Cuba is waging an organized, intrusive war on Zika. It’s working

Cuba is waging an organized, intrusive war on Zika. It's working
By ROB WATERS
NOVEMBER 8, 2016

HAVANA — The retired accountant went to her neighborhood health clinic
one Friday last month for a scheduled blood pressure check. Doctors
noticed 74-year-old Elsa Pérez Garcia's red eyes and skin rash and
immediately suspected Zika virus.

The week before, her neighbor, Rosalina Coffigny Acosta, 52, had noticed
a similar rash as well as joint pain, fatigue, and swelling in her
cheeks. She walked two blocks to the same clinic — run, like all health
services in Cuba, by the government.

Tests determined that Pérez Garcia had Zika and that Coffigny Acosta,
along with her husband and 20-year-old son, had dengue, another
mosquito-borne condition. Doctors hospitalized all of them for eight
days in beds surrounded by nets to keep mosquitos from biting them and
spreading their illness. Meanwhile, fumigation squads sprayed their
homes and their neighbors'.

"It smelled like gasoline when we came back," Acosta said. "I had a big
cleaning job to do."

In Cuba, the fight against mosquito-borne diseases is hyper-organized,
intrusive, and remarkably effective. On disease trackers' epidemic maps,
Cuba is an island in a sea of Zika: Virtually the entire Caribbean has
experienced widespread transmission of the virus, but global health
officers say there has been only "sporadic" spread in Cuba.

The Obama administration's top health official praised Cuba's efforts to
prevent transmission of Zika and other mosquito-borne viruses during a
scientific meeting here last month. "What it takes is local communities
doing very strong vector control," Health and Human Services Secretary
Sylvia Mathews Burwell said at a press conference at the recently opened
US Embassy. "I think it is what they've been successful with."

Other countries could learn from Cuba's response to Zika, public health
experts said. "The great difference between Cuba and the rest of Latin
America as well as the US is that Cuba tried to anticipate the arrival
of the virus to mitigate the impact," said Carlos Espinal Tejada, a
tropical disease specialist who directs the Global Health Consortium at
Florida International University in Miami.

"In Miami and in places in Latin America, they waited until they had
cases and then mobilized," Espinal Tejada said. "In Cuba, it's the
opposite. When they see a virus about to arrive, they mobilize."

Cuba began building a system to aggressively track and prevent
mosquito-borne diseases after a 1981 outbreak of dengue fever killed 158
people, said Carilda Peña García, director of vector control for the
Cuban health ministry. "The Cuban people don't forget that," she said.

Cuba's success in limiting Zika's spread is due largely to prevention
efforts coordinated from local health clinics. In addition to doctors
and nurses, these clinics deploy 15,000 workers — in a country of 11
million people — who "visit every house in Cuba" to look for mosquitoes
and kill them, said Peña García.

In Havana, each mosquito-control worker is responsible for 280 to 300
households and is expected to visit 20 each day, checking for mosquitos,
larvae, and standing water that could become breeding grounds, said
Nilda Roca Menendez, director of health and epidemiology for Havana.

If a case of Zika, dengue, or chikungunya virus is diagnosed, or
mosquitos or larvae are found, every home within 100 meters will be
checked more intensely, Roca Menendez said. If a second case or infected
home is identified, that radius is extended to 300 meters.

People who travel abroad are closely tracked. During an interview at
Polyclinic 15 y 18 in Havana's Vedado district, Roca Menendez pulled out
an address list for 33 area residents who had recently returned from
other countries. Doctors will monitor them for two weeks after their
arrival, she said.

Pregnant women are also screened for Zika because of the risk their
babies could have serious brain damage. Acosta said she shared a
hospital room at Pedro Kouri Institute with two Zika-infected women who
were seven months pregnant. When doctors explained the risks of birth
defects, both elected to have abortions, she said.

"They had been carrying their babies for seven months and were very
sad," she said. "They were crying a lot."

The intensive efforts to thwart Zika appear to be paying off. Cuba has
recorded just three cases of the virus caused by a mosquito bite inside
the country, although most cases are mild and go unreported. (In
comparison, 211 cases of local spread have been confirmed in South
Florida.) Since these three cases were reported in August, however,
outbreaks causing local transmission have occurred in Havana and two
other cities, said Cristián Morales Fuhrimann, the Pan American Health
Organization's representative in Cuba. Garcia is among the new cases,
but they have not been reported to international authorities.

"We have had some degree of local transmission in three provinces in the
country but that has remained under control," said Peña Garcia of Cuba's
health ministry.

Cuba's experience highlights the importance of preparing the health
system to respond quickly, detecting infection as soon as possible, and
involving the public in the effort, Fuhrimann said. "If you don't have
people engaged, you won't be able to succeed," he said.

'Not many people want this job'

The mosquito control campaign is not universally popular among Cubans,
however. Many residents say they resent inspectors coming into their
homes and worry that inspectors or fumigators may steal from them.
Workers complain of being underpaid, overworked, and unprotected from
the toxic chemicals they spray.

Outside one clinic in Havana last month, a group of young men clad in
khakis finished their lunch before resuming their inspections. Future
university students, they had been assigned to mosquito-control work
during their year of mandatory military service.

In the first five weeks of their deployment, said an 18-year-old who
gave his name as Abel, they worked seven days a week but now have a more
normal schedule.

"We're aware of the importance of the job we're doing, helping stop the
spread of disease," Abel said, but he and his companions don't like
being compelled to do it.

Their lack of motivation can negatively affect their work, Abel said, so
bosses supervise them closely. If mosquitos turn up in a house they've
previously checked, they could be disciplined, have their military
service extended or be prosecuted for spreading disease, Abel said,
though he didn't know of anyone who had been punished.

More serious complaints came from a group of fumigation workers gathered
after work in a park, spray guns at their side. One, who gave his name
as Yasmani, said he'd been doing the job for four years. His pay, he
said, is 490 Cuban pesos a month (about $20), plus up to 200 pesos more
for overtime — barely enough to live on.

"Every day you're carrying this heavy equipment, up and down stairs," he
said. "Not many people want this job."

Source: How Cuba is defeating the feared Zika virus -
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