By Luke Taylor
As coronavirus cases soar in the US, Brazil and other countries in the Americas, some countries have found strategies to contain the virus and limit deaths.
More than 5 million confirmed cases of covid-19 and nearly 250,000 related deaths have been reported in the Americas as of 29 June, around half of the world total. The coronavirus is spreading exponentially in many countries, warned Carissa Etienne, the director of the Pan American Health Organization (PAHO) on 9 June.
But in a few places, the picture is very different. Cuba, an island of 11.3 million people is an unlikely exemplar of how to manage a pandemic, according to Michael Bustamante at Florida International University. Its infamously long queues for state-provided goods make social distancing and self-isolation difficult, he says, and the country’s healthcare system, “suffers from scarcities and material shortages that are characteristic of the Cuban economy as a whole”.
One particular concern was that Cuba’s ageing population – the oldest in the Americas – would be hit hard when the first case of covid-19 arrived from Italy on 11 March.
Even so, it had reported just 2348 confirmed cases and 86 deaths as of 1 July.
What the health system lacks in materials, it makes up for in workforce – it has the highest doctor-per-patient ratio in the world, 8.19 per 1000. By comparison, Brazil has 2.15, and the US 2.6.
Before the first reported case, Cuba’s government dispatched teams of doctors, nurses and medical students door-to-door asking about respiratory symptoms and educating the public on the disease. It sent suspected covid-19 cases to state-run isolation centres and traced all their recent contacts.
“A really strong primary healthcare system has been a major player in controlling the outbreak,” says Alcimar Perez-Riverol at São Paulo State University.
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The government should also be credited for acting early, says Perez-Riverol. “They were preparing the whole system for diagnostics two months before the first case was detected,” he says.
Unlike Cuba, Uruguay hasn’t been able to count on an authoritarian government to stem outbreaks. It also has land borders, including a busy border with Brazil, South America’s coronavirus hotspot with more than a million reported cases to date.
Yet Uruguay had reported only 936 cases and 27 deaths as of 1 July. That equates to 264 cases and 7 deaths per million inhabitants, compared with 6370 cases and 285 deaths per million in Brazil.
Perhaps surprisingly, Uruguay never enforced a mandatory quarantine. When the country’s first case of covid-19 was confirmed on 13 May, president Luis Lacalle Pou closed borders and schools and cancelled public events. Pou also declared a “voluntary quarantine”, asking the public to isolate if possible.
“The Uruguayan government did not have to demand that people self-isolate – they did it themselves,” says Giovanni Escalante, World Health Organization (WHO) representative to Uruguay.
The government also undertook aggressive testing measures and rolled out a contact-tracing app from which home visits and tests can be requested.
Like Cuba, it responded early. Uruguay’s government asked the WHO for best practice on testing and for lessons learned elsewhere, says Escalante. It also increased the number of testing laboratories from one to 25 and sent scientists to Brazil for training.
Uruguay had conducted 162 tests per new case of covid-19 as of 26 June, the highest number for any country in South America.
Various lessons should be learned from its response, says Escalante, not least the importance of clear messaging. “There was a good communication strategy and only one message,” he says.
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