLAD vs PROSPECT participants excluding the returning participants, and for returning participants vs PRADLAD participants who did not participate in PROSPECT. All analyses were conducted using SAS statistical software version 9.4 (SAS Institute Inc). Significant differences were considered at a 2-tailed P  < .05. Data were analyzed from April to October 2020.

A total of 825 participants from both cohorts were included, with 380 participants in the 2015 PRADLAD study and 532 participants in the 2019 PROSPECT study, including 87 participants returning from the 2015 study. In the 2015 study, the mean (SD) age was 51.5 (11.2) years, 249 participants (65.5%) were assigned female at birth and 131 participants (34.5%) were assigned male at birth, and 60 participants (15.9%) lived in rural areas ( Table 1 ). Compared with PRADLAD participants, the participants from the PROSPECT sample in 2019 were older (mean [SD] age, 53.7 10.8] years), more likely to report Puerto Rican ethnicity (491 participants [92.3%] vs 310 participants [81.6%]), have household income higher than $20 001 per year (205 participants [38.5%] vs 72 participants [18.9%]), be currently employed (263 participants [49.5%] vs 139 participants [36.5%]), and have lived in Puerto Rico most of their lives (505 participants [94.9%] vs 337 participants [88.6%]), but less likely to be single (137 participants [25.8%] vs 138 participants [36.3%]) and to plan moving from Puerto Rico (29 participants [5.5%] vs 67 participants [17.6%]). In the 2019 cohort, 363 participants (68.2%) were assigned female at birth and 169 participants (31.8%) were assigned male at birth. Similar differences were noted when contrasting the returning participants from PRADLAD in 2015 vs 2019 ( Table 2 ). Additionally, returning participants were more likely to report receiving NAP in 2019 vs 2015 (48 participants [55.1%] vs 35 participants [40.2%]). When we excluded returning participants from analysis, results remained similar, except for higher educational attainment among participants of PROSPECT vs PRADLAD (74 participants [16.6%] vs 29 participants [9.9%]) (eTable 1 in the Supplement ).

PROSPECT participants, compared with all PRADLAD participants, had higher prevalence of abdominal obesity (389 participants [73.2%] vs 233 participants [61.3%]), high waist-to-hip ratio (443 participants [83.2%] vs 292 participants [76.8%]), sedentary physical activity (236 participants [44.4%] vs 136 participants [35.8%]), alcohol use (255 participants [47.9%] vs 99 participants [26.1%]), binge drinking (95 participants [17.9%] vs 46 participants [12.1%]), and yearly influenza vaccination (169 participants [31.8%] vs 96 participants [25.3%]), but lower self-rated health as poor or fair (179 participants [33.7%] vs 152 participants [40.0%]) ( Table 3 ). PROSPECT participants, compared with PRADLAD participants, also reported lower mean depressive symptoms score (mean [SD] score, 13.1 [11.8] vs 17.6 [12.6]), lower prevalence of depressive symptoms (169 participants [31.7%] vs 200 participants [52.6%]), and lower perceived stress score (mean [SD] score, 19.3 [9.5] vs 21.7 [7.7]) but higher mean social support score (mean [SD] score, 26.9 [7.2] vs 24.7 [7.1]). Differences were noted for 2019 PROSPECT participants compared with 2015 PRADLAD participants for higher hypertension (252 participants [47.3%] vs 149 participants [39.2%]), arthritis (172 participants [32.3%] vs 97 participants [25.6%]), high cholesterol (194 participants [36.4%] vs 90 participants [23.8%]), high triglycerides (123 participants [23.1%] vs 56 participants [14.7%]), eye disease (94 participants [17.6%] vs 48 participants [12.7%]), fatty liver disease (68 participants [12.8%] vs 29 participants [7.5%]), and osteoporosis (74 participants [13.9%] vs 20 participants [5.2%]) ( Figure ; eTable 2 in the Supplement ). In 2019 vs 2015, use of medication was significantly higher for high cholesterol (126 participants [23.7%] vs 56 participants [14.7%]), high triglycerides (63 participants [11.8%] vs 23 participants [6.1%]), respiratory problems (93 participants [17.5%] vs 42 participants [11.1%]), and osteoporosis (40 participants [7.5%] vs 8 participants [2.1%]); no other significant differences in medication use were detected.

