Cuba managed to navigate the first waves of the coronavirus pandemic thanks to a strict quarantine and a public health system that, although hit by many shortages in recent years, remains stronger than its counterparts in many of its Caribbean neighbors. But a new wave of cases has cast a spotlight on the lack of resources lashing the island’s hospitals.
Doctors in cities like Cienfuegos say the shortages of PCR tests and personal protection equipment have put them at risk. In Havana, the number of patients in hospitals has been rising, and the government says it is adding ICU beds. Health professionals say they are concerned about a shortage of medical workers to help care for COVID-19 patients.
“We have pediatricians, endocrinologists, nephrologists, surgeons and nurses sick with COVID,” said a doctor who works at the largest hospital in Cienfuegos and asked not to be named, for fear of reprisal. “The situation in the hospitals is critical because we’re collapsing under the weight of patients, and almost without tools to work appropriately.”
During the months last year when the island closed its borders, Cuba reported one of the lowest levels of infections in the region. But the number of cases began to rise after international flights resumed in November — with no requirement to show a negative test.
The public health system, frequently held up by the government as a key achievement of the revolution, is now being pushed to its limits by the pandemic.
“The Cuban public health system is under one of the most severe tests in its history,” said Julio César Alfonso, a Miami doctor who heads Solidarity Without Borders, which helps Cuban medical personnel enter the U.S. health system and is in frequent contact with those on the island. “With shrinking resources and personnel, the typical government lack of transparency that does not allow an understanding of its data, it is the Cuban people who wind up paying for the broken china.”
Statistics from the Cuban Public Health Ministry, the only entity that publishes COVID-19 data, show 15,168 cases were reported in January alone, more than the total reported in all of 2020. Dr. Francisco Durán, national director of epidemiology, said at a news conference last week that mathematical models show the number will continue to rise this month.
The government has blamed visitors from abroad for the virus, and recently reduced the number of international flights even further, while also now requiring arrivals to show a negative test and quarantine on arrival. But the virus has quickly spread around the country’s three largest cities — Havana, Santiago de Cuba and Villa Clara. Authorities have complained that Cubans lack discipline and have been relaxing their personal protection habits.
Many Cubans say they worry that long lines for food, family gatherings and political activities organized by the government could also be playing a role in the spread.
“There’s practically no food in the stores. The farmers’ markets are empty. People wait in line for days to buy frozen chicken. There’s nothing, not even in the dollar stores,” said Caridad Mena, 40, who makes ends meet selling cigarettes in Santiago, the island’s second-largest city.
“Who could expect anyone, with all that heat at one in the afternoon, to keep a mask on in Santiago? Police want to enforce social distancing, but there’s no way to control people. And there’s not even any chlorine to wash one’s hands with,” she added.
Havana is the current epicenter of the pandemic, with more than 2,000 cases reported since the beginning of February.
On Jan. 23, the capital’s hospitals were at 76.7% capacity with 2,126 patients, according to local authorities quoted in the Tribuna de la Habana, an official newspaper in Cuba. Four days later, the number rose to 2,734. Back in September, there were less than 300.
City officials in Havana are expanding the number of intensive care beds for COVID-19 patients, the president of the Provincial Defense Council, Luis Antonio Torres Iríbar, said in a meeting last week covered in the local press. Havana had 62 ICU beds available for serious virus cases, and was expected to add 59 medium-care beds, he said.
The rapid increase in the number of reported cases has forced the government to open temporary hospitals in schools and universities. But local officials and five doctors interviewed by el Nuevo Herald expressed concern about not being able to fully operate COVID-19 treatment centers because of staff shortages. Doctors also complained about risky work conditions.
Some of the doctors said they received only one disposable gown per day. There also are not enough disposable gloves or masks, so they must reuse the ones they have. Neither doctors nor patients have enough soap to wash their hands, several doctors in Cienfuegos said.
“The health clinics in Cienfuegos have become a transmission vector for the virus,” said one doctor who works in a clinic for COVID-19 patients and spoke on condition of anonymity because he was not authorized to discuss conditions inside.
