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Plan for Confronting Influenza A H1N1by the Civil Defense National of Cuba
Convened by the Civil Defense National General Staff, officials from the Ministry of Public Health on Thursday appeared before high-ranking representatives of 15 Central State Administration agencies and the People’s Power bodies to present a multi-sector plan for confronting Influenza AH1N1, considering the spiraling advance of the new virus, which as of Wednesday, June 3, had resulted in 21,145 sick and 123 dead in 72 countries.

For this purpose, Cuba has the necessary human resources and materials and a health care system that is accessible and free of charge for all citizens.

On April 24, the World Health Organization declared an international emergency after an outbreak of the flu in Mexico, and given the increase in new cases and its spread to other countries, four days later Cuba’s Civil Defense declared the alert phase to the leaderships of the national, provincial and municipal system.

Since then, a series of measures have been adopted to reinforce international health controls and monitoring and medical treatment, starting with primary health care and including isolation measures, according to regulations and indications issued by the Ministry of Public Health (MINSAP).

The health care system has duly organized in each province areas for hospital admittance, with wards for children and adults diagnosed as being infected with the virus. The areas are equipped with resources for protecting health care personnel, diagnoses and virology laboratories, antiviral medications for H1N1 and other specific pharmaceuticals for treating patients with acute respiratory infection.

When required by epidemiological conditions, the country is in a position to begin distributing face masks providing protective covering for the nose and mouth and which are currently being used by workers involved with travelers who enter the country at ports, airports and marinas, and by health care personnel in isolation areas.

In addition, work is ongoing at international airports to install body temperature sensors acquired by Cuba, useful for the preventive diagnosis of travelers presenting fever upon arrival, and an active clinical/epidemiological search will continue among travelers and their direct contacts who present flu symptoms, up until 10 days after their arrival.

The multi-sector plan drawn up identifies three stages of epidemiological alert in the country: pre-epidemic, limited autochthonous transmission, and epidemic, and the corresponding clinical/epidemiological measures to be adopted for each.

According to this classification, at this time we are in the "pre-epidemic" stage, with no confirmed cases having been reported or those reported corresponding to travelers from affected countries. Forty-one days after the epidemic broke out, the only cases registered were three Mexican students and a Canadian boy, all of whom have been discharged from hospital.

The "limited autochthonous transmission" stage is declared when cases are diagnosed without having had any links to travelers from affected countries or regions. The "epidemic" stage refers to the point when sick individuals are detected and confirmed without links to any travelers, appearing in different parts of the country and in a sustained manner.

Based on the technical indications provided by Doctor Manuel Santín Peña, MINSAP’s national epidemiological director, by June 20, the Central State Administration agencies and People’s Power bodies from the countries 14 provinces and the special municipality of the Isle of Youth will have prepared their comprehensive plans for measures to confront the pandemic, which will be presented for approval to MINSAP and the Civil Defense National General Staff.

At the recent closing session of the 62nd World Health Assembly in Geneva, Dr. Margaret Chan, WHO general director, responded to repeated questions from delegates as to how long the H1N1 virus situation might continue: "We are currently not in a position to resolve that dilemma…. This is just the beginning, and we do not know enough to formulate generalizable recommendations." She also said that we are facing a highly contagious virus, which is expected to continue spreading to new countries and within the countries already affected. It is a "subtle, sneaky" virus, she said, which gives no signs of its presence when it arrives in a new country.

She recognized that the world was "alert and on guard as never before," and that scientists, doctors and epidemiologists were collecting a lot of data, "but we do not have the scientific knowledge to interpret these signals with certainty. We have clues, many clues, but very few firm conclusions."

Chang highlighted the fact that to date, the virus has circulated above all in the Northern Hemisphere, where the seasonal flu virus should be coming to an end. "We need to watch the behavior of H1N1 very carefully as it encounters other influenza viruses circulating during the winter season in the Southern Hemisphere," she said. "The current winter season gives influenza viruses an opportunity to intermingle and possibly exchange their genetic material in unpredictable ways."

And she emphasized, "…In cases where the H1N1 virus is widespread and circulating within the general community, countries must expect to see more cases of severe and fatal infections. We do not, at present, expect there to be a sudden and dramatic jump in severe illnesses and deaths."

According to experts, the soundness of each country’s health care system will play an important role in the evolution of those infected and the survival rate in a flu epidemic, which could decisively benefit depending on the degree of social responsibility provided individually and collectively by citizens.

The months of June to September, when students and many workers take their vacations, are decisive with respect to prevention measures, as well as the return to schools and workplaces.

We should not forget that respiratory viruses are highly contagious, given their principal means of transmission is person-to-person contact from the "droplets" of saliva that fly when one coughs or sneezes, when people kiss each other on the cheeks or converse closely, and also via the use of utensils such as cups, silverware, and other objects and surfaces contaminated with the secretions of sick people.

It is essential that we avoid talking over food in places where it is processed or served, and that we step up hygiene measures when that food is delivered.

General regulations included in this plan for protecting the health of the population is increased State Health Inspection monitoring and control actions, which is why the help of all citizens is needed.

There are simple, common-sense precautions that should be incorporated into our routines, such as washing hands frequently and conscientiously with soap and water, especially after coughing, sneezing or wiping our noses; covering up the mouth and nose to cough or sneeze, and if we are sick, staying at home and avoiding going to work or school or frequenting places with large concentrations of people.

According to Doctor Luis Estruch Rancaño, MINSAP deputy minister of hygiene, epidemiology and microbiology, it does not seem likely that any country will escape the introduction of the Influenza AH1N1 virus. The question now is for us to remain on alert and prepared to prevent its entry into the country via international health controls; if it penetrates, to diagnose it early on and prevent contagion; and if autochthonous outbreaks occur, establish rapid isolation to prevent its spread, which depends on coordinated work among the agencies of the Central State

Administration and community participation in implementation of personal hygiene measures.

Major General Ramón Pardo Guerra, head of the National Civil Defense, who chaired the meeting, recounted the efforts that our country has been making given the appearance of a new flu virus, and the considerable resources used to acquire equipment, medicines and other supplies. "Our Civil Defense, made up of all of the forces and resources of society and the state, has the accumulated experience and competence to be able to preserve the health of our people to the maximum."


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