Similar results were observed for these comparisons using age-standardization, although differences were attenuated (eTable 3 in the Supplement ). Results were also similar when excluding the PRADLAD returning participants, except that more prediabetes was noted in 2019 vs 2015 (eTable 4 in the Supplement ).

In the subset of returning participants, differences in the prevalence of lifestyle risk factors and chronic conditions remained in the same direction as those observed when contrasting the full studies, although some differences were weakened ( Table 4 ). Within this subset, more participants reported gastrointestinal disease in 2019 than 2015 (27 participants [30.6%] vs 13 participants [15.1%]) and heart disease or stroke (8 participants [9.5%] vs 2 participants [2.3%]). Age-standardized results were similar, albeit attenuated (eTable 5 in the Supplement ).

We conducted some sensitivity analyses. First, we contrasted PRADLAD participants returning to PROSPECT with those who did not participate in PROSPECT. Sociodemographic characteristics were similar, except that more returning participants vs nonreturning participants reported living alone and fewer reported receiving NAP or having lived in the mainland US for at least 1 year (eTable 6 in the Supplement ). Health conditions and risk factors were also similar between these subgroups, except that returning participants vs nonreturning participants had lower depressive symptom scores and higher social support scores (eTable 7 in the Supplement ). We also compared 2019 sociodemographic data from the 87 participants returning from PRADLAD to 2019 data from the rest of the PROSPECT participants; similar characteristics were noted except for age, rural residency, Puerto Rican ethnicity, and health insurance type (eTable 8 in the Supplement ).

In this cross-sectional study using data from 2 studies before vs after Hurricane Maria (ie, 2015 vs 2019), we found a higher prevalence of unhealthy behaviors and several chronic conditions and a more positive, albeit still concerning, social-emotional health profile after the hurricane. These observations were generally corroborated in a subset of individuals participating in both studies, although some results were attenuated, likely owing to the small sample size. The results contribute new evidence on the excessive burden of multiple chronic disease after a massive natural disaster, helping expand the existing literature that has been mostly limited to postdisaster reports and to communicable diseases. 30 , 31

The 2019 PROSPECT participants had similar characteristics to the 2015 PRADLAD participants, although the older age in the 2019 sample may contribute to higher prevalence of some chronic conditions. Also, income and employment rates were higher in 2019. These observations are supported by data from the US Bureau of Labor Statistics. 32 However, it is possible that instead of socioeconomic improvement, the differences are a product of the larger impact of the hurricane on people living with low incomes or unemployment, who were more prone to experience damages but received less assistance and were more likely to leave the island. 33 Also, PRADLAD participants with a lower socioeconomic profile may have had a strong migratory intent, hastened by Hurricane Maria. Furthermore, posthurricane mortality was highest for individuals living in municipalities with the lowest socioeconomic status. 2 Stable employment and income after the hurricane may have contributed to the observed healthier psychosocial profile. Additionally, higher private health insurance enrollment after the hurricane could translate to more chronic diseases being diagnosed.

Other noted differences, such as a higher percentage of Puerto Rican individuals (vs other ethnicities) and fewer single individuals, might reflect specific recruitment strategies, such as having 1 of the recruitment sites in the 2015 study within a community of individuals from the Dominican Republic. Interestingly, participants in 2019 were more likely to report that they had lived in Puerto Rico their whole lives. A survey among Latino immigrants to the mainland US showed that 84% of Puerto Rican individuals had been to the mainland US at least once. 34 While posthurricane migration was substantial, 35 , 36 it may be possible that lack of previous connections to the mainland US, or a strong cultural and social attachment to the island, discouraged some adults from moving.

In 2019, several unhealthy lifestyle factors became more prevalent. These observations align with BRFSS data from Puerto Rico showing higher age-adjusted prevalence of body mass index–classified overweight and obesity in 2019 (68.8%) compared with 2015 (66.1%). 13 In 2015, 47.1% of adults reported not participating in any exercise and 13.7% reported binge drinking, compared with 49.8% reporting not participating in exercise and 14.1% reporting binge drinking by 2019. 13 In addition to these factors, we observed higher prevalence of hypertension, arthritis, and high cholesterol after the hurricane, but BRFSS reported decreases in these conditions from 2015 to 2019. Discrepancies may be due to methodological differences. Notably, our results remained similar after age-standardization, diminishing the possibility of shifts in age structure as a discerning factor. Other conditions for which we observed higher prevalence in 2019, and which are not tracked by the BRFSS, include high triglycerides, eye disease, fatty liver disease, and osteoporosis.

