Cuban civil defense teams keep swine flu at bay

October 3, 2009
Cuban civil defense teams keep swine flu at bay
By JAMES ANDERSON Associated Press Writer
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Cuba is ready to use just about everything at its disposal, from its
well-oiled civil defense system to the soldiers of a totalitarian
government, to keep swine flu cases to a minimum.

Everything but a vaccine.

As the U.S. prepares an extensive health survey for side affects from its
massive inoculation plans, Cuba's No. 2 health official says relying on a
shot to contain a world pandemic is risky as best - and demoralizing at
worst.

"Nobody knows if it would work," Dr. Luis Estruch told The Associated Press
in an interview. "How safe would it be?"

Cuba's sophisticated public-monitoring system and geographic isolation as an
island have kept swine flu cases to just 435 in a country of 11 million -
and no deaths to date. That's roughly one in 25,000 people, compared with
one in 6,900 in the U.S. and one in 4,000 in Mexico.

Swine flu plans for the new season involve all ministries, including the
armed forces. If necessary, the government will isolate neighborhoods or
entire villages, shut down highways and dispatch medical teams to
communities affected by swine flu, Estruch said.

Soldiers can go door-to-door to enforce mandatory quarantines and
evacuations - and authorities think nothing of severing areas from all
contact with the outside world.

"In a matter of hours, we can determine what resources to send," Estruch
said. "We've thought it out. ... We've considered what to do if we have to
paralyze a town, if we have to stop public transit, if we have to close the
schools."

It works - but only at the cost of individual freedoms, said Jose Azel, an
economy specialist at the University of Miami's Institute for Cuban and
Cuban-American Studies.

Cuba "certainly has advantages to do what it wants to do that we can't -
commanding people," he said.

Globally, the virus has caused at least 3,205 deaths since it first appeared
in Mexico and the U.S. earlier this year, the World Health Organization
says. More than a quarter-million cases worldwide have been confirmed,
though most are mild and don't require treatment.

This fall, the U.S. government plans to track possible side effects as it
attempts to vaccinate more than half of the 300 million population in just a
few months.

It's not that Cuba isn't up to the task of developing a vaccine.

Cuba's Center for Genetic Engineering and Biotechnology makes nearly 100
products, including more than three dozen drugs to fight infectious
diseases. The island also has 12,000 registered scientists, impressive for a
tiny and poor nation, reflecting the importance the government places on
medicine and science.

"If we had confidence in a vaccine, we would get it," Estruch said.
"Immediately."

But he warned against promising a cure for a flu strain that can evolve at
any time. And he cited the 1976 U.S. campaign to vaccinate millions against
a swine flu epidemic that never happened.

Hundreds of U.S. citizens blamed that vaccine for other illnesses, including
Guillain-Barre Syndrome, a neurological disorder that generally is
reversible but can cause permanent paralysis and in some cases is fatal.
Lawsuits cost the U.S. government almost $100 million.

Instead, Cuba has its civil defense system, which has proved invaluable in
carrying out mass evacuations and saving lives during hurricanes that batter
the Caribbean island nearly every year.

Its disaster-response machine - overseen by President Raul Castro and the
armed forces - is organized at the block level in every town, and the
government collects health data daily from its extensive network of
neighborhood clinics.

"When it comes to hurricanes, there are people in each area who are
responsible for keeping track of everyone - who will need assistance,
pregnant women, the elderly, which buildings are vulnerable," said Wayne
Smith, a former top U.S. diplomat in Cuba who is now with the Center for
International Policy in Washington. "It's sort of the same thing with the
health system."

That's how the island detected its first swine flu cases.

For two weeks after Mexico reported the outbreak on April 24, Cuba's health
ministry monitored everyone who arrived from that country before instituting
the monthlong travel ban with almost no advance notice on May 1.

Ten days later, Cuba confirmed its first cases: three Mexican students who
had recently arrived from Mexico and were studying in three different
locations.

"We detained them in a matter of hours," Estruch said.

The students were treated and allowed to stay in Cuba.

Also working in Cuba's favor is its health care system. Treatment is free at
clinics in most neighborhoods, though the island's brand of universal
coverage faces unspecified cuts to stem what Raul Castro called "simply
unsustainable spending" in an August speech.

"When a person goes to the neighborhood clinic with a cold he's checked for
the virus. And that's how we're going to confront the second wave," Estruch
said. "I'm not saying there isn't an epidemic in Cuba. There is. But it's
limited."

What Cuba won't do this time around is close its borders again. The May
travel ban was "totally necessary at that time" because nobody knew what
they were up against, Estruch said.

Today, passengers arriving at Havana's Jose Marti International Airport are
still greeted by customs workers wearing face masks. They are asked if they
have flulike symptoms and are subject to a thermal imaging scan. Airline
pilots are required to report if any passengers were sick.

Dr. Jarbas Barbosa of the Pan American Health Organization praised Cuba's
close collaboration with international health agencies. But he questioned
the government's methods of isolating people to stem the spread of the
virus.

"In general, we have no evidence that they work," said Barbosa, who is chief
of health surveillance and disease management. "And they can produce a
profound social and economic impact."