In his latest dialogue with experts and scientists directly involved in the country’s battle against Covid-19, President of the Republic Miguel Díaz-Canel Bermúdez again noted the usefulness of these weekly meetings, during which results of work underway are examined demonstrating the strengths of Cuban protocols followed in treatment of the disease.
In particular, Díaz-Canel highlighted the effort made in caring for the pediatric population, with the principal success of this work being that no child or adolescent has died, as a result of the new coronavirus, given the differentiated attention they received from the first moment of the epidemic.
In commenting on the evolution of the disease in Cuba, the President pointed out that the number of patients who reach critical or serious condition continues to decrease, and most remain in these conditions for a short period of time. "This also shows the soundness of the protocols that have been used," he said.
Diaz-Canel also expressed his certainty that, as the days pass and experience acquired by medical brigades combating the epidemic in other nations is evaluated, better treatment protocols will be available for all possible scenarios, especially in the functioning of intensive care units.
It was precisely the evolution of some of these protocols that was the focus of the day’s agenda, with Prime Minister Manuel Marrero Cruz also on hand.
The first report was presented by Dr. Lissette López González, head of the Ministry of Public Health’s national pediatric group, who outlined how children and adolescents have been impacted by COVID-19.
She explained that thus far, 274 pediatric patients have been confirmed positive for the new coronavirus, representing 11.3% of the total number of cases diagnosed in the country. Ninety-two percent have been discharged from the hospital and are receiving follow-up at home. Dr. López noted that 55% of these patients are male and that the incidence rate is highest for adolescents between 15 and 18 years of age.
Taking into account the clinical evolution of each of these patients, the relevant modifications have been made to different treatment protocols, she noted.
Over the course of these months, she stated, the importance of work at the primary care level has become evident, noting that active monitoring has been a key strength in the detection of infected children and adolescents, and that preventative measures have been essential to containing the epidemic.
Dr. López also reported that, since April, when the global alert on Multisystemic Inflammatory Syndrome was issued, immediate attention was paid to the issue in the country, conducting thorough epidemiological surveillance efforts.
To date, she said, only two patients have been diagnosed with this illness linked to COVID-19 in Cuba and, although both developed severe complications, their response to treatment was positive. They have recovered, and are receiving regular attention to prevent possible long term effects.
The Cuban protocol designed for these cases, as well as the constant supervision of multidisciplinary work teams, made it possible to satisfactorily overcome the numerous complications that arose in these cases, she said.
Another of the issues discussed was related to experience gained in the treatment of Covid-19 patients requiring intensive care. These findings were explained by Dr. Ileana Morales Suárez, the Ministry of Public Health’s director of Science and Technological Innovation, in an interactive presentation developed to share these experiences, which also allowed for evaluation of elements that can be included in medical school curricula for related specialties.
Of 2,399 COVID-19 patients, confirmed at the time of the study, only 172 had been admitted to intensive care units, representing 7.1%. Unfortunately, 86 died, while 67 were reported to have reached critical condition, and 105 serious condition.
The establishment of a single protocol at the national level for the treatment of these patients, she stated, allowed for a decrease in mortality across the country in relation to other countries in the Americas and the rest of the world. At present," she said, "the mortality rate has progressively decreased to 3.58, which has been possible thanks to the learning we have acquired over these months, along with the incorporation of innovative therapies and products in treatment plans.”
There have been many lessons learned during these difficult months confronting COVID-19, among which Dr. Morales emphasized the collective discussion of cases in real time; expediting of clinical and therapeutic decision-making; early incorporation of innovative products and reorganization of services.
She also highlighted the way in which multi-professional teams in intensive care units work, and as an essential element she considered the experiences provided by the Henry Reeve brigades, which have made it possible to expand our protocols and adjust them to the characteristics of the disease and achieve better results.
In this regard, President Díaz-Canel recalled several ideas shared by collaborators who recently concluded their mission in Lombardy, which could be applied in our country in different circumstances, noting that this experience could be useful not only in perfecting our treatment protocols, but also in updating study plans for training programs.
An update was also presented on the status of several projects regarding pulmonary ventilators being built in Cuba, to be available for intensive care units. As detailed, the prototypes have been subjected to tests required in accordance with international standards and work is already underway to incorporate recommended improvements.
In this regard, the President emphasized the way in which the development of these electro-medical devices has been conducted, practically designed in record time. In addition to strengthening intensive care services, having domestically produced equipment of this kind will contribute to replacing imports and could even become exportable lines for the country.
As is frequent in this type of exchange, Raúl Guinovart Díaz, dean of the University of Havana’s department of Mathematics and Computing, presented an updated graph representing the evolution of active cases.
He commented that, although the epidemic is controlled within the country, the situation that has arisen recently in the Havana municipalities of Centro Habana and Cerro has led to the increase noted on the active cases curve.
Havana, he said, had the highest peak of infections later than the rest of the country. Just as there are vulnerable segments of the population, due to age or health condition, he noted, there are vulnerable geographical areas that are associated not only with epidemiological factors, but also socioeconomic, cultural, demographic and other factors.
The first local transmission events in the capital emerged within institutions with large workforces, leading to a significant number of cases, he recalled. Recent events, however, have developed in communities, which are more difficult to address since the support of the Ministry of Public Health and provincial government authorities is not enough. The population’s cooperation is essential.
If residents do not cooperate in complying of basic measures that have been proposed from the beginning, such as the use of facemasks, physical distancing and frequent hand washing, an increase in cases is more likely to occur. "If we want to achieve effective control of the epidemic in a few days, then we must all cooperate," he reiterated.
Taking into account precisely these precepts, the COVID-19 prevention and control task force, led by President Miguel Díaz-Canel Bermúdez, Vice President Salvador Valdés Mesa and Prime Minister Manuel Marrero Cruz, met in the late afternoon, with authorities from Matanzas, the Isle of Youth special municipality and Havana, via tele-conference.
The first two territories are currently in the second phase of the recovery period, maintaining stability and implementing measures established for the gradual re-opening underway there.
In Havana, Public Health Minister José Angel Portal Miranda recalled that the capital is where the highest numbers of patients hospitalized and active cases are concentrated.
According to Havana Lieutenant Governor Yanet Hernández Pérez, to stop the spread of the disease, which has increased in recent weeks, action is being taken in vulnerable areas and specific groups in the municipalities, facing the greatest epidemiological risk.
In all quarantined areas, she reported, rapid and PCR tests are being administered to the entire population, while residents’ movement has been restricted. Hernández added that all basic services are guaranteed in these areas.
"The cooperation of all Havana residents is essential to finally contain the epidemic," she concluded.
