Coronavirus response: why Cuba is such an interesting case

[El Presidente]

Good article. 

Coronavirus response: why Cuba is such an interesting case

April 15, 2020 9.26am EDT

https://theconversation.com/coronavirus-response-why-cuba-is-such-an-interesting-case-135749

Some countries seem to be weathering the coronavirus pandemic better than others. One country that moved rapidly to deal with the emerging threat was Cuba.

Cuba has several advantages over many states, including free universal healthcare, the world’s highest ratio of doctors to population, and positive health indicators, such as high life expectancy and low infant mortality. Many of its doctors have volunteered around the world, building up and supporting other countries’ health systems while gaining experience in emergencies. A highly educated population and advanced medical research industry, including three laboratories equipped and staffed to run virus tests, are further strengths.

Also, with a centrally planned, state-controlled economy, Cuba’s government can mobilise resources quickly. Its national emergency planning structure is connected with local organisations in every corner of the country. The disaster-preparedness system, with mandatory evacuations for vulnerable people such as the disabled and pregnant women, has previously resulted in a remarkably low loss of life from hurricanes.

However, COVID-19 presents differences. Cuba’s lack of resources, which hampers recovery from disasters, also contributes to a housing shortage that makes physical distancing difficult. And the island’s poor infrastructure creates logistical challenges.

Also, the pandemic comes at a particularly difficult time, as tightened US sanctions have sharply cut earnings from tourism and other services, deterred foreign investment, hampered trade (including medical equipment imports) and obstructed access to international finance – including emergency funds.

Given these strengths and weaknesses, Cuba provides an interesting case study in responding to the current pandemic.

Cuba’s reaction to the coronavirus threat was swift. A “prevention and control” plan, prepared in January 2020, included training medical staff, preparing medical and quarantine facilities, and informing the public (including tourism workers) about symptoms and precautions. So, when the first three reported cases were confirmed on March 11, arrangements were in place to trace and isolate contacts, mobilise medical students for nationwide door-to-door surveys to identify vulnerable people and check for symptoms, and roll out a testing programme.

On March 20, with 21 confirmed cases reported, the government announced a ban on tourist arrivals, lockdown for vulnerable people, provision for home working, reassignment of workers to priority tasks, employment protection and social assistance.

As issues arose, the Cuban government adjusted its response. For example, when face-masks and physical distancing proved insufficient to keep public transport safe, services were suspended and state and private vehicles and drivers were hired to transport patients and essential workers. And to reduce crowding in shops, the distribution system was reorganised and online shopping introduced. Physical distancing enforcement has also been stepped up in response to instances of non-compliance.

With 766 reported cases by April 15 (68 cases per million of population), Cuba is around the middle of the range for Latin America and the Caribbean.

Latin America and the Caribbean: reported cases per million, April 13th 2020. World Health Organization

The quality of data varies hugely between countries, with some governments substantially under-reporting cases. Cuba’s reported cases are based on tests using WHO protocols. Two Caribbean neighbours, using similar methods, provide useful comparisons. The Dominican Republic, the most closely comparable in terms of population, income and tourism dependence, shows how the disease might have spread if measures had been less effective. In contrast, Jamaica seems to have succeeded in halting the spread of the disease.

Cumulative cases per million, Cuba, Dominican Republic and Jamaica. World Health Organization

Jamaica’s initial response was similar to Cuba’s, but fewer cases had slipped into the country undetected before tourism was halted. Having identified 16 outbreak clusters now, Cuban authorities are still struggling to prevent a take-off.

What happens next in Cuba will depend largely on the amount of testing. An indicator of commitment to this task is the ratio of tests to reported cases. According to available data, Cuba (with 18,825 tests done) leads the region with a ratio of 25:1, compared with 16:1 in Jamaica and 3:1 in the Dominican Republic. (Vietnam and Taiwan have over 100:1, Germany 10:1, US 5:1 and UK 4:1.) Around 40% of Cuba’s recent positive results are from asymptomatic cases.

If Cuba’s contact-tracing and testing regime gets the disease under control, its experience might offer lessons for controlling the pandemic, and more of its doctors will be available to help with the effort to combat the pandemic abroad.