Interestingly, there were no significant differences in the prevalence of diabetes, physical impairment, or heart disease or stroke. People with chronic conditions often require considerable medical care, such as multiple medications, specialized services or medical devices, and frequent visits to diverse medical specialists. Studies in Puerto Rico documented the severe posthurricane disruptions to these medical services, as well as widespread physical destruction to health care facilities or shortages in electricity, communications, water, and transportation, requiring many individuals with chronic conditions to leave the island for essential medical care. 33 , 37 - 41 Many clinical workers also left the island. 38 For people with physical disabilities, the broken infrastructure exacerbated already existing vulnerabilities. 42 Notably, heart disease and diabetes were among the top causes for excess deaths after Hurricane Maria, 3 which may further explain the lack of differences in these conditions. Within the subset of the returning participants, 3-fold higher heart diseases or stroke was observed in 2019. It may be possible that unhealthy behaviors and higher biological risk factors hastened heart conditions in these adults. Gastrointestinal disease was twice as high in 2019 in the subset, consistent with another posthurricane report from the island. 39

From 2015 to 2019, we noted lower depressive symptom and stress scores but higher social support scores. Mental and emotional health are usually worsened after natural disasters, yet studies also report increases in protective factors, including resilience and coping strategies. 43 - 45 In a study conducted after several storms in Mexico, depression symptoms remained high compared with prestorm periods, yet social support returned to better than prestorm levels in some communities. 46 Among survivors of major bushfires, depression risk was higher for individuals with fewer social connections, connected to other people with depression, or connected to people who had left their community. 47 Optimism, social support, and social ties are strong among Puerto Rican adults and have been shown to have a protective association against psychological distress in the face of stressful life events. 29 , 33 , 48 Sustained high-quality mental health care, breaking cultural barriers for seeking support, and continued compassionate and culturally relevant communal support may strengthen coping and resiliency among disaster survivors. 49 , 50 These strategies are essential, given that nearly one-third of adults exhibited depressive symptoms in 2019.

Social determinants of health, namely poverty, the physical environment, environmental factors, and shortages in safe food and water, may contribute to postdisaster vulnerability to the adverse health outcomes reported here. 51 Hurricane Maria revealed underlying social and structural inequities, including discriminatory practices, systemic racism, human rights violations, negligence, and ineffectual policies, that led to inadequate emergency responses. 52 , 53 Analysis of federal spending estimates showed that the federal government responded faster and better to Hurricanes Harvey and Irma in Texas and Florida, compared with Hurricane Maria in Puerto Rico, a variation that was not commensurate with storm severity and need after landfall. 54 Similar disparities have been reported after Hurricane Katrina, where cardiovascular disease rates between Black and White older adults were exacerbated during and following landfall; after the Haiti 2010 earthquake, where women experienced more survival needs, violence, exploitation, and class- and race-based stigmatization than men; and after the September 11, 2001, terrorist attacks in New York, New York, where socially or economically marginalized individuals had higher depression than those who were more socially and financially secure. 55 - 57

This study has some limitations. First, we used data from 2 different studies. However, the results were corroborated in a subset of individuals followed from 2015 to 2019. Second, the recruitment strategies, including recruiting in clinics in the San Juan metropolitan area only in the 2015 study, may limit representation of the general Puerto Rico population. This limitation is lessened by the socioeconomic and health profile representation of PRADLAD participants and by the islandwide efforts in PROSPECT—approximately 35% of the PROSPECT sample used in this analysis was recruited from the nonmetropolitan area. 16 , 17 Furthermore, the sociodemographic characteristics of the returning participants matched population-wide surveillance data, and there were few differences noted in the characteristics of returning participants vs those whom we could not contact. Using mainland US-based census data for age-standardized estimates may not fully represent the age structure of Puerto Rico; however, sampling weights for Puerto Rico were unavailable. Fourth, although behavioral and psychosocial risk factors were measured using validated tools, chronic disease status was self-reported and not validated against objective measures or medical records. The widespread health insurance coverage in Puerto Rico may facilitate awareness of diagnoses among participants, lessening this concern. Any underreporting of conditions would likely be similar for both studies, which may attenuate our estimates but still support the main conclusions. Fifth, we cannot distinguish if the observed differences were owing to ongoing trends or directly triggered by Hurricane Maria. However, existing evidence of similar increases in chronic conditions after natural disasters supports that hurricanes and other disasters may trigger or exacerbate disease state. 58 , 59 Notably, we restricted the PROSPECT sample to individuals recruited before COVID-19 to avoid potential changes in health conditions and risk factors during the pandemic. Future studies should analyze the compounding effect of concurrent public health emergencies on the health of Puerto Rico residents.

