Puerto Rico seemed to be sprinting toward herd immunity this spring before people began letting their guard down against Covid-19 and new variants started spreading across the US territory.

Now, a spike in cases and hospitalisations has put medical experts at odds with the government, which is struggling to protect people’s health while also trying to prevent an economic implosion on an island battered by hurricanes, earthquakes and a prolonged financial crisis.

It’s a delicate balance for an island that imposed a lockdown and mask mandates ahead of any US state and has some of the strictest entry requirements of any American jurisdiction — measures that helped contain infections before the latest surge.

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