Ian Powell: Cuba’s Fight Against Covid-19 Is Impressive, Even Compared To NZ’s

Health commentator Ian Powell – formerly the Executive Director of the Association of Salaried Medical Specialists – visited Cuba earlier this year, learning about their health system, and says the country has now done extremely well in combating Covid-19, especially given the attempts by their neighbour to undermine their very existence.

The United States has continued a devastating economic war with Cuba since 1959. No other country in the world has faced this for so long. Officially the US calls it a blockade but let us call a spade a spade. It is economic warfare. The war abated towards the end of the Obama presidency but became more severe under Donald Trump. In a manner consistent with his cruelty this warfare further intensified with the outbreak of Covid-19.

From afar it is difficult to comprehend the impact of this warfare because of its extreme and unusual nature. Where the United States is bigger than Goliath and Cuba smaller than David, it would have been reasonable to expect that Covid-19 would have wrecked the small island country at least as much as it is wrecking the United States. But Cuba is one of the small number of better performing countries (although the only one with a huge neighbour doing its best to destroy its economy).

New Zealand has been rightly acclaimed internationally and domestically for achieving elimination of community transmission. It is difficult to compare the responses of Cuba and New Zealand because only one of them suffered such a protracted vindictive economic war. I know from my own visit to Cuba in January, which included a polyclinic in Havana providing community and less complex hospital care, that this economic warfare has had a huge effect on the provision of medicines and medical equipment supplies. This is an ongoing struggle of a magnitude that countries like New Zealand have not experienced.

Cuba’s health system

Right from the early days of the Cuban revolution the country gave the highest priority to the health of the population along with education and culture. Having a universal public health system the government was able to lead a unified rather than fragmented strategy to deal with Covid-19.

Unlike many universal public health systems, Cuba’s has had a sharp appreciation of the importance of workforce capacity in such a labour-intensive sector. According to WHO (2016-17 data) Cuba is the world leader for medical doctor-to-population ratio at 82 per 10,000 compared with 26 in the United States and 30 in New Zealand. This enables it to send medical missions to many other countries (over 90). Even during Covid-19 it had the capacity to send missions to assist 60 countries.

To enable this workforce investment Cuba spends a higher proportion of its Gross Domestic Product on healthcare than any other country in its region. Despite economic warfare Cuba’s life expectancy is higher than the United States. Whereas 30% of people living in Latin America and the Caribbean have no access to healthcare because of financial reasons, all Cubans are covered at no charge. Its strong emphasis on prevention also made it well-placed to cope with the virus.

Cuba’s Covid-19 experience

Cuba’s economy is heavily dependent on tourism which might have affected its decision to close its border a little later than most countries in its region. It was closed on 20 March, the same day as New Zealand. But since then it has given all that it has got in the fight to defeat the vicious virus.

The Caribbean island has a population of over 11.3 million, more than twice New Zealand’s 5 million people. As of 5 July, according to the World Health Organisation (Situation Report 167), Cuba had 86 deaths of which nearly 50 were more than 70 years old. The Cuban population is one of the oldest in the Americas and around 25% of the population were identified as being at risk.

New Zealand had 22 deaths (all elderly and the majority in rest homes). Per capita New Zealand has done better but this is statistically insignificant especially given the cruel American economic war against Cuba.

The WHO data (18 July) also shows that Cuba had 2,445 confirmed cases of Covid-19 compared with 1,550 in New Zealand. On 18 July itself Cuba had 4 new confirmed cases compared with 3 in New Zealand today. Per capita there is little difference.

WHO categorises its Covid-19 confirmed cases in 2 main groups – the more serious ‘community transmission’ and the more positive ‘clusters of cases’ (there is also a third less common category of ‘sporadic cases’). Both Cuba and New Zealand are categorised as ‘clusters of cases’. Even the well-performing Iceland is still categorised as ‘community transmission’.

How Cuba responded

The Cuban health system was fully mobilised to respond. The structure, capacity and culture of the health system enabled this. Tens of thousands of doctors, nurses and medical students were redeployed to screen all homes (test and contact trace). In the case of the 28,000 medical students in Cuba, all were required to participate in these home visits if they were to graduate.

These home visits involved walking for hours, Monday to Sunday, until the job was done. No other country has been able to do this. But Cuba was well-placed because every year the health system mobilises to visit every home for immunisation. Cuba’s polyclinic system is fit for purpose because of its strong community base.

There are nearly 500 polyclinics across the island each serving defined populations of between 20,000 and 60,000 people (almost like large neighbourhoods). They have similarities with New Zealand’s smaller DHBs such as Tairawhiti, Wairarapa and West Coast (a little smaller than Whanganui and South Canterbury). It means that they know their populations well and most likely better than most of our DHBs.

Cuba’s workforce capacity, community based health system, and culture enabled suspected virus carriers to be relocated in state-run ‘isolation centres’ usually for 14 days. Cubans who wished to move to another part of the country to live during the shutdown were quarantined in an ‘isolation centre’ until tested and cleared. Although severe and rigid, there was sufficient public recognition that these ‘isolation centres’ were the right approach because it was seen to be for the common good.

In contrast, the United States and European countries didn’t set up ‘isolation centres’ because of a lack of social acceptance or negative public perceptions even though they are more effective than home isolation. It was interesting to note the advocacy of something similar to this recently by a public health specialist in Melbourne. This Cuban acceptance also extended to the mandatory wearing of masks in public.

A job well done

Both New Zealand and Cuba have done extremely well in confronting coronavirus. We have achieved elimination. Cuba has not but initially through containment it is well on the way to achieving this objective. Further, through superior workforce capacity and the structure of their health system, ability to test and contact trace expeditiously is superior.

Even when facing continued economic warfare and in the absence of a vaccine, the Cuban experience confirms that the combination of quick identification of cases (testing), contact tracing and quarantine are the only way to contain the virus on route to elimination.

Ian Powell was formerly the Executive Director of the Association of Salaried Medical Specialists for over 30 years until December last year. He is now a health commentator, editor of the blog ‘Otaihanga Second Opinion’, and based in Otaihanga on the Kapiti Coast.

This article has been republished under a Creative Commons CC BY-ND 4.0 license. Original link is here. 

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