RESUMO O Sistema Nacional de Saúde de Cuba tem assegurado uma resposta eficaz e com equidade ao enfrentar a pandemia de COVID-19. A cobertura de saúde universal e gratuita baseada na atenção primária se pauta no princípio da equidade. Mais recursos são destinados às áreas de nível socioeconômico mais baixo que concentram risco de saúde maior e a seguir, nesta ordem, às áreas de nível socioeconômico médio e alto. Assim, a taxas de letalidade tem sido semelhante nos três níveis e a taxa nacional é uma das mais baixas da Região. Antes de o primeiro caso de COVID-19 ter sido detectado em Cuba, preparou-se o Plano para prevenção e controle do coronavírus com participação multissetorial. Quando o primeiro caso da doença foi confirmado, instituiu-se o Grupo de trabalho temporário para combater a COVID-19 como um órgão assessor do governo. As ações de combate à pandemia começam na comunidade com medidas preventivas, prosseguem nos centros de isolamento e retornam à comunidade com medidas de vigilância sanitária e o acompanhamento dos pacientes recuperados. E, seguindo o princípio de territorialidade, laboratórios de diagnóstico molecular foram instituídos nas províncias onde eles inexistiam. A atenção médica, o tratamento gratuito, a preparação de um plano de governo único intersetorial nacional, o emprego de estratégias próprias para pesquisa, diagnóstico e rastreio de casos e a implementação de um protocolo universal para prevenção da doença e tratamento dos casos confirmados possibilitaram controlar a doença de uma perspectiva de equidade em saúde.

ABSTRACT Cuba’s National Health System has managed to guarantee an effective and equitable response to COVID-19. Universal and free health coverage, based on primary care, follows the principle of equity and the greatest resources are allocated to areas of the lowest socioeconomic stratum (where higher risk is concentrated), followed by those of medium and high strata, in that order. This allowed for similar mortality rates in the three strata, and Cuban national mortality rate was one of the lowest in the Region of the Americas. Before the first case was identified in Cuba, a Plan for Coronavirus Prevention and Control was elaborated with multisectoral participation, and when the first case was confirmed the Temporary National Working Group to Fight COVID-19 was created as an advisory body of the government. The actions to face the pandemic began with preventive measures in the community, continued in the isolation centers and ended again in the community with actions of surveillance and follow up of recovered patients. Following the principle of territoriality, molecular diagnosis laboratories were created in the provinces that did not have one. Free medical care and treatment; the preparation of a single national intersectoral government plan; the use of particular strategies for research, diagnosis and case tracing; and the implementation of a universal protocol for disease prevention and treatment of confirmed cases made it possible to control the disease with a health equity perspective.

RESUMEN El Sistema Nacional de Salud de Cuba ha logrado garantizar una respuesta eficaz y con equidad en el enfrentamiento a la COVID-19. La cobertura de salud universal y gratuita, basada en la atención primaria, sigue el principio de equidad, por lo que los mayores recursos se asignan a los territorios del estrato socioeconómico más bajo, que concentra mayores riesgos de salud, seguidos de los de estratos medio y alto, en ese orden. Esto permitió tener tasas de letalidad similares en los tres estratos, y a nivel nacional la de Cuba es una de las tasas más bajas de la Región de las Américas. Antes de identificar el primer caso en Cuba, se elaboró el Plan para la Prevención y Control del Coronavirus, con participación multisectorial, y al confirmarse el primer caso se creó el Grupo Temporal de Trabajo para Enfrentar la COVID-19 como órgano asesor del Gobierno. Las acciones de enfrentamiento a la pandemia comienzan en la comunidad con medidas preventivas, continúan en los centros de aislamiento y terminan nuevamente en la comunidad, con acciones de vigilancia y acompañamiento a los enfermos recuperados. Siguiendo el principio de territorialidad, se crearon laboratorios de diagnóstico molecular en las provincias que no lo tenían. La atención médica y los tratamientos gratuitos; la preparación de un plan de gobierno intersectorial nacional único; la utilización de estrategias particulares para la pesquisa, diagnóstico y rastreo de casos; y la implementación de un protocolo universal para la prevención de la enfermedad y el tratamiento de los casos confirmados permitieron el control de la enfermedad con una perspectiva de equidad en salud.