The finds of this cross-sectional study suggest that, given the observed high prevalence of several risk factors and chronic disease after Hurricane Maria, clinical and public health prevention measures should be prioritized in disaster-prone areas. Health promotion strategies should be strengthened to sustain a culture of health at all times. It is essential to implement populationwide surveillance systems on chronic diseases and their risk factors for continued monitoring, especially to detect changes during unforeseen public health emergencies. Relevant policies that could help curb detrimental health impacts after natural disasters include strengthening the health care system, developing policies that address social determinants of health and social inequities, strengthening social services and nutrition assistance programs (including emergency funds), enhancing food and medical stockpiles, and investing in climate resiliency, emergency preparedness, and disaster response. 39 , 60 Lastly, public health and clinical programs should leverage positive psychosocial factors for better postdisaster socioemotional health. Timely attention to these issues is imperative, given that natural disasters are becoming more prevalent, destructive, and costly, 61 particularly in populations already at high risk of poor health, 58 and their impact on health persists for years. 62

Accepted for Publication: October 22, 2021.

Published: January 12, 2022. doi:10.1001/jamanetworkopen.2021.39986

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2022 Mattei J et al. JAMA Network Open .

Corresponding Author: Josiemer Mattei, PhD, MPH, Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston MA 02115 ( [email protected] ).

Author Contributions: Drs Mattei and Tamez had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Mattei and Tamez contributed equally to the manuscript as co–first authors.

Concept and design: Mattei, O’Neill, Lopez-Cepero, Tucker, Rodriguez-Orengo.

Acquisition, analysis, or interpretation of data: Mattei, Tamez, O’Neill, Haneuse, Mendoza, Orozco, Lopez-Cepero, Rios-Bedoya, Falcon, Tucker.

Drafting of the manuscript: Mattei, Tamez, O’Neill.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Tamez, Haneuse, Orozco.

Obtained funding: Mattei, Rios-Bedoya, Falcon, Rodriguez-Orengo.

Administrative, technical, or material support: Mattei, O’Neill, Mendoza, Rodriguez-Orengo.

Supervision: Mattei, Mendoza, Rodriguez-Orengo.

Conflict of Interest Disclosures: Dr Mattei reported receiving grants from the National Institutes of Health (NIH) and Robert Wood Johnson Foundation during the conduct of the study and providing professional services for Dove Self-Esteem Project, Center for Nutrition Policy and Promotion, and Ponce Medical School Foundation outside the submitted work. Dr Mendoza reported receiving grants from NIH outside the submitted work. Dr Rios-Bedoya reported receiving grants from FDI Clinical Research during the conduct of the study. No other disclosures were reported.

Funding/Support: PRADLAD was supported by private anonymous donations to Harvard T.H. Chan School of Public Health, a Dry Bean Health Research Program Incentive Award from the Northarvest Bean Growers Association, institutional funds from FDI Clinical Research, and NIH National Heart Lung and Blood Institute (grant No. K01-HL120951 [Dr Mattei]). PROSPECT was supported by the NIH National Heart Lung and Blood Institute (grant No. R01-HL143792 and K01-HL120951 [Dr Mattei]) and National Institute on Minority Health and Health Disparities (grant No. R21-MD013650 [Dr Mattei]) and a Robert Wood Johnson Foundation Culture of Health Leaders Award (Dr Mattei). Dr. Tamez received grant support from the NIH (grant No. T32-HL098048).

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Things to Do in Puerto Rico with Kids | 6 Fun Family-Friendly Activities

P uerto Rico is one of the best Caribbean destinations for families . With culture and adventure, the US territory is perfect for those looking for a quick, tropical getaway from the continental United States or Canada.