But tests are expensive, at around US$50 each, so if its hard-fought battle against COVID-19 is prolonged, Cuba’s lack of access to finance could prove fatal.

[FireMedic]

Phenomenal read, sort of expected 

[DSegal]

Nice article. As with all of the Covid info, days matter, so it's hard to put anything in print and have it remain true and relevant a week later...what I think is so interesting about Cuba's response, aside from numbers and data, is that they seem to be taking a pretty transparent approach. Highly unlike their government. But they seem to be. I remember a few years ago thinking wow, they have no Zika, even as Zika was becoming common in the Caribbean. Of course later it became clear that Cuba was just not reporting. Here, they seem to be. No country really seems to have it totally under control, so I won't hold Cuba to a higher standard than any other country there...but being transparent and communicative is a hugely unexpected response for them in my opinion...

[alloy]

So Haiti and Nicaragua don't have any reported cases? I find that intriguing. Then why did they shut down the cigar factories? Preventive medicine? Are they back up?

[Monterey]

Did they ever shut down the cigar factories in Cuba?  Always see video of them really packed in those warehouses.

[Habana Mike]

49 minutes ago, alloy said:

So Haiti and Nicaragua don't have any reported cases? I find that intriguing. Then why did they shut down the cigar factories? Preventive medicine? Are they back up?

Haiti doesn't get many tourists so there's that....

[Isaac]

9 minutes ago, Monterey said:

Did they ever shut down the cigar factories in Cuba?  Always see video of them really packed in those warehouses.

I was there from the 11-18th and was told they were closed 

[Meklown]

Buy more cigars to help fund more test kits

[CaskStrength]

The less freedom people have, the easier it is to lock things down.

[Habana Mike]

1 hour ago, CaskStrength said:

The less freedom people have, the easier it is to lock things down.

Even in "free" countries it seems the lockdown is happening.

Controlavirus,,,,

[Nino]

Brilliant piece of Agit-Prop misinformation for the believers.

Reminds me of why Cubans ask for a "lie" when ordering a Cuba Libre.

As of last week cigar factories in HAV were open.

PS :

A more balanced and less pink-glasses toned article :
 

CUBA’S REPUTATION AS MEDICAL POWERHOUSE TESTED

Posted on April 9, 2020 by Arch Ritter

https://thecubaneconomy.com/articles/2020/04/cubas-reputation-as-medical-powerhouse-tested/

Marc Frank, Financial Times, April 5 2020

Cuba has long been proud of sending thousands of its doctors to work around the world as icons of socialist solidarity — and important sources of dollars.

But the coronavirus pandemic has given a communist government with a reputation as a medical power one of its toughest domestic challenges since Fidel Castro seized power six decades ago.

All but bankrupted by US economic sanctions, the Caribbean island nation is grappling with the threat posed to the oldest population in the Americas, where more than 20 per cent are aged over 60.

A severe outbreak of Covid-19 could also potentially threaten the domestic authority of a government whose comprehensive free healthcare system has been a pillar of the revolution’s success.

But the global outbreak has also created diplomatic opportunities, say analysts. The government has stepped up its overseas medical programme, sending doctors and nurses to help fight the virus in the Chinese city of Wuhan, where the pandemic began, as well as Italy, Andorra and elsewhere.

The strategy had long been a soft power play for the island, said Nicholas Watson, Latin America director at the consultancy Teneo, in a note. “[President Miguel] Díaz-Canel is not just looking to restore revenues that the program used to provide but to drive a wedge between the US and Europe over the medical assistance program.”

Cuba has so far reported close to 250 cases of Covid-19, mostly related to foreign visitors, and six deaths — an Italian and a Russian tourist and four Cubans. On March 20 it shut its borders, banned tourism and began implementing measures to curb the virus. This year’s May Day parade has been cancelled for only the third time since the 1959 revolution. Schools, bars and public transport between provinces have been shut down. Restaurants and stores remain open but with new rules on social distancing and hygiene, and all outside gatherings for festive purposes are banned.

