14ymedio, Havana, 21 April 2020 — The official press has revealed this Tuesday a strong outbreak of coronavirus that afflicts an old age care home in Santa Clara. According to Cubadebate, it is the largest outbreak in the country, with 57 positive cases — 44 residents and 13 workers — one deceased, and 148 contacts of isolated employees.
The danger of massive contagion occurring in these settings is very high and is behind the great lethality in several European countries, such as Italy, Spain and France, where investigations are being opened to clarify the failures in the management of some centers.
The commission that studies the origin of the infection hypothesizes that the responsibility lies with a doctor and a nurse who tested positive for Covid-19 and probably underestimated their symptoms.
“Perhaps they did not believe that it was something serious or that they should not be absent and affect others, because it was resolved immediately, but the truth is that they failed to comply with the guidelines to stay home in the face of any suspicion of illness,” said Neil Reyes Miranda, director of Hygiene and Epidemiology in Villa Clara.
The alarm went off when a patient admitted to the Arnaldo Milián Castro hospital tested positive on Sunday, April 12, and, following her contacts, several asymptomatic positives were found in the home. Three days later there were already 17 cases, twelve of them over 60 years old and the rest were workers. Later, the cases have increased until reaching the current figures, which are current to April 20.
The infected are distributed among the Military Hospital, where there are 16 patients, two of them serious; and the Oncological Celestino Hernández, in which the others remain, all stable so far.
Manuel Togoso Alcántara, director of this center, indicated that those affected receive “treatment with monoclonal antibodies and other medications to avoid torpid changes” and other conditions typical of hospitalization, such as pneumonia, thromboembolism and bedsores.
Carlos Hidalgo Mesa, chief of these patients at the Military Hospital, explained that there are currently no cases of pneumonia or bedsores and that patients also receive injected vitamins as part of care.
“Many came here with underlying diseases, an element that called for more personalized attention. So we strengthened the teams and increased the number of doctors per shift by one to three, while increasing the number of nurses from two to five. Likewise, we increase surveillance and visit every six hours, although we take vital signs every four if there is no abnormal situation,” he said.
In the isolation center of the province, opened in the Marta Abreu special school, 79 elderly people remain who have not tested positive. Meanwhile, domestic workers who are infected or isolated are in good condition and have not required treatment to date, but they are quarantined in various hospitals, as are the 148 contacts associated with them.
Dr. Rodolfo Ramírez Álvarez, who runs the Marta Abreu isolation center, said that interferon is being supplied by the nasal route to the elderly to “strengthen the immune response to possible infections.”
Some studies carried out in Madrid and Boston warn that interferon could be counterproductive by accelerating the production of two proteins that act in two directions, since although they protect the tissue, they also serve as a gateway to the virus, facilitating invasion. The analyses are not yet conclusive, but they raise fears that the Cuban “miracle” will do more harm than good.
The dangers to old age homes in Cuba are not just that health personnel or other employees carry the virus and spread it to residents. In the Alfredo Gómez Gendra old age home, on Reina street, in Centro Habana, residents coexist with other elderly people who spend some of their time in the premises and some outside. Most come from families with serious financial problems that cannot guarantee their food. “We have old people who spend a few days here, especially to have access to lunch and food, but they go outside and sleep for a few days at home,” a local employee who preferred anonymity told 14ymedio.
“We have tried to reduce to the maximum those entrances and exits but it is difficult because also many of them take advantage when they go out to the streets to make some money selling newspapers and other things, or visit a friend who gives them some food,” adds the worker. “Then they come with bags with food or with clothes that are given to them and that they need here.”
Care home personnel are on notice and have instituted a disinfection method for everything that comes from outside, particularly because they are located on one of the most populous and deteriorated streets in the Cuban capital. “Many people pass through this sidewalk every day, the hygiene around it is not good and there are many tenements where families live on top of each other, so we are in a high-risk area.”
Along with the material problems suffered by all old age homes on the Island, the difficulty of finding cleaning personnel is another aggravating factor in times of coronavirus. “They are not interested in the wages, even if they are given some bonus of hygiene products or food on top every month,” acknowledges the employee. “Getting people to keep the floors, bathrooms and the place clean is the hardest thing right now.”
In Europe there is a strong suspicion that the beginnings of outbreaks of coronavirus in nursing homes are behind the high lethality in Spain and Italy. These countries are, along with Japan, those with the highest life expectancy and very aged population pyramids.
In Spain, mortality from coronavirus in those under 60 years of age is 1%. The figure increases to 5.2% between the ages of 70 and 79 and reaches 17.9% in those over 80. Nearly 12,000 people have died in these centers, almost half in Madrid. The seriousness of the situation has led the authorities to close residences in poor condition and open investigations to clarify responsibilities.
A similar situation has occurred in Italy, where there are about 7,000 elderly people who have died in residences, double the number that were initially counted. More than 600 centers are being investigated and about 17% have irregularities. In both countries, management is decentralized in the regions, which has added complications in determining the magnitude of the tragedy.
France also has a good number of cases of deceased elderly in institutions, with the number exceeding 7,000. Of the confirmed cases throughout France as of April 16, more than half, 56,180, were in these centers. As in the previous cases, the control through testing and intervention of the security forces of the state has tried to redirect a situation out of control.
United Kingdom, Germany, Belgium, Holland… in all European countries, all heavily aged, the same pattern is repeated. Cuba, the country with the oldest average age in the Americas, faces the possibility that outbreaks like that of Santa Clara will escalate the disease on the island.
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