If visiting Puerto Rico with kids, you’ll find plenty of fun things to do on the island territory. From beaches to rainforests; colorful colonial buildings to bioluminescent bays; Puerto Rico boasts some of the most incredible and unique activities for families.

This guide to the best things to do in Puerto Rico with kids includes kid-friendly activities, excursions and attractions, plus tips for when to visit and where to stay in Puerto Rico for families.

Don’t have time to read the entire post? Here are our top picks.

Where to stay: Hotel Convento Old San Juan

Best Tours or Guided Excursions:

• Day Trip to Parguera Bioluminescent Bay
• Cueva del Indio and Rio Camuy Caverns Tour
• El Yunque Rainforest and Natural Waterfalls Tour

Something you probably wouldn’t think to do but won’t regret doing: Hire a Flytographer Destination Photographer for Family Photos

Best time to visit Puerto Rico

Puerto Rico is a great place to visit any time of year. With a tropical climate, the Caribbean Island stays warm year-round. However, when deciding what time of year to visit Puerto Rico on a family vacation, keep in mind the months of August and September are hurricane season. 

High season for tourism is typically November through January, as it is less rainy and great for those looking for a tropical escape during the winter months. 

If you are looking to plan a summer trip to Puerto Rico with kids after school lets out, aim for early June to avoid crowds, get the best prices, and have the best chance for enjoyable weather. 

How many days do you need in Puerto Rico?

Puerto Rico is a great, family-friendly place to visit for a long weekend, a full week, or even a couple of weeks. Unlike many islands that only offer beach activities, Puerto Rico has mountains, rainforests and caves, as well.

There are lots of fun things to do in Puerto Rico with kids that can entertain you for weeks, if you desire.  

Give yourself no less than 4 days in Puerto Rico with kids, but if you want to explore the entire main island as well as travel to the other islands of Vieques and Culebra, you’ll want to be sure to have at least one week in Puerto Rico.

Where to stay in Puerto Rico

If you are spending most of your time in San Juan, there are two main areas to stay in Puerto Rico. 

Old San Juan

Staying in Old San Juan puts you within walking distance to the forts, restaurants, shops, and the general atmosphere of this beautiful, historic area. Be sure to select a hotel with a rooftop pool , as it will be a great place to relax during the heat of the afternoon.

We stayed at Hotel El Convento; a former convent built in 1646 that has been renovated into a beautiful hotel. While it has a great rooftop pool, guests also get access to the beach resort at El Convento’s sister property , where you can enjoy a day splashing in the ocean and access to bathrooms, lounge chairs, and a beach bar and restaurant.

Check pricing and availability at El Convento

Isla Verde is another popular option, particularly for families seeking a beach vacation.

Isla Verde is lined with large hotels, resorts and beach clubs that offer a relaxing beach holiday for those who want to play in the waves or put their toes in the sand. 

While a day at the beach is still an option even if you stay in one of the boutique hotels in Old San Juan, if you are primarily looking for a beach holiday in Puerto Rico, Isla Verde is a great way to go.

Check pricing and availability at hotels in Isla Verde

Getting around Puerto Rico with Kids

Although taxis and Ubers are readily available in Puerto Rico, if you plan to do a Puerto Rico road trip or even a self-guided day trip to some of the fun places outside of San Juan, you will likely need to rent a car . 

You can get around San Juan using Ubers or taxis , but to get to the El Yunque rainforest, other cities in Puerto Rico, or one of the bioluminescent bays, you will either need to book a guided tour or have a car.

FIND THE BEST DAY TRIPS AND GUIDED TOURS IN PUERTO RICO HERE OR COMPARE RENTAL CAR PRICES HERE .

Things to do in Puerto Rico with Kids

While Puerto Rico is a diverse island with lots of unique activities there are certainly some that are more suited for those visiting Puerto Rico with children.

Wander the streets of Old San Juan 

San Juan is one of the oldest cities in the Americas . With blue cobblestone streets, colorful facades, and colonial architecture, wandering through the streets of Old San Juan is a memorable and cultural experience.

Similar to Old Town Cartagena, Colombia , there are lots of centuries-old buildings, beautiful doors and historical churches that the whole family will love exploring. 