Mr Díaz-Canel has appeared daily in the state-run media since the restrictions were rolled out, co-ordinating measures and urging citizens to take the threat seriously. “We have in our favour a public health system for all, a dedicated scientific community and an effective civil defence system, a party and a government that put Cubans at the centre of their attention,” he said in a nationwide address last month as he announced preliminary measures to contain the pandemic. “Serenity, discipline and collaboration, values that every Cuban has incorporated, can prevent the spread of the virus,” he added.

Paul Hare, a former UK ambassador to Cuba who lectures at Boston University’s Pardee School of Global Studies, said the country’s tight social control over its population would also aid the effort. But, he added, “the strains on the Cuban health service will show in equipment and resources”.

While Cuba still boasts the best health statistics in the region, including number of doctors and nurses per capita, many health facilities are in disrepair and there are scattered pharmaceutical shortages.

Cuba initially did little Covid-19 testing but is now conducting more than 500 a day — a fivefold increase since last month — after a donation of kit from China. The government has not said how many ventilators are available. Community-based doctors and nurses, as well as medical students, have been going door to door asking about recent travel, contacts with visitors from abroad and possible symptoms.

Suspected cases are swiftly quarantined in state facilities. Confirmed cases have been hospitalised and their primary contacts quarantined.

The measures appear to have drawn near unanimous support.

“I approve of the measures, though the government should have taken them earlier, especially closing the border like other countries did,” said Anaida González, a retired nurse from central Camagüey province.

The government is, meanwhile, continuing to promote its narrative of global solidarity. As well as sending personnel to virus-stricken nations, state media have broadcast extensive footage of passengers being rescued from the Braemar, a cruise ship that docked in Havana after being refused entry by other Caribbean nations, and images of a Cuban-run hospital in Qatar and nurses marching into hospitals in seven other Caribbean island nations.

Cuba earned $6.3bn from medical services exports in 2018, its biggest source of foreign exchange and twice as much as tourism, its second biggest export earner. It needs the money more than ever given the tourism shutdown.

“Tourism generates $3bn annually in desperately needed hard currency and keeps most of the nascent private sector in business,” said William LeoGrande, a professor and Cuba expert at American University in Washington.

“A prolonged closure will reverberate across the entire economy, producing a recession not quite on the order of the 1990s Special Period [following the collapse of Cuban ally the Soviet Union], but a close second,” he warned.

“The photos of the Cuban medical brigade arriving in Italy are an icon of the revolution’s epic of international solidarity,” said Bert Hoffman, a Latin America expert at the German Institute of Global and Area Studies.

“But this narrative will only function as long as Cuba can control the coronavirus situation on the island itself.”

 

 

 

[Nino]

PPS from Reuters :

April 8, 2020 / 5:49 PM / 9 days ago

 

https://www.reuters.com/article/us-health-coronavirus-cuba-economy-featu/cubans-cast-aside-coronavirus-fears-to-search-for-scarcer-food-idUSKCN21Q2C6

Cubans cast aside coronavirus fears to search for scarcer food

Marc Frank

HAVANA (Reuters) - From the seafront capital Havana to the foothills of the Sierra Maestra mountains, Cubans are defying fear of the new coronavirus to search for food as global trade disruptions worsen shortages of basic goods on the Caribbean island.

Residents of all ages are trudging from store to store in the country to locate scarce goods despite recommendations from health experts to stay at home and respect social distancing guidelines to avoid contracting the highly contagious disease.

Communist-run Cuba imports more than 60% of its food, but the pandemic has forced its government to close the borders, denying it the hard currency from tourism needed to pay for goods from overseas. The leisure industry accounts for 25% of the country’s foreign exchange earnings.

With shortages biting, many residents are using apps to swarm shops when coveted products arrive - from chicken and cheese to powdered milk and tomato sauce - creating long lines on the streets of Havana where police attempt to keep order.

While Cuba has faced scattered shortages ever since the collapse of the Soviet Union began in 1989, they have worsened since a decline in aid from socialist ally Venezuela and a tightening of decades-old U.S. sanctions under U.S. President Donald Trump.

Now they are intensifying as the pandemic compounds Cuba’s cash crunch and disrupts international trade and food prices.

