Covid-19: Lessons from Cuba
By Charles McKelvey
April 17, 2020
In the battle against Covid-19, Cuba has important lessons to teach the world. With more than four and one-half million international tourists per year and thousands of Cubans resident in the exterior visiting the island at any given time; and with the pandemic epicenters of Italy, Spain, and the United States being central to Cuban international interaction; the Cuban population of eleven million was vulnerable to an outbreak. However, by adopting coherent and comprehensive measures based in scientific knowledge, Cuba so far has been able to contain the epidemic. It has 862 confirmed cases as of April 17, which represents 8 confirmed cases per 100,000 people, in contrast to 403 per 100,000 in the Spain, 280 in Italy, and 204 in the United States. In Cuba, 27 people have died from Covid-19, which is less than 1 death for every 100,000 people, in contrast to 42 per 100,000 people in Spain, 37 in Italy, and 9 in the United States. Moreover, the Cuban graph appears to be leveling rather than growing exponentially. The number of new cases per day has stayed around 50 or 60 for the last couple of weeks.
What is Cuba doing right? Above all, for the last sixty years it has had the fundamentals right. The political-economic-cultural system has given priority to providing for the basic human needs for all, as a fundamental political and social principle. Cubans are not Puritans, and when they have a few available dollars, they buy unessential products that they enjoy. But no one thinks that the economy and society should be organized to give maximum possibility to the purchase of the superfluous by those with surplus money; rather, it is taken as given that primary attention must be given to fundamental human needs.
In practical terms, this means that priority is given to education, not only universal, free access to formal education, but also the creation of an educated people with knowledge of the natural and social sciences, history, culture, and art. In the forging of an educated people, the schools, universities, media, popular organizations, and political institutions are involved; academics, journalists, and political leaders are partners in the same educational project, conceived as the key to human emancipation and fulfillment. And it means giving priority to caring for one another, especially caring for those in need, and especially the sick. In the forging of caring institutions, a comprehensive, universally accessible health care system has been developed, which includes attention to education and science. Dedicated medical scientific researchers, visible and celebrated these days at the nation confronts Covid-19, reflect the syntheses of these interrelated tendencies and values.
As a society that had the fundamentals right, Cuba was well prepared to respond to the pandemic. In late January, a short time following the confirmation in China that the new coronavirus could be transmitted from person-to-person, Cuban scientists formed two teams, one to assess the knowledge and resources that Cuba had available, and another to focus on the application of measures to respond to the pandemic. They determined that Cuba essentially had the medical personnel, medical equipment, and medicines necessary to respond, but they possibly were short on hospital beds. So, the Ministry of Public Health established the necessary conditions with respect to hospital beds, making adjustments in the hospital infrastructure and incorporating tourist lodging. At the same time, Cuba intensified its previously established structures for the surveillance of incoming travelers at airports and other points of entry. Subsequently, international tourism was stopped, as was the entrance of Cuban citizens living abroad, except for those on medical and educational missions.
The transmission of the disease by asymptomatic carriers creates special challenges. Cuba tests frequently, and each day it reports on the number of tests that it has done as well as the number of positive cases found. Cuba has undertaken systematic inquiries, in which thousands of university medical students, with the support of mass organizations, go from door-to-door, looking for people with symptoms or people who have had contact with sick persons, with the intention of detecting possible carriers of Covid-19. During the last ten days, because of the systematic inquiry, approximately half of the newly confirmed cases have been asymptomatic. The systematic inquiry is driving up the number of confirmed cases each day, at the same time that it is reducing the number of asymptomatic carries not under supervision and surveillance, thus reducing the number of confirmed cases that would otherwise appear later in the cycle of the infirmity.
Because of the phenomenon of transmission by asymptomatic carriers, Cuba stresses social isolation and physical distancing. People are required to stay at home, either by taking a furlough (with full salary for thirty days and 60% of monthly salary later), or by working from home via telephone and Internet, with the exception of workers in necessary sectors and of shopping for necessary items. Necessary work continues. Every effort is being made to maintain necessary production and commerce. Adjustments are being made in the system of distribution to ensure that people are able to obtain necessary products, especially food and medicine.
In Cuba, there have been twenty “local transmission events,” in which there are a number of cases in the locality, and the sources of the infection cannot be identified. These twenty communities have been placed in thirty-day quarantine for observation and care. The communities can be from 1500 to 14,000 residents, and they are found in different provinces in the country. The quarantined communities have forced isolation in the home, with food delivered to the door. There is a systematic inquiry of all of the homes in the quarantined community. In some of the communities, people can leave the restricted area with authorization.
In Cuba, there is much less attention than there is in the United States to the question of when and how the economy can get moving again and things can return to normal. In Cuba, there is a general sense that there is and will be an economic cost, but the focus for now is on saving lives and containing the infirmity. And there is a general view that, whatever be the economic cost, there is no option but to pay it; and that there is and will be a sustained effort by the government and the people to ensure that everyone has their basic needs met, with special attention to those who are most vulnerable.
Cuban maintains that frequent testing, including testing of asymptomatic persons, and the isolating of positive cases are critical for containing the pandemic. Moreover, that it is very important to not relax isolation prematurely, because it would free asymptomatic transmitters who would launch a resurgence in the number of positive cases.
In Cuba, as a result of decades of having attended to the fundamentals, there is widespread trust in the institutions of the society, in the medical system, in the system of science, and in the dedication, sincerity, and competence of the political leadership. We trust that the return to normalcy will be guided by intelligent judgments. We are concerned with the high level of home energy consumption as a result of home confinement, for which, so far, the only guidelines have been to try to reduce consumption during peak hours. We are annoyed by the few slackers who do not follow the health regulations, and by the few scoundrels who are exploiting the situation for personal economic gain, who are being pursued by the authorities, with respect for due process, and with the support of the people. We wonder how the world might be permanently changed by the pandemic, and our intellectuals are beginning to work on formulations that point to a more just, sustainable, and democratic world, one that pays more attention to the fundamentals.
