To The Editors: Related to my earlier publications on central nervous system involvement in COVID-19,[1,2] I would like to stress the importance of diagnosing obstructive sleep apnea syndrome (OSAS) in infected patients, prompting early use of continuous positive air pressure (CPAP) to prevent hypoxemia. OSAS is commonly related to obesity, which is considered an important […]
Three fourths of the 175 staff at Cuba’s National Medical Genetics Center (CNGM) are women. And women constitute 90% of the research team working on the Center’s largest current project—unlocking the biological secrets of COVID-19 in the Cuban population. They are identifying particularly vulnerable groups and geographies, reviewing therapies applied and long-term sequelae of the […]
To the Editors: We write to share the experience in COVID-19 transmission control at our hospital, National Center of Minimally Invasive Surgery (CNCMA) in Havana, Cuba. The institution is the national reference center for application, training and research related to minimally invasive surgical procedures.[1] From April through October, 2020, 719 surgeries were performed and 3529 […]
It is unclear why we constantly need reminding, but COVID-19 serves as a blatant reminder of the importance of international scientific cooperation—this should include cooperation between political rivals. In the case of Cuba and the United States, this might again be possible with the new US President, Joe Biden. Globalization, climate change and social determinants […]
On March 23, 2020, Cuba’s Henry Reeve Emergency Medical Contingent began treating COVID-19 patients at Maggiore Hospital in Crema, Lombardy. Within days, the 52-member contingent comprised of 36 doctors and 15 nurses (plus 1 logistics specialist), together with Italian colleagues, were receiving patients in an adjacent field hospital established and equipped for this purpose. At […]
To the Editors: As the latest issues of MEDICC Review reveal, the global scientific community is fully engaged in unraveling the mysteries of COVID-19, including its relationship to chronic conditions such as diabetes mellitus (DM), a frequent comorbidity with SARS-CoV-2 infection. Various studies report up to 30% of persons with COVID-19 are diabetic,[1] and such […]
The 2020 fall semester at Havana’s Latin American School of Medicine (ELAM) began on an especially somber note: honoring 17 of its alumni felled as they battled COVID-19 in their home countries and beyond. A few were recent graduates among the 30,047 from 118 countries who received scholarships from Cuba to study medicine at ELAM. […]
Despite fast-tracked research, the precise origin, transmission and evolution of COVID-19 are still unknown. While the bat genus Rhinolophus is likely the primary source of the zoonotic-origin pathogen SARS-CoV-2 that causes COVID-19, its transmission route into the human population is still being studied.[1,2] Coronaviruses (CoV) affect humans and various animal species. Bats were the original […]
COVID-19 has dominated the conversation this year. Following the first outbreaks in December 2019, it became clear that older adults were predisposed to greater disease severity and death. What occurred in nursing homes across Europe and the Americas was brutal—as much for the older adults themselves as for their families. Many didn’t even get to […]
A perplexing clinical aspect of COVID-19 is presentation of patients with pronounced hypoxemia without expected signs of respiratory distress or dyspnea, even when cyanotic. Nonetheless, these patients frequently leapfrog clinical evolution stages and suffer acute respiratory distress syndrome (ARDS), with concomitant cardiorespiratory arrest and death.[1] This phenomenon is referred to as silent or ‘happy’ hypoxemia.[2–5] […]
At first, COVID-19 was thought to be primarily a respiratory disease, progressing in some patients to serious respiratory symptoms, pneumonia, severe respiratory distress syndrome and even death. Later analysis revealed entire systems were compromised, affecting other vital organs, including the kidneys, and a correlation was observed between chronic kidney disease (CKD) and COVID-19 severity.[1,2] This […]
To the Editors: The Cuban Ministry of Public Health’s Protocol for Attention to COVID-19 Patients establishes that case confirmations are determined by positive virological tests of persons with and without symptoms.[1] These studies are carried out for SARS-CoV-2 by real-time polymerase chain reaction (RT-PCR) in specimens of respiratory mucosa collected via nasopharyngeal swab. The Protocol […]
If all physicians are detectives, using their skills to track down what ails body and mind, then epidemiologists are medicine’s social detectives, using their training to understand the great calamities of population health. For over 30 years, Dr José Moya has worked in the field since his initial position as head of epidemiology in Ayacucho, […]
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
Virologist Dr María Guadalupe Guzmán is recognized as a global leader in dengue research and heads the Pedro Kourí Tropical Medicine Institute’s work as a WHO/PAHO Collaborating Center for the Study of Dengue and Its Vector. The Institute (IPK) was founded in 1937 and is now Cuba’s national reference center for the diagnosis, treatment, control […]
BACKGROUND The novel coronavirus SARS-CoV-2 is responsible for the current global pandemic. There is a concerted effort within the global scientific community to identify (and thereby potentially mitigate) the possible modes of transmission through which the virus spreads throughout populations.
OBJECTIVE Summarize the ways in which SARS-CoV-2 is transmitted and provide scientific support for the prevention and control of COVID-19.
EVIDENCE AQUISITION We conducted an extensive literature search using electronic databases for scientifi c articles addressing SARSCoV-2 transmission published from December 28, 2019 through July 31, 2020. We retrieved 805 articles, but only 302 were included and discussed in this review. The report captured relevant studies investigating three main areas: 1) viral survival, 2) transmission period and transmissibility, and 3) routes of viral spread.
DEVELOPMENT Currently available evidence indicates that SARSCoV-2 seems to have variable stability in different environments and is very sensitive to oxidants, such as chlorine. Temperature and humidity are important factors influencing viral survival and transmission. SARSCoV-2 may be transmitted from person to person through several different routes. The basic mechanisms of SARS-CoV-2 transmission person-to-person contact through respiratory droplets, or via indirect contact. Aerosolized transmission is likely the dominant route for the spread of SARS-CoV-2, particularly in healthcare facilities. Although SARS-CoV-2 has been detected in non-respiratory specimens, including stool, blood and breast milk, their role in transmission remains uncertain. A complicating factor in disease control is viral transmission by asymptomatic individuals and through what would otherwise be understood as innocuous human activities.
CONCLUSIONS This article provides a review of the published research regarding human-to-human transmission of SARS-CoV-2 and insights into developing effective control strategies to stop viral propagation.
KEYWORDS COVID-19, SARS-CoV-2, transmission, pandemics, microbial viability