“There is a queue for everything, products are scarce,” Havana resident Luis Alberto said as he waited in a line for chicken that stretched for more than 100 meters (330 ft).

Since the first coronavirus cases were logged on the island last month, authorities have closed the borders to people and called on Cubans to only go out if strictly necessary, always wearing face masks. Disinfectant has been included on the ration cards that residents use to obtain goods.

“No one is walking around except the family doctor and nurse,” Nuris Lopez, a hairdresser, said from a medium-sized town in the foothills of the Sierra Maestra in eastern Granma province.

“But when some ground meat finally arrived the other day everyone emerged from their homes in masks and lined up with a policeman keeping order,” she said.

‘PERFECT STORM BREWING’

President Miguel Diaz-Canel recently warned citizens they would be consuming less imported food “due to the current situation.”

When ships arrived last week with corn and rice, it was big news in the state-run media.

Cuba is not a member of the International Monetary Fund, World Bank or other multilateral lending institutions it could turn to for emergency funds.

Economy Minister Alejandro Gil has said the only solution is to “find in agriculture the main source of food for the people” but the sector is suffering an intensifying lack of inputs - like fertilizer and pesticides - partly due to U.S. sanctions.

“There is a perfect storm brewing. By May, the food situation here will be much worse,” a local agricultural expert said, requesting anonymity due to restrictions on talking with foreign journalists.

FOOD PRODUCTION IN TROUBLE

Cuba is famous for fighting epidemics and infamous for its centralized and unproductive Soviet-style agricultural system long since jettisoned by other Communist-run countries.

Many express faith in the former and not the latter.

“Cuba has the virus under control and I am sure it will stay that way,” said Emandez Maseo, a teacher in eastern Cuba. “At the same time, we are going into a critical situation, there is nothing in the markets and it is getting worse.”

Cuba has reported 396 coronavirus cases and 11 deaths, all but a few linked to travelers entering from abroad.

Much of the economy not related to tourism remains open, but it is hard to see agricultural production making up for lower imports.

Just 40% of normal fuel supplies and even less fertilizer and pesticides were used for the winter crop, according to the government. Planting began before the pandemic in November and harvesting ended in March.

The government has not reported on the results of Cuba’s most important growing season. Agriculture ministry official Yojan García Rodas told local radio that farmers were able to plant less than half the planned acreage of beans - a local staple - because they had to use oxen to till the land due to lack of fuel.

Speaking about a plague that wiped out much of the crop, Rodas said only 15% of the 22,000 hectares (54,000 acres) planted could be protected by chemical pesticides.

Luis Enrique Plutin, a farmer working the fields under a hot sun with fellow cooperative members on the outskirts of Havana, was phlegmatic.

“Through sacrifice and work we can produce something, but not much, for the population,” he said. “And we can continue to produce more, but imagine the difficulties we have.”

 

[dominattorney]

On 4/15/2020 at 11:31 PM, Habana Mike said:

Even in "free" countries it seems the lockdown is happening.

Controlavirus,,,,

So true. Our governor got all teary eyes when questioned about it and said "but we are doing it to save lives!"  

Let's be honest here. That may damn well be true. However, it is a convenient excuse to take away basic freedoms. The paradigm has changed yet again, and here we are. 

[helix]

39 minutes ago, dominattorney said:

So true. Our governor got all teary eyes when questioned about it and said "but we are doing it to save lives!"  

Let's be honest here. That may damn well be true. However, it is a convenient excuse to take away basic freedoms. The paradigm has changed yet again, and here we are. 

"convenient excuse to take away basic freedoms." Come on really ? This is not a conspiracy , this is a pandemic and the only way to deal with it is to stop the spread by social distancing like or not , be angry, but don't go all crazy thinking this some opportunity the Government is using to take away your freedom.

[dominattorney]

5 minutes ago, helix said:

"convenient excuse to take away basic freedoms." Come on really ? This is not a conspiracy , this is a pandemic and the only way to deal with it is to stop the spread by social distancing like or not , be angry, but don't go all crazy thinking this some opportunity the Government is using to take away your freedom.

