Stories of patients dying of COVID-19, without access to oxygen, other life-saving treatments or even a bed in a hospital are now coming out of Cuba as the country has become a global pandemic hot spot with the fourth-highest rate of infections per person in the world.
Despite a vaccination campaign with much-touted locally produced pharmaceuticals, cases continue to trend upwards, pushing the country’s impoverished health system to the brink of collapse. Almost 100,000 people are currently admitted into hospitals and other health facilities because they tested positive or doctors suspect they contracted coronavirus.
The situation is so out of control that Cuban leader Miguel Díaz-Canel acknowledged the country is overwhelmed — rare candor from the authoritarian regime.
“We are at the limit of the capacities we have of infrastructure, resources, medicines, and oxygen,” Díaz-Canel said at a cabinet meeting on Monday, according to a report published on the presidency’s own website. “We are at the limit of what is possible today with the current conditions.”
“The health system is overwhelmed,” he insisted in another meeting on Thursday reported on state media.
The admission comes when the Caribbean island has become the epicenter of the pandemic in Latin America, with a positivity rate skyrocketing above 20 percent this week. In the first ten days of August, health authorities confirmed over 89,000 COVID-19 cases and 839 deaths.
The numbers are sobering. So far this year, 4,536 pregnant women and women who have just given birth contracted COVID, and 35 died, official newspaper Granma reported Tuesday.
“The situation is difficult because of the lack of availability of essential supplies in response of COVID-19 but also essential supplies at all levels of the health system in Cuba,” said Dr. Ciro Ugarte, director for health emergencies at the Pan American Health Organization.
Help from the U.S.?
Earlier this month, President Joe Biden had said he was willing to send vaccines to Cuba if he was assured an international organization would administer them — a requirement that was a non-starter for the Cuban government, which routinely rejects international oversight. But with the situation on the island taking a turn for the worse, the administration seems to have softened its stance.
A State Department’s spokesperson told the Herald that “the U.S. is willing to provide a significant number of vaccines, so long as we are certain that average Cubans should have access to them,” dropping the reference to an international organization.
“We share the people of Cuba’s concern about an exponential rise in COVID-19 cases,” the spokesperson said. “Cuba has made a sovereign decision on how it will address the pandemic, which includes the development and use of its own vaccines. However, Cuba could always decide to receive outside vaccine donations.”
The spokesperson also said the administration was expediting requests to export humanitarian and medical supplies to Cuba and had authorized charter flights carrying humanitarian aid to fly to Cuba’s provinces. Previously, the Trump administration banned all flights to Cuban cities other than Havana.
So far, the Cuban government has rejected Biden’s offer to send vaccines. On Wednesday, several Cuban scientists sent him a letter replying that the country did not need American vaccines and that he should lift the embargo instead because it prohibits selling supplies to Cuba’s biotech industry.
A collapsed system
Over the past few weeks, Cubans have shared disturbing images on social media about the country’s health emergency, including a video of a woman who allegedly died in a taxi before she could get treatment, pictures of patients in crowded hospital rooms and bodies piling in a hospital’s morgue in the eastern province of Guantanamo.
A state TV journalist said a video of a mass grave in Santiago de Cuba — the island’s second-largest city — circulating on social media was ‘fake news.’ But after another Cuban came forward and posted a video of workers accommodating two white coffins inside a mass grave in Juan Gonzalez, a town near Santiago, the official newspaper Granma confirmed the mass burial did happen. According to a local official quoted in the newspaper, there was insufficient space in the city’s main cemetery, the historic Santa Ifigenia, but he said the burials had been conducted in an “organized” manner. He said the grave was temporary and that both COVID patients and people who died of other reasons had been buried in Juan Gonzalez.
The coffins are white because there are shortages of clothes of other colors to cover them, independent new outlet 14ymedio reported.
One distressed young man who lives in Yara, in the eastern province of Granma, recorded a video saying he had tested positive and was sent back home despite his pleas to get isolated elsewhere to protect his wife and eight-month-old baby. He was told only patients with severe symptoms would be admitted. After he returned home, his fears came true, and they both got COVID. The baby had a fever but his parents struggled to find medical help.
After being rejected in several health facilities, mother and baby were accepted in a school turned into a provisional health facility in the nearby town of Bayamo. They had to share a bed because the facility had no cribs.
“Who the f*** is to blame,” said Julio Adriel Merladet Olazábal, on the verge of tears in his video. “It’s not the U.S. This is happening because of how poorly they are handling this.”
A high school history teacher, he said he knew he would be fired for posting the video. He said he didn’t care.
“Nobody is paying me to say this. I am just fed up, I am fed up with the lies about the health [system]. Enough is enough,” he said. “If I had shouted Patria y Vida outside my house a few days ago, the police would have come quicker than the doctors who finally came to check on us,” he added, referring to the recent anti-government demonstrations.