You’ll also find lots of colorful murals tucked away down narrow alleys and streets. It is a great place to hire a local photographer and take professional family photos or simply wander and take your own pictures.

Stop in local shops, eat traditional Puerto Rican food at one of the locally owned restaurants, or enjoy a pina colada (without alcohol for the kids) at the birthplace of the sweet drink . 

Your kids will also love finding, and sometimes petting all of the stray cats that roam the streets. Don’t worry, they are all vaccinated, and many of them are friendly and even adoptable through Save a Gato Cat Sanctuary , a wonderful nonprofit organization that feeds, vaccinates, and spays or neuters the stray cats. 

To learn more about the history of San Juan and the settlement of Puerto Rico, you can join a guided walking tour through the town, which is a great way for older kids to combine vacation and education!

Explore the fortresses of El Morro and San Cristobal

All kids love fortresses and castles, and luckily San Juan, Puerto Rico has two of them!

The old defensive forts of Castillo San Felipe del Morro and Castillo de San Cristóbal are impressive fortresses originally built to protect the island from invaders. Nowadays, they are historical sites and museums that are fascinating to visit. 

With lots of kid-sized nooks and crannies to explore, kids can squeeze through small tunnels and gaze out at the ocean through small windows in the fortress.

The fortresses are in full sun and can get very hot, so be sure to bring plenty of water, wear sunscreen, a hat, breathable clothing, and sunglasses to keep you cool while you explore. 

Enjoy a Day at the Beach

No island trip would be complete without at least one day spent at the beach.

Puerto Rico has some beautiful beaches, including those near Rincon, on the island’s west side and those near Fajardo on the east side. But even within the capital city of San Juan, there are several beaches where kids can swim and play in the waves or sand. 

Along Isla Verde, hotels and family-friendly resorts line long, clean stretches of soft sandy beaches. All beaches in Puerto Rico are public , so even if you are not staying at one of the hotels, you can visit and enjoy the beaches in front of them.

Just make sure you bring your beach essentials with you!

Explore Caves 

One of the best things about visiting Puerto Rico with kids is the diversity in the types of activities on the island. Puerto Rico boasts the third largest cave system in the world , Rio Camuy Cave.

Tours of the cave are kid-friendly and take you along a well-defined path through stalagmites and beneath stalactites. But that isn’t the only cave on the island. 

A day trip to the northern coast of Puerto Rico, near the town of Arecibo, allows you to explore Cueva del Indio , an inexpensive hidden cave along the coast.

While in this region, you can also go cave tubing at Tanama Eco-Adventure.  

You can book a guided cave tubing tour that meets up in Arecibo or book a day trip from San Juan that takes you to Cueva del Indio and Camuy Caverns if you prefer to let someone else make the arrangements and do the driving. 

Hike in the El Yunque National Forest

El Yunque Rainforest is the only rainforest in the US National Forest System. It is a great place to experience the diversity of a tropical climate and teach kids about the environment.

There are several popular hikes in El Yunque that are easy and kid-friendly, including la Mina Trail, which was damaged in Hurricane Maria but could reopen in late 2024.

The trail follows a river and then ends at a picturesque waterfall that cascades into a small natural pool that is gentle and shallow enough for a family swim.

For families visiting Puerto Rico with kids over the age of five, you can book an excursion that takes you to the El Yunque National Forest and to an area with natural waterslides .

You’ll get to enjoy the natural pools with a rope swing, small cliffs to jump from and natural rock water slides that dump you into the river. It’s better than any water park you can take them to!

Kayak through a Bioluminescent Bay

One of the most unique experiences in Puerto Rico for kids and adults alike is the bioluminescent bays. While this natural phenomenon is not common in many places on earth, Puerto Rico has three bioluminescent bays where you can experience the bioluminescent glow in the water!

While its brightest bioluminescent bay, Mosquito Bay , is located on the island of Vieques, there are two others located on Puerto Rico’s main island. 

Having visited both of the bioluminescent bays on the main island, La Parguera , located in southwest Puerto Rico, is the best bioluminescent bay for families , and the only one that allows you to swim in the glowing water. 

However, the other one at Bio Bay Laguna Grande near Fajardo, is closer to San Juan.

