Controlling asymptomatic cases: Cuba's success against the coronavirus.
Of the 380 new cases registered in Cuba between April 20 and 29, 222 were asymptomatic, accounting for more than 58% of the cases.
World Opera - Mapping and isolating patients who are contagious without showing symptoms and searching for possible cases from house to house are some of the measures with which Cuba seeks to favorably change the course of the pandemic and reach the peak of transmission sooner than expected. As of Wednesday (April 29), the island had accumulated 1.467 cases of the new coronavirus, with 58 deaths, since the first patients tested positive for the disease on March 11, a much smaller number than that of several of its neighbors.
Among patients who tested positive for COVID-19, Cuba decided to focus its attention on asymptomatic individuals, that is, those who do not even cough but spread the virus. Without testing, this population does not know they have the disease and represents a risk for the spread of the new coronavirus.
Of the 380 new cases registered in Cuba between April 20 and 29, 222 were asymptomatic, accounting for more than 58% of the cases. But all of them were already isolated in some health center because they had been in contact with someone who tested positive.
"If I detect a patient confirmed to have COVID-19, I look for the last person who may have had contact with them in the last 14 days and who may have become infected," stated the Director of Epidemiology at the Cuban Ministry of Health (Minsap), Francisco Durán.
"I isolate and study all these people. This undoubtedly has to have an impact on reducing the incidence, on decreasing transmission," he added.
Suspect? Isolate!
Cuba tests all contacts of a confirmed COVID-19 case, with or without symptoms. "There are times when the result is negative, but surveillance is maintained in case any symptoms appear," Durán explains.
Those who show symptoms immediately receive treatment "as if they had" the disease, until it is confirmed. The island has its own arsenal to treat them, according to Durán.
Among them is the antiviral Interferon Alpha 2B, which replenishes human defenses, used by China as one of the options to combat the virus. It does not prevent contagion, but patients progress "a little better," says Durán.
Cuba is also using plasma from recovered patients in its therapies. "The impact of its use is already evident in patients who have benefited," he stated. Chloroquine and azithromycin are also part of their protocol, depending on each case.
From door to door
According to the Ministry of Public Health (Minsap), the new coronavirus is present in 104 of Cuba's 168 municipalities. There are a total of 39 locally transmitted outbreaks under monitoring to prevent them from spiraling out of control. Since mid-March, thousands of medical students have been scouring every corner of the country in search of possible cases.
"This research is the guarantee of success," declared Luis Armando Wong, director of Health in the province of Mayabeque, neighboring Havana, which has recorded 45 cases. "So far, we have not had to mourn any deaths, and that is precisely because we identified them in time in the research and they were treated in time," he added.
In Mayabeque, with 30% of its 382.000 inhabitants scattered in rural areas, research becomes complicated. "Since I live in the countryside, the houses are a bit far apart. I walk a kilometer and sometimes I do the survey in two houses," explained first-year medical student Darlyn de Caridad.
Health authorities are investigating whether Cubans examined have respiratory symptoms, dry cough, or fever. If they detect suspected cases, they report them immediately. "I don't feel overwhelmed or stressed because I know we have a very comprehensive health system," said Bárbara García, a 70-year-old woman living in the countryside who suffers from lung problems.
Anticipating the peak of the pandemic
If all goes well, Cuba should bring forward the peak of the coronavirus infection curve to next week, with a maximum of 2.500 active cases.
Initially, mathematical calculations estimated that the peak should be reached at the end of May. However, its earlier arrival corresponds to the effectiveness of the social isolation and health measures adopted, according to the Minister of Health, José Portal.
A critical scenario, with a peak of 4.500 active cases, cannot be ruled out, because "there may be a group of cases (mainly asymptomatic) that we have not identified," said Portal.
The situation is complicated due to long lines to buy food or due to negligence, such as an outbreak in a nursing home that caused a resurgence in infections in mid-April.
Whether or not we reach an "epidemic stage will depend exclusively on how many cases we are able to diagnose and isolate, identify contacts, but more than anything, on the capacity for cooperation" of citizens, the minister pointed out.