The COVID-19 pandemic exhibits different characteristics in each country, related to the extent of SARS-CoV-2 local transmission, as well as the speed and effectiveness of epidemic response implemented by authorities. This study presents a descriptive epidemiological analysis of the daily and cumulative incidence of confirmed cases and deaths in Cuba from COVID-19 in the first 110 days after first-case confirmation on March 11, 2020. During this period, 2340 cases (20.7 x 100,000 population) were confirmed, of which 86 patients died (case fatality 3.67%; 52 men and 34 women). Mean age of the deceased was 73.6 years (with a minimum of 35 years and a maximum of 101), with the average age of men lower than that of women. More than 70% of all deceased had associated noncommunicable diseases. The incidence curve ascended for five weeks and then descended steadily. The average number of confirmed cases and deaths for the last week included (June 23–28, 2020) were 25 and 1 respectively; the curve always moved within the most favorable forecast zone of available mathematical models and the effective reproductive number fell below 1 after the fifth week following the onset of the epidemic.

We present the prevention and control measures implemented during this period—some unique to Cuba—and assess their effectiveness using two analytical tools: comparison of observed deaths and confirmed cases with those predicted by mathematical models; and estimation of the effective reproductive rate of SARS-CoV-2. Some distinctive features of this strategy include nationwide door-to-door active screening for individuals with fever and/or symptoms of respiratory distress, isolation of cases and quarantine of contacts of confirmed cases and of persons suspected of having the virus. During this period, Cuba’s response to the epidemic was successful in flattening the curve and limiting transmission, resulting in fewer cases and a lower number of subsequent deaths.

KEYWORDS COVID-19, SARS-CoV-2, epidemiology, pandemic, emerging infectious disease, contact tracing, patient isolation, Cuba

The Adelaide Statement on Health in All Policies (2010), lays out equity-based principles designed to guide policymakers on incorporating health and well-being components into the development, implementation and evaluation of policy and practice while moving towards shared governance at all levels—local, regional, national and international. Special emphasis is placed on cross-sector coordination to achieve policy goals, while improving health and well-being for all.[1]

In Cuba’s case, experience in disaster preparedness, particularly for hurricanes, has shown good cross-sector coordination.[2] Zika serves as another recent example. First identified in Uganda in 1947, Zika, an emerging disease with outbreaks in Africa, Asia, the Pacific and the Americas and linked to neurological disorders in newborns, was declared a global health emergency by WHO on February 1, 2016.[3] In response, Cuba further stepped up measures for surveillance, prevention and control it had already announced in December 2015. Building on decades of experience fighting dengue, intensified efforts to stamp out Aedes aegypti and albopictus, the mosquitoes that transmit Zika (as well as dengue, chikungunya and yellow fever), and issued a national 11-point Zika Action Plan to prevent, detect and respond to these arboviral infections.

Over 700,000 cases of cholera were reported in Haiti between October 2010 and February 2015. In November 2011, the Cuban Medical Team serving in Haiti established a laboratory-supported sentinel surveillance system for cholera in 10 public hospitals (one in each of Haiti’s 10 departments), to estimate the proportion of hospitalized patients with cholera and detect emergence of new Vibrio cholerae serotypes. Each month, the first ten stool samples collected from patients admitted with acute watery diarrhea were studied in all hospitals involved. Surveillance system findings from November 1, 2011, to October 30, 2012 showed that acute watery diarrhea was caused by V. cholerae serogroup O1 in 45.9% (210/458) of patients: Serotype Ogawa was found in 98.6% of this isolates (207/210) and serotype Inaba in 1.4% (3/210), indicating low circulation level of the latter in Haiti. Continuing laboratory sentinel surveillance of V. cholerae is needed to monitor the spread of the disease and prevent and contain outbreaks, particularly of new serotypes. It is important to ensure that these findings are systematically integrated with data available to MSPP from other surveillance sources.

KEYWORDS Vibrio cholerae, serotype Inaba, serotype Ogawa, epidemiological surveillance, medical cooperation, Haiti, Cuba

Translated from the Spanish and reprinted with permission from the Revista Cubana de Higiene y Epidemiología, Vol 48 No 18, Jan–Apr 2010.
Original available at: http://bvs.sld.cu/revistas/hie/vol_48_1_10/hie02110.htm

ABSTRACT

OBJECTIVE Determine point prevalence of febrile syndromes and compare with prevalence reported by habitual clinical and seroepidemiologic dengue surveillance system in Havana City.

METHODS In October 2007, a descriptive, cross-sectional study was carried out in a representative sample, calculating prevalences of febrile syndromes and undifferentiated febrile syndromes. Chi-square analysis was used for rate comparisons.

RESULTS Point prevalences of febrile syndromes and undifferentiated febrile syndromes were 352.6 and 144.2 times greater, respectively, than those reported by the habitual clinical and seroepidemiologic dengue surveillance system; these differences were statistically significant (p < 0.001).

CONCLUSIONS Point prevalence of febrile syndromes was far greater than prevalence reported by the habitual clinical and seroepidemiologic dengue surveillance system, an indication of underreporting.

KEYWORDS fever, undifferentiated fever, dengue, dengue fever, dengue/epidemiology, seroepidemiologic studies, Cuba

The rapid aging of Cuba’s population is garnering greater attention due to its foreseeable and profound economic and social repercussions. This is no wonder: by the end of 2009, 17.4% of Cuba’s 11.2 million people were 60 years or older, and this trend is accelerating. By 2030, some 31% of Cubans are expected to reach this age group, making the country the “oldest” in the Americas.[1]

Among the complex implications of this process for Cuba’s future are dilemmas arising from the health transition that accompanies the demographic one. In particular, with life expectancy nearing 80, people are living longer, meaning more people in the age groups most prone to disease and disability, with resulting consequences for the economy, labor force productivity, pension schemes, and design and costs of health care delivery.