Bioluminescence is caused by microorganisms in the water that emit a short burst of light when disturbed, so with every movement of your hand as you tread water, a greenish-blue glow is created in the water.

In the words of our daughter when she experienced it, “it’s the coolest thing ever!” 

Final Thoughts on Visiting Puerto Rico with Kids

While there are some romantic Caribbean islands that are more suited for couples, Puerto Rico is an island that has a lot of activities geared for family travel.

Families with children of all ages will love all of the things to do in Puerto Rico for kids. Plus, it is a great place to practice your Spanish, one of the best languages for travel ! Although it is a US territory and most people speak both English and Spanish in Puerto Rico, the latter is the official language.

With so many different areas in Puerto Rico to visit and so many great reasons to visit, it is an island you will definitely want to come back and explore!

No Passport Required for US Citizens

One of the best reasons to visit Puerto Rico with kids is that you won’t have to apply for passports for your kids if you are US citizens. Flying from the United States or any of its territories is considered a domestic flight since Puerto Rico is a US territory. 

So, even if you have already taken your baby’s passport photo and applied for your children’s passports, you won’t need to hassle with customs or worry about any of the other stressors that go along with international travel. 

Ecological Diversity  

Puerto Rico is a wonderful destination for kids to learn about different biospheres and ecosystems . From the ocean to the rainforest and even the caves and bioluminescence, Puerto Rico is an immersive science experience. 

Charm and Beauty

Not only does Puerto Rico have a ton of natural beauty and ecological wonders, but its historic capital city of San Juan is dripping with charm and colonial beauty. 

It is one of the best places to book a family photo shoot .

Whether you want to capture your vacation memories in the colorful streets of Old San Juan or you want a picturesque photo shoot on one of the island’s beaches, you won’t regret having professional photos taken in Puerto Rico.

Like it? Pin this guide to the best things to do in Puerto Rico with kids to save it for later!

Do you have a question or comment about any of these things to do in Puerto Rico with kids? We’d love to hear from you. Leave your thoughts or questions in the comments below.

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Puerto Rican woman shares impact Hurricane Maria had on her life, and how she's giving back

TAMPA, Fla. — The path of a hurricane can change at any moment.

It’s why having a plan and the right resources in case of power outages is important. 

What You Need To Know

Hurricane maria hit back in 2017, with puerto rico being one of the most affected areas nivia montanez leduc helped her community during the hurricane working with fema she lived with no water or electricity for nine months after the hurricane.

That was the case for many residents in Puerto Rico when Hurricane Maria hit in 2017. The U.S. Census reported an increase in migration from Puerto Rico to other parts of the U.S. at the time.

The impact of the hurricane and the pandemic were the main reasons Nivia Montanez Leduc made the move to Hillsborough County.

When she cooks, it reminds her of her Puerto Rican roots. “We have here some bacalaitos. They’re a tradition that we eat on the beaches. It can’t be left out," she said.

Now it’s a meal she makes with a smile, but at one point, making this meal was the only way to make ends meet.

“Any way I could, I would make these quickly and I would ensure that people liked the food I made,” she said.

It was especially crucial in the months after one of the most terrifying moments of her life: Hurricane Maria.

“It was a tough moment because you didn’t know what would happen after. How many hours had passed, if the hurricane passed quickly or fast, you just felt like it lasted forever,” she said.

Leduc spent nine months with no water or electricity. Photos show the damage she encountered every day as she traveled throughout Puerto Rico to help people.

She was determined to stay strong and focused.

“I think the toughest part was having to see a woman asking me to please help her because her husband needed oxygen to survive, because they were running out, and people that didn’t have anything to eat,” she said.

Even today, she says there are still parts of Puerto Rico that haven’t fully recovered.

Eventually, she left Puerto Rico and made her way to Tampa Bay.

She’s an economic mobility mentor and coach at Enterprising Latinas , where she works with women who’ve just moved to the U.S. and with underserved communities.

“I’ve not only learned about the experience of these communities, but I’ve also been able to understand what these communities are facing because of what I have experienced," she said.

Turning her own hurricane experience and re-location into a lesson, she hopes to continue helping people in Tampa Bay.

She was even honored as a Lightning Community Hero last month.

As we prepare for this hurricane season, you can stay up to date on ways to keep your family safe with our Storm Season guide .