Following identification of the coronavirus disease COVID-19, Cuba activated its National Action Plan for Epidemics and convened a National Intersectoral Commission to design measures to protect population health. Following approval of the COVID-19 Prevention and Control Plan, scores of measures were implemented to fight the pandemic. Internationally and in Cuba, these are organized according to three epidemiological phases: stage 1, pre-epidemic; stage 2, limited local transmission; and stage 3, epidemic. As of this writing, Cuba is in Stage 2. Actions and measures have been rolled out gradually and systematically.

The Ministries of Tourism, Culture, Education, Higher Education, Labor and Social Security, Domestic Trade, and Agriculture; the Sports and Recreation Institute; Civil Defense; Immigration and Customs; national media; and mass/social organizations have participated in design, organization and implementation of actions taken.The Ministry of Public Health (MINSAP) and the Council of Ministers decide guidelines, then coordinate and monitor activities and their results, which are reported daily by national television and radio, print media and carried on digital platforms and social networks.

DateActionsJanuaryMinistry of Public Health, Civil Defense (CD) and others establish National Intersectoral Commission for COVID-19.National Action Plan for Epidemics (last updated during Ebola, 2015) is updated and activated.Surveillance at all ports, airports and marinas is increased, including use of digital thermometers and infrared scanners for incoming passengers from the USA, France, Spain, Germany, Italy, China, Japan and South Korea.COVID-19 response training begins for border and immigration officials.Protective protocols are implemented for Cubans posted abroad (including health professionals).COVID-19 Prevention & Control Plan is drafted.February1Council of Ministers approves COVID-19 Prevention & Control Plan.26The Cuban health network Infomed launches COVID-19-InfoCU, a free mobile application for Android to provide current, reliable information on COVID-19 using sources from the Infecciones por coronavirus site. This is later complemented by Juventud Técnica infographics dashboard on COVID-19 in Cuba.All monthHealth services in community polyclinics and hospitals are reorganized to reinforce and isolate areas for attending infectious disease patients, particularly those with respiratory symptoms.Health professionals, cleaning, cooking and administrative staff, ambulance drivers and others working directly with patients in isolation centers and hospitals are trained according to COVID-19 prevention and treatment protocols.March5Council of Ministers updates COVID-19 Prevention & Control Plan.National Intersectoral Commission for COVID-19 begins meeting daily.6–7Regional meetings (west, central, east) with national authorities are held to analyze and implement measures according to COVID-19 Prevention & Control Plan.9First prime-time television “Roundtable” broadcast on COVID-19 announces series of measures; frequent hand washing, physical distancing recommended.Military hospitals around the country are added to those previously designated for remission of suspected cases.Molecular biology laboratories in Villa Clara Province (central region) and Santiago de Cuba Province are activated for COVID-19 testing, supplementing lab at Havana’s Pedro Kourí Tropical Medicine Institute (western region, national reference center).More than 3100 hospital beds are designated for COVID-19 patients, in addition to 100 ICU beds.Science and biotechnology group comprised of experts from various research institutes is created to develop COVID-19 treatments, including antivirals and rapid tests, as well as vaccine candidates, diagnostics and other innovations.Ministry of Labor & Social Security applies Law #116 as established in the National Labor Code regulating worker protection, salaries and social security.Production of digital and print health messaging materials begins.10All in-bound travelers are tested for COVID-19 using rapid tests, expanding previous testing, which was limited to travelers coming from countries with transmission.11First cases of COVID-19 are confirmed in Cuba: three Italian tourists. Stage 1, “pre-epidemic” phase declared.Public health information meetings begin in communities across the country to inform population about COVID-19 transmission, prevention and measures implemented to date.121322 additional beds in 11 hospitals and 824 beds in 10 isolation centers around the country are set aside for COVID-19 cases, contacts and suspected cases. More to be added as needed.17National broadcasts of daily Ministry of Public Health press briefings begin, including domestic, regional and global updates on COVID-19, implementation of new measures, detailed epidemiological data, and press Q&A.Active screening (case detection) commences in neighborhoods across the country involving 28,000 medical students.18Cuba allows the MS Braemar cruise ship, with 1063 passengers and crew (5 confirmed COVID-19 cases), to moor off Havana coastline. Cuban specialists facilitate safe transfer of all personnel to charter flights for repatriation to UK. After a 14-day quarantine, all Cubans involved in the transfer are tested and receive clean bill of health.Cuba begins COVID-19 testing post-mortem on all who died with critical and severe respiratory complications, or diarrhea.All patients presenting in hospitals with acute respiratory infections receive a real-time polymerase chain reaction (RT-PCR) test.19Validity of travel-related documents for Cuban residents working, studying and traveling abroad is extended past expiration dates until further notice.20President Miguel Díaz-Canel announces new national measures on prime-time “Roundtable” television broadcast.Large meetings, gatherings and social/cultural events are prohibited.Hotels (except those used for quarantine), campgrounds, discos, cinemas, theaters, etc. are closed.Restaurants are required to reduce capacity, maintaining at least six feet between tables.Physical distancing of at least 1–1/2 yards is mandated; citizenry advised to wash hands often and properly; avoid touching eyes, nose and mouth.At-risk groups are advised to shelter at home, limiting contact with others as much as possible.Telecommuting is indicated for those offices and workers where feasible.Tax payments are suspended for small business owners.Hospitalized patients are guaranteed 