Covid-19: Cuba follows the recommendations of WHO
By Charles McKelvey
April 8, 2020
The Cuban Plan of Prevention and Control of Covid-19, approved on March 5 and modified as the situation has evolved, is fully consistent with the recommendations of the World Health Organization (WHO).
Dr. Tedros Adhanom Ghebreyesus, WHO Director-General, at a press conference on April 4, reviewed WHO recommendations to countries. He stressed the importance for countries to “detect, test, isolate and treat cases, and identify contacts.” That is to say, countries should first detect persons who possibly have contracted the illness, test them, and if positive, isolate and treat them; and in addition, they have to identify contacts with the positive cases, and test, isolate, and treat them as well.
The Cuban Plan, announced on national television of March 9, before the arrival of the virus to the island, have been oriented to detection. Initially, it focused on epidemiological surveillance in airports and in tourist places and activities, marshalling the support of workers in these sectors, in order to identify all persons with respiratory symptoms for testing and observation. Subsequently, the surveillance had been expanded to include all places of work and study, with mass organizations of women and neighborhoods also participating in the surveillance. Persons with respiratory symptoms were prohibited from entering places of work and educational centers and were sent to the local family doctors. This was supplemented by a program of active inquiry, in which 28,000 medical students have been going from door to door, inquiring if anyone in the house had respiratory symptoms. The family doctors determine if the symptoms warrant clinical analysis, and persons so detected are taken to the local hospital for testing. Samples have been sent to one of three laboratories, where testing kits designed by Cuban researchers are able to identify eighteen respiratory viruses, including Covid-19. Even if they do not test positive on the first test, all persons with respiratory symptoms who have traveled internationally or have had contact with an international traveler are hospitalized for up to fifteen days, where they are regularly tested. If confirmed for Covid-19, they remain hospitalized for treatment. Some people have been placed in obligatory fifteen-day home quarantine, including persons with respiratory symptoms but who have not had contact with international travelers; and persons who have traveled internationally but who do not have symptoms. They are tested regularly during the quarantine, and confirmed cases are hospitalized for treatment.
WHO recommends hand washing, but in recognition of the fact that many people in the world do not have access to clean water, it recommends setting up handwashing stations at the entrances to public buildings, offices, bus stops, and train stations. In Cuba, the people have access to clean water. Nonetheless, all places of work are mandated to provide solutions for hand-washing in multiple and convenient places. Bottles of chlorinated water are distributed at the entrances to public building, offices, and stores; and some bus drivers have them available for passengers as they enter the vehicle. The sale of a chlorine solution has been expanded, with the establishment of 444 points of distribution throughout the country.
WHO recommends physical distancing, as does Cuba, requiring a distance of one and one-half meters between persons in lines for stores. Police help to organize the queues, and they are able to impose fines for violations.
The WHO Director General declared, “Many countries are asking people to stay at home and are shutting down population movement, which can help to limit transmission of the virus, but can have unintended consequences for the poorest and most vulnerable people. I have called on governments to put in place social welfare measures to ensure that vulnerable people have food and other life essentials during this crisis.”
In the case of Cuba, the government has called on as many people as possible to stay at home. To this end, tourism, school and university classes, and travel from one province to another have been suspended. Restaurants are permitted to be open, with the application of physical distancing; in practice, many are closed. All social gatherings, including cultural and political events, have been cancelled. Persons over 60 years of age or with respiratory and heart health issues also are encouraged to stay at home. People should leave their homes only for work and for necessary purchases. To the extent possible, people should work from home using telephone and Internet. Those who are doing so receive full salaries. Those who are not working because of the pandemic will received full salary for 30 days and eighty percent of salary after 30 days. Food, water, natural gas, and electricity are subsidized for all citizens and residents.
The World Health Organization maintains that it is necessary for front-line health workers to have access to essential Personal Protective Equipment, including medical masks and respirators. In Cuba, the health system has all the medical equipment and supplies needed to treat sick persons. Initially, the government did not call upon the people in general to wear cloth face masks, except for those with symptoms and those who have transactions with large numbers of people. But as the global pandemic increased exponentially, the government called upon the people to wear cloth masks when leaving the home, which by now is universally followed. There are 151 workshops that are dedicated to the fabrication of cloth masks, and instructions are disseminated for making them in the home, which many people are doing and distributing to their neighbors.
The Cuban Plan has been conceived as having three phases. The first or pre-epidemic phase is characterized by confirmed cases of travelers proceeding from affected countries or local cases produced by contact with these travelers. The second phase is that of limited autochthonous transmission, where there are confirmed cases in which direct links with travelers proceeding from affected areas has not been established, but such cases are limited to a locality of the country or a particular center or institution. The third is the epidemic stage, where cases are confirmed without links to travelers, and there are an increasing number of cases in different localities of the national territory.
Until April 7, Cuba was still in the first phase or pre-epidemic stage. There had been seven cases of local transmission, in which a Cuban who has not traveled abroad infected another Cuban. However, in these seven cases of local transmission, a tie to foreigners or to Cubans who had traveled abroad had been traced, so there has not yet been an autochthonous transmission, However, on April 5 through April 7, the number of cases of local transmission rose, including cases in which the sources of transmission could not be determined. Accordingly, on April 7 and April 8, the Minister of Public Health, José Angel Portal Miranda, reported on the need to begin the second phase.
The second phase will involve the taking of new measures. Six communities with local transmission in different provinces are quarantined. The Ministry of Transportation will analyze the public transportation system to find ways to increase distances among passengers. An analysis of those sectors that qualify as necessary work will be undertaken. The number of laboratories in the nation conducting texts will be increased from three to four, and more hospital beds set aside by Covid-19 patients will be prepared.
Cuba continues to have a relatively low level of confirmed cases, 457 as of April 8. During the last five weeks, the number of cases in the world has grown exponentially. Cuba has found that, thus far, its growth has been steady, and not exponential. It hopes that the measures that it is adopting will be effective in enabling it to avoid the exponential growth that has plagued many countries. It points to the example of China, which was able to control the epidemic with organization and discipline. With reference to the graphs showing exponential growth in many countries, the Cuban government is calling upon the people to “break the curve.”
