The Cuban health system is working hard to solve the SARS-CoV-2 crisis. In this effort, the interaction between the different fields of the Cuban society that are protagonists in this fight plays a decisive role. Science and its research-development institutions, seven in all, do not cease in their efforts to provide Cuban doctors with the necessary weapons to win this battle.
In the field of virology, as well as in Bionanomedicine and Pathological Anatomy, new advances are emerging which are unquestionably being reflected in the results that Cuba is having in its daily work. Suffice it to say that in the last 42 days only four deaths have occurred on the island.
The number of serious or critical patients has decreased exponentially; there have been no critical patients in Cuba for more than 14 days.
Among the investigations under way is that related to patients with prolonged periods of C-reactive protein (CRP).
Dr. María Guadalupe Guzmán Tirado, Head of the Research, Diagnostic and Reference Center of the Pedro Kourí Institute of Tropical Medicine (IPK), reported that four new laboratories will soon be opened in the provinces of Ciego de Avila, Holguin, Matanzas and the Isle of Youth, which will enable the country to expand its epidemiological surveillance capacity.
In the results of the investigation it has been detected that the period of infection of the COVID is from five to seven days, although there are people who can remain in this state between 15 or 17 days.
The study included 219 patients and 36 asymptomatic individuals confirmed in the IPK by SARS-CoV-2.
“I explained that there are individuals who remain with a positive CRP, there are patients who after 14 and 15 days of living with the disease and despite being well clinically are still positive. Another seven patients after 30 days were positive. Another case studied was a patient more than 40 days positive to PCR. After the first five days he was in good health, however he did not become negative until day 50,” said Dr. Guzmán.
The study includes genetic, immune response and epidemiological research. In addition, emphasis is placed on the research of asymptomatic patients.
Nanoscience is another of the lines of research of Cuban institutions applied to the fight against the Coronavirus.
Dr. C. Angelina Díaz García, Director General of the Centre for Advanced Studies of Cuba (CEA), recently described the role of nanosciences against COVID-19.
Dr. Díaz pointed out that the new coronavirus is between 60 and 400 nanometres in size, for which studies are being carried out using scanning electron microscopy, transmission microscopy, atomic force microscopy and optical microscopy.
The scientist called attention to studies that demonstrate the existence of a greater quantity of the virus in the nasal cells.
Another field associated with the battle against COVID-19 is that of pathological medicine. In May, autopsies became obligatory in the protocols for all patients who died from the disease.
Dr. C. Teresita Montero González, Chief of the Development Center of the Luis Díaz Soto Central Military Hospital, explained that the main issue in this task was related to the protection of personnel who would work in these processes.
According to Dr. Montero, the predominance of men and those that exceed 70 years of age were most affected. Likewise, associated comorbidities are highly related to the death rate.
Arterial hypertension and diabetes mellitus share first place in the associated comorbidities of the deceased.
Similarly, severe bacterial bronchopneumonia, pulmonary edema of permeability (diffuse alveolar damage) and multiple organ dysfunction syndrome are the main causes of death in patients who are positive for the new coronavirus.
In 13 of the 27 autopsies studied, COVID-19 is the direct cause of death. The remaining 14 have other complications triggered by SARS-CoV-2.
In turn, one out of every four autopsies revealed a diagnostic error about the cause of death, hence the value of this specialty and the pathologist as a professional to help in the fight against the disease.
The treatment protocols of COVID-19 are also under constant review by the Cuban scientific community. These are not static and have been varying as new scientific evidence has been obtained.
Dr. Gerardo E. Guillén Nieto, Director of Biomedical Research at the Center for Genetic Engineering and Biotechnology (CIGB), explained that as a result of the studies carried out, the organic damage observed in tissues obtained from patients who died from COVID-19 was evident.
The kidney is one of the organs where the virus accumulates most within the body. It is also common to find high presence in the lungs and liver.
“This shows the capacity of multiplication and the level of infection that this virus presents. One can have up to 10.8 million viral particles in a single cell,” the scientist said.
Dr. Guillen referred to the “Esperanza” study being developed by the CIGB in collaboration with other institutions.
This study was developed at the Luis Díaz Soto Central Military Hospital with more than 130 patients. Its main purpose was to compare the results of the application of Interferon Alpha 2b (Heberon) with those of the combination between this and the gamma Interferon (Heberferon).
The “Esperanza” study showed that after starting treatment with Interferon Alpha 2b, 50 percent of the patients treated showed no infection by the fifth day. Meanwhile, after the application of Heberferon, 50% of the patients took only three days to be virus-free.
Based on the research carried out and the evidence from the treatments in China, the decision was made to treat asymptomatic cases with interferon and not chloroquine. “Interferon alpha 2b was given to asymptomatic patients who did not have comorbidities, and Heberferon was given to those who did,” Dr. Guillen said.
In June and July, after the modification in the protocol and the advancement of the CRP to day one, of a total of 126 patients, 56 were still positive on day seven, but 70 of the group (56 percent) already showed no signs of the virus. Most of these patients were asymptomatic.
As a result of this research it was decided to treat not only the symptomatic but also the asymptomatic with interferon.
“This protocol had an impact on the low numbers of serious and critical patients in Cuba and also on the decrease in morbidity,” Dr. Guillen said.
In this way, Cubans and their centralized health care system are fighting the COVID-19 pandemic.