50% of their average salary.Households with insufficient earnings due to economic measures qualify for Social Assistance; Family Assistance System, providing food, medicine and other goods to extremely low income households activates home delivery.Central Bank announces debt suspension and restructuring for businesses and individuals until situation improves.All facilities are required to have a 0.1% sodium hypochlorite solution at the door for hand disinfection.Sales of sodium hypochlorite are increased to the public nationally.155 workshops begin manufacturing face masks; President encourages citizens to make their own, sparking a national, grassroots production movement of face masks.23Education is suspended at all levels, schools closed until further notice.Health measures are instituted at orphanages and those day care centers still open (for children of essential workers: health, transport, food supply); 444 day care centers remain functioning.Outbound travel by Cuban citizens is limited to humanitarian reasons.Interprovincial transportation is suspended; 100% of passage on public transportation reimbursed.24International arrivals are limited to Cuban residents; asymptomatic travelers are transferred directly from airport to isolation centers in their home province for 14-day quarantine and receive rapid tests. Travelers with symptoms are transferred to a hospital and receive RT-PCR tests.Shelter-at-home order is issued for all remaining foreign visitors in the country, required to stay either in their hotel or rental home.Discos, gyms and pools are closed at all hotels.Privately-owned bars, pools and gyms are closed.Churches, synagogues, mosques and other religious institutions are asked to avoid large gatherings.Police presence is reinforced on streets.Elective surgeries and non-emergency, regularly-scheduled appointments with specialists are postponed; non-urgent dental appointments suspended.Until further notice, prescription medicine refills and government-subsidized special food allotments for health conditions are extended six months beyond original renewal deadlines.Provincial and Municipal Defense Councils are activated.26Cuban Society of Psychology launches Psico Grupos, online consultations via WhatsApp, grouped by theme: older adults; families with children; teens; essential workers; and families with members abroad.30Camilo Cienfuegos, Pinar del Río Province, is first community put under quarantine.Teleclasses begin for elementary, middle and high school students.31All crew on recreational boats must leave Cuban territorial waters within 48 hours or submit to 14-day quarantine in an on-shore isolation center.April1Use of face masks is made obligatory in public.7Stage 2, “limited local transmission” phase declared with six local transmission events in Pinar de Río, Havana, Matanzas, Ciego de Ávila, Camagüey and Holguín Provinces.8Number of hospital and ICU beds for COVID-19 patients is increased.Five more molecular biology laboratories are activated for COVID-19 testing.Every police station is staffed with a district attorney representative to permit violators of COVID-19 regulations to be charged.Alcohol sales are limited; drinking prohibited in public.Restaurants are limited to takeout or home delivery; stores and restaurants must close business by 8:00 PM.Payment of utility bills is temporarily suspended without penalty (electricity, phone, water, gas).9University entrance exams are postponed.10Large supermarkets are closed to help reduce overcrowding; online sales rolled out; stores limited to selling food and personal hygiene products.11All urban and intermunicipal public transportation is suspended; government transportation and private cars (except in quarantine zones) may still circulate.Hospital taxi service is reinforced and guaranteed, including transport for dialysis patients, cancer treatments and patients discharged from hospitals.Transport is guaranteed for medical staff and other essential workers.13Prime-time television “Roundtable” airs on Cuban biotechnology products for COVID-19. Includes details on new antiviral CIGB 210, inhibitory peptide CIGB 300 and CIGB 258, a regulatory treatment for hyper-inflammation in critical patients; new diagnostic tests; and a vaccine for activating innate immunity (in clinical trials). National treatment protocols use 25 domestically-produced medicines and products.13–19Use of interferon alfa-2b, administered nasally, to protect medical personnel begins.13–19Disinfection of main streets in Havana and other cities begins using a soap, water and bleach solution.14Government leaders and expert group convene to analyze organizational plan moving forward as epidemiological picture gets more complicated following 20 instances of local transmission.National hotline goes live to answer population’s questions and concerns about COVID-19.1520 communities in six provinces (Havana; Pinar del Río; Matanzas; Ciego de Ávila; Holguín; Camagüey) and the Isle of Youth are under total or partial quarantine.Molecular biology lab at the Genetic Engineering and Biotechnology Center (CIGB) is added to those processing RT-PCR tests for COVID-19.16Prime-time “Roundtable” airs explaining COVID-19-related offenses (price gouging, hoarding, public disobedience of health measures) and legal rights/mechanisms including Article 87 of the Penal Code (crimes against health); over 100 cases tried to date.1726 cases of local transmission are reported; 92 health workers confirmed infected with COVID-19.Cuban-designed mobile phone application “Virtual Screening” goes live to complement the 28,000 medical students conducting active screening. A free, opt-in application allowing users to submit epidemiological survey for statistical inclusion and analysis by the Ministry of Public Health.19Provincial Defense Council, Havana, urges citizenry to conserve water and electricity as situation becomes more complex.23Prison protocols, first implemented in mid-March, are reinforced: newly-charged prisoners go into 14-day quarantine; workers or visitors presenting with respiratory symptoms cannot enter; number of visitors is reduced; workers and visitors must disinfect hands upon entering; active screening is increased to twice daily; and dedicated wards for possible COVID-19 cases are established. To date, there are no confirmed cases in any prison but quarantine is not ruled out as epidemiological situation evolves.

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