ABSTRACT The Ebola virus is a pathogen that causes high morbidity and mortality in epidemic events during which health personnel are frequently infected. Such an epidemic occurred in West Africa, prompting WHO to issue a call in 2014 for health personnel to be dispatched to affected countries. Cuba responded and signed an assistance agreement under which 265 Cuban health professionals, members of the Henry Reeve Emergency Medical Contingent, volunteered their services in the Republic of Guinea, Sierra Leone and Liberia. This article presents Cuba’s strategy of medical aid and organization of the three medical teams formed; refers to the teams’ contribution to epidemic control in treatment centers where they worked alongside other personnel; and describes measures taken in Cuba to prevent the virus from entering the country through returning volunteers or other means. In the centers where Cuban medical teams worked with other health professionals in West Africa, case fatality decreased from 80%–90% to 24%, contributing to control of the epidemic; no Ebola outbreaks occurred in Cuba. During the epidemic, two Cuban health professionals died of malaria and one physician fell ill with Ebola. This paper includes an overview of the treatment and evolution of the latter case, a doctor who contracted the disease in Sierra Leone and was treated in Geneva and Havana.

Aedes albopictus was found in six of the 10 departments of Haiti and in 14 of the 35 communes surveyed. The survey found the larvae of Ae. albopictus in 13 different types of containers. Used tires and tins were by far the most common breeding sites used by this mosquito species. At the breeding sites, Ae. albopictus was associated with other mosquito species, such as Aedes aegypti, Culex nigripalpus and Aedes mediovittatus. The highest proportion of association was with Ae. aegypti. This study represents the first report of Ae. albopictus in Haiti.

Introduction: the earthquake occurred in Haiti in January 2010 led to the worsening of the hygienic, sanitary and environmental conditions and increased the number of breeding sites for disease-borne vectors in the country. Objectives: to report the first results of the entomological surveillance set by the Cuban advisory group in Haiti after the earthquake. Methods: the work was carried out in 7 sites located in West department, one of the ten departments of the country; larval sampling was conducted in reservoirs and natural breeding sites based on the methodologies for both. The sampling was weekly in the May-October period in 2010. Results: twelve mosquito species were reported in the West department as well as the presence of Triatoma rubrofasciata. The fundamental breeding sites of the three most important mosquito species were identified including Aedes aegypti with water tanks followed by worn car rubbers and small artificial deposits, Anopheles albimanus in rice fields, animal footprints and coastal swampy plains, and Culex quniquefasciatus, one lymphatic phylarosis-borne vector still existing in Haiti, in drains and waste water ditches. Conclusions: these results are the first ones from this surveillance program after the earthquake and represent valuable information for the decision-making at the time of designing a control program to face the occurrence of any epidemics in which these insect vectors might be involved in this department.

Introducción: el terremoto ocurrido en Haití en enero de 2010 condujo a un agravamiento de las condiciones higiénicas, sanitarias y ambientales, lo cual incrementó la disponibilidad de sitios de cría de vectores de enfermedades en el país. Objetivo: reportar los primeros resultados acerca de la vigilancia entomológica establecida por parte de la asesoría que realiza Cuba en Haití después del terremoto. Métodos: el trabajo se llevó a cabo en 7 localidades situadas en el departamento Oeste, uno de los 10 en que se encuentra dividido Haití; se realizaron muestreos larvales en recipientes y sitios de cría naturales con las metodologías establecidas para ambos. La frecuencia de muestreo fue semanal en el período mayo-octubre, 2010. Resultados: se reportaron la presencia y distribución en el departamento Oeste en Haití de 12 especies de mosquitos y la presencia de Triatoma rubrofasciata. Se identificaron los principales sitios de cría de las tres especies de mosquitos de mayor importancia; Aedes aegypti, que correspondió a depósitos de almacenamiento de agua seguidos por gomas usadas de auto y pequeños depósitos artificiales; Anopheles albimanus en los campos de arroz, pisada de animales y planicies pantanosas costeras; y para Culex quinquefasciatus vector de filariosis linfática aún sin erradicar en Haití, fueron los canales y las zanjas de aguas residuales. Conclusiones: estos resultados son los primeros que se obtienen en esta vigilancia después de la ocurrencia del terremoto, que constituyen información valiosa para la toma de decisiones en el momento de programar el control ante la presencia de cualquier epidemia, donde se involucren estos insectos vectores en este Departamento.