The government has said little about the number of health workers infected with the virus, but local media occasionally publish figures. At least 40 such cases were reported in May at a provincial hospital in Matanzas, east of Havana. The government blamed the outbreak on a “lack of discipline” by the personnel, but a number of doctors said it was the result of the lack of protective gear and bad sanitary conditions.
Cuba announced the first COVID-19 death of a doctor late last month, but several health workers said they don’t trust the official figures, with one asserting that some of those who die from the virus have their cause of death listed as “acute respiratory disease” or another ailment instead.
Pressed by a Santiago TV journalist, Ricardo Manuel Lahera, the director of the provincial Sanitation and Epidemiology Center, acknowledged that some deaths linked to COVID-19 had not been officially reported. Lahera justified the omission by saying that patients who are admitted to hospitals with a COVID-19 diagnosis and die from complications are not included in the list of virus deaths if they no longer test positive before passing.
During a separate interview last week on a provincial television station, Tele Turquino, Lahera said 176 health workers had been infected with the virus during the recent outbreak in Santiago, 70 of whom got it “during the exercise of their profession.” Separately, Havana officials reported in a meeting on the pandemic that there were 50 reports of infected healthcare workers “during the day,” at the Salvador Allende, Manuel Fajardo and San Miguel Pediatric hospitals.
The Cuban health system’s troubles are not new. They are the result of not only a sharp economic crisis but also budget cuts, the emigration of medical personnel, staff reductions in the primary care system and a government program that deploys thousands of doctors, nurses and technicians to work abroad — meaning there are fewer back home.
The Cuban government’s main source of hard currency is the medical personnel it hires out to countries around the world, earning about $6 billion per year, according to the latest available official figures. Even as the pandemic lashes the island, the government actively has sought to send doctors and nurses to dozens of countries and set aside part of its domestic production of medicines for export.
As the export of medical personnel rose from 2008 to 2018, the staff in the domestic public health system plunged by 22%, according to figures published by the National Office for Statistics and Information. The cuts in the system have long worried experts like Cuban American economist Carmelo Mesa Lago, who warned in a report in May that they could aggravate the COVID-19 crisis on the island.
What’s more, shortages of many medicines have also grown sharper amid the pandemic. A pharmacy employee in Camaguey last week told a local TV station that she had regular shortages of 111 medicines during January. The hardest hit categories were antibiotics, painkillers and antihistamines. When new supplies do arrive, they are more expensive because the government increased prices in January as part of a currency reform and an effort to eliminate subsidies.
Many Cubans also have complained on social networks about delays in taking PCR tests, getting the results and transporting COVID-19 patients to hospitals, problems that government officials in some provinces have acknowledged publicly.
Katiuska Ordoñez said the local hospital center in the eastern city of Holguin where she and her nephew went for care was clearly stressed, but she nonetheless praised the doctors who treated them. Her relative tested positive, while she was negative.
“The quarantine center was very deteriorated and there was little food, but the doctors always took good care of us,” she said.
Daniel Epstein, a spokesman for the Pan American Health Organization, the Americas branch of the World Health Organization, said Cuba is one of the 34 countries that has acquired test supplies from the agency’s strategic stockpiles. Durán, Cuba’s epidemiology chief, has said the island has 20 laboratories that can process the tests.
But the island’s capacity to perform PCR tests is limited. Although the number of positive cases reported since early January jumped by about 80%, the number of daily tests conducted rose by only about 40%, or about 7,000 tests more. The average number of tests per day currently stands at about 18,000. BioCubaFarma, a government-owned pharmaceutical company, has announced it will increase its production of the swabs used in the tests.
A doctor at the pediatric hospital in Cienfuegos also reported a shortage of PCR tests for children who are to be admitted or undergo surgery.
“The health staffers are running a high risk,” said the doctor, who like the others interviewed spoke on condition of anonymity, for fear of retribution. “The government’s penchant for keeping everything secret does not help to understand the real dimension of this crisis.”