I am not going to start a war with you over this, but I stand by my post. I make my living fighting the government, and am innately skeptical of any political overhaul "for my own good."  That said, I am not an idiot, nor a monster, as I believe my post clarifies that social distancing may be necessary to prevent the virus spreading more severely. My point is that I cannot hear a government official tell me they are doing something for my own good without having my gonzo radar flare up. Simple as that. They ran for office, I did not run for critic, but was simply born this way. 

[helix]

 

32 minutes ago, dominattorney said:

I am not going to start a war with you over this, but I stand by my post. I make my living fighting the government, and am innately skeptical of any political overhaul "for my own good."  That said, I am not an idiot, nor a monster, as I believe my post clarifies that social distancing may be necessary to prevent the virus spreading more severely. My point is that I cannot hear a government official tell me they are doing something for my own good without having my gonzo radar flare up. Simple as that. They ran for office, I did not run for critic, but was simply born this way. 

 Nothing wrong with some healthy skepticism .  Cheers.

[dominattorney]

1 hour ago, helix said:

 

 Nothing wrong with some healthy skepticism .  Cheers.

Cheers to you too buddy. Be well. 

[Cigar Surgeon]

On 4/15/2020 at 4:26 PM, alloy said:

So Haiti and Nicaragua don't have any reported cases? I find that intriguing. Then why did they shut down the cigar factories? Preventive medicine? Are they back up?

Nicaragua has cases, they're just being underreported as with a lot of countries.Haiti is going to be ravaged by Covid.

[Nino]

2 hours ago, Cigar Surgeon said:

Nicaragua has cases, they're just being underreported as with a lot of countries.Haiti is going to be ravaged by Covid.

Indeed Nicaragua has cases - and a useless gvmt that does nothing.

Here is a Human Rights Watch report on the Covid-19 crisis there :

https://www.hrw.org/news/2020/04/10/nicaragua-reckless-covid-19-response

(Washington, DC) – Nicaraguan President Daniel Ortega’s administration has responded to the COVID-19 pandemic with tactics that blatantly contradict global health experts’ advice and put people’s health and lives at risk, Human Rights Watch said today.

Ortega is the only Latin American leader who has not made a single public announcement on how his government would address the pandemic. Vice President Rosario Murillo, Ortega’s wife, told Nicaraguans to remain calm and continue working. The authorities have encouraged attendance at massive rallies and school and adopted only voluntary quarantine measures for people arriving from abroad.

“While the world faces the most serious pandemic in a century, President Ortega is nowhere to be seen and his government is recklessly failing to put in place the basic preventive measures recommended by public health experts,” said José Miguel Vivanco, Americas director at Human Rights Watch. “Ortega’s failure to take this crisis seriously puts the lives and health of Nicaraguans at risk.”
 

In a document obtained by local media in mid-March, the Health Ministry predicted that the number of COVID-19 cases could rise to over 32,500 and the number of deaths to 813 in a 6-month period. Such numbers could cause the collapse of the already frail health care system.

Nonetheless, the Ortega government has not taken any emergency measures in response to the pandemic and has kept schools open and allowed church services and events for tourists. Vice President Murillo has encouraged families to attend Easter festivities, although the Nicaraguan Episcopal Church and bishops advised vulnerable people to stay home.

Local sources have also reported that the government is discouraging Nicaraguans, including health workers, airport staff, and policemen, from wearing masks, and one activist said that pro-government groups have harassed those seen wearing them.

[Nino]

On 4/15/2020 at 11:04 PM, El Presidente said:

On March 20, with 21 confirmed cases reported, the government announced a ban on tourist arrivals, lockdown for vulnerable people, provision for home working, reassignment of workers to priority tasks, employment protection and social assistance.

For the record :

On March 5th the Cuban Ambassador to Italy was actively promoting tourism to Cuba under the banner that sun would kill bacteria.
 

On March 13th the Cuban Travel Organization was promoting tourism to Cuba under the - false news - banner that temps of 29 to 32C in Cuba would not replicate the Coronavirus in a UK advertising campaign on Twitter.

 

That was just a week before Cuba announced a ban on tourism arrivals and closed off its borders.

So much for medical or scientific "national emergency planning" by the Cuban gvmt..