Some COVID patients are skipping the health system altogether and trying to ride out the disease at home, even if symptoms like pneumonia and difficulty breathing would typically require hospitalization. And they are paying astronomical prices in the black market for medicines like the potent antibiotic ceftriaxone, known in Cuba for its commercial brand Rocephin.
The Herald learned of a man in Havana who paid $500 for 14 vials of Rocephin to get treatment at home for his COVID-induced pneumonia. A doctor friend told him it was safer to stay at home than going to a hospital, where he might struggle to get adequate treatment. The man asked not to be named for fear of retaliation by the authorities.
Groups in the Telegram social app for exchanging or buying medicines in Cuba are flooded with urgent messages from people all over the island asking for the antibiotic azithromycin, which is being used to treat COVID-induced pneumonia, though there is no clear evidence of its effectiveness.
The speculation with drug prices in the black market is so widespread that the government took notice.
“Tolerance for the sale of medicines in the provinces is over,” said Diaz-Canel in an official meeting last Saturday. “That cannot be allowed, and that is heating up the situation with the population, and we are passive in the face of that.”
Shortages of tests, workers
But the problem is not only the shortage of medicines but also of PCR tests, oxygen tanks, and healthcare workers.
Yirovy J. Cuesta, from Cienfuegos, said on Facebook that he waited from 7 a.m. to 3 p.m. to get a PCR test in a local polyclinic. “The selfless healthcare workers there really couldn’t keep up with the number of people who were waiting (I estimate more than 100),” he wrote.
“And where is the oxygen?” asked Liz Escoto on the Facebook page of the local state television channel Perlavision. “Because at the moment, my grandmother has cyanotic fingernails due to lack of oxygen in the Dr Gustavo Aldereguia Lima hospital in Cienfuegos.”
She said she had to buy insulin in the black market for her grandmother, who also has diabetes, because the hospital could not provide it.
Last week, local TV station Perlavision reported that 60 percent of the PCR tests administered in Cienfuegos were coming back positive. Doctors are sending home suspected COVID patients admitted to isolation facilities if they don’t show symptoms because there are not enough tests to confirm they are infected. The results of the PCR tests are also delayed, and “suspected patients are getting critical before the tests come back, without even being confirmed positive,” an unidentified official said in the TV news report. Salvador Tamayo, the provincial health director, said about 600 children and teenagers had “active cases” of COVID.
On Tuesday, 60 intensive care nurses arrived in Cienfuegos from nearby Matanzas and Venezuela, where the Cuban government operates one of its largest medical “missions.”
Vaccines and humanitarian aid
Cuba is not unique in its struggle against the coronavirus.
Patients waiting in gurneys in hospital halls were a common sight around the world during the pandemic, and the virus has strained the health systems in many countries, including those with plenty of resources. Other Caribbean nations also are short on vaccines and other supplies. On Wednesday, the Biden administration began shipping more than 830,000 doses of vaccine to six Caribbean nations.
But Cuba’s troubles go beyond COVID as basic needs in the healthcare system, from syringes and gloves to furniture and bed linen, have been accumulating for years.
Government decisions contributed to the current crises since Cuban authorities slashed the health system budget, even as the government was receiving billions in revenue for the work of its doctors abroad. According to official data, the country has one of the highest per-capita rates of doctors, but nurses and technicians have dropped out of the system. The export of medical services has also weakened the primary care system.
The pandemic hit when the country was already in a severe economic crisis and seriously cash-strapped. But then authorities took the controversial decision to spend the few remaining resources in developing their own vaccines, with the hope to sell them abroad, and declined to participate in the Covax initiative, a program co-administered by the World Health Organization to provide donated vaccines or vaccines at better prices for developing nations. Also, Cuba did not purchase vaccines abroad, not even from its allies, Russia and China.
Authorities managed to keep the virus under control with strict lockdowns and border closures during most of 2020. Still, more infectious variants arrived this year and started ravaging a country where people have to spend long hours every day in crowded lines to buy food or other necessities.
In May, authorities began inoculating the population with two locally developed vaccine candidates, Soberana and Abdala, which they claim are over 90 percent effective. But they require three doses and several weeks for the immunity to kick in. Cases have not gone down in Havana yet, where about 64 percent of the population is already fully vaccinated. A health official said last week that 72 percent of those infected in Havana in recent days had gotten the three doses of one of the Cuban vaccines.
As an acknowledgment that the country needs help, the government is receiving aid from allies like Bolivia and Nicaragua. Mexico and Canada have also sent humanitarian aid to the island.
Ugarte said the Pan American Health Organization was working with Cuba’s Ministry of Health to identify the more pressing needs. Beginning in August, the organization sent “five kits of COVID supplies but also trauma kits, emergency care kits and other supplies including laboratory reagents and we are preparing additional support,” he said.
Ugarte said PAHO was exploring whether other donors and countries were willing to support Cuba also with humanitarian aid.
“The solidarity of the region is something we look for,’ he said. “It is a very difficult situation because the needs are too high in Cuba.”
