CAMAGÜEY.- For various reasons, including the health situation the world is experiencing, from which Cuba does not escape, publications in this section ceased. Today we resume it precisely with the issue of the SARS-CoV-2 coronavirus that causes COVID-19, because despite the fact that much has been written and said about this pandemic declared as such by the World Health Organization (WHO) on March 11th of the current year, due to the "youth" of the disease, all we know is little to avoid suffering from it.
For that reason I went to Dr. Alfredo Leal Gutiérrez, specialist in Hygiene and Epidemiology and head of the Acute Respiratory Infections and Tuberculosis Program, of the Provincial Center for Hygiene, Epidemiology and Microbiology, who clarified that coronaviruses constitute many types of viruses with the characteristic that its reservoir are animals, germs of these that almost always pass from animal to man. For this reason, when the Wuham pneumonia (Hubei province, China) begins, as it was called in its beginnings, it was inferred that it had passed from an animal to man, in this case it was attributed to a bat, one of its greater carriers, although it has not been the only one that has been thought about, it is something not defined yet.
—Then it has not been determined which animal was responsible, but so many people in the world have been infected that it keeps it in suspense ...
—In fact, it is clear that the virus "learned" to pass from person to person very quickly. This happens when the new germ of zoonotic diseases (a group of infectious diseases that are transmitted naturally from animals to humans) develop a major outbreak or, in this case, a pandemic.
—If it is common for a germ to pass from an animal to man, why what happened between humans with COVID-19?
—The first oddity is that a coronavirus pandemic had never been reached. We knew about the Middle East syndrome transmitted by the camel; the severe acute respiratory syndrome transmitted by the civet, and in these cases the coronaviruses caused outbreaks and epidemics, but they were controlled although their way of contagion was very similar.
- How is it possible that later the animals are not infected by people?
—Yes, infections have been reported in pet animals, such as dogs and domestic felines, that is, in some the SARS-CoV-2 virus has been isolated, what happens is that sometimes they live with it and nothing happens to them, even 50% of people are asymptomatic before the disease, although they transmit it, they are known as asymptomatic carriers.
"In China they accelerated the investigations about this ailment and in January the world already knew some important things, such as that a significant number of people do not present symptoms, but infect others, even when it gives symptoms it is known that it began to transmit it before and you can spread it a month later, if you are sick ”.
"You mentioned a first oddity, are there others?"
—It does not attack children so much, as the age increases the incidence increases, and the same happens with the serious form of manifesting itself and the mortality of those who suffer from COVID-19, which does not mean that they are exempt from contagion or getting worse. In the case of small children, it is known that they have fewer receptors for the virus in the lower respiratory tract (trachea, bronchi and bronchioles, and the alveoli, which form the lungs), and that is one of the causes.
"This is something curious because it is not usual in viruses, although it is known that it has left sequelae to patients of different ages".
- What does the contagion and the manifestation of the disease in young people depend on?
—Comorbidities in young people are rare, they have fewer associated diseases, hence, when infected they have a better prognosis, although in medicine nothing is absolute. In this age group, the most determining factor is the socio-environmental factor, due to the places that they frequent and the activity they carry out.
—And those that we classify in the third age?
—In older adults, comorbidities are frequent, they abound over the years and sometimes up to several in a single person, such as: arterial hypertension, diabetes mellitus, cardiovascular diseases, just to mention a few, and if above of these problems do not keep their chronic diseases under control, so the danger increases.
—Many of the elderly take care of themselves, but what role do the young people who live with them play?
—That question brings me to the 2009-2010 influenza A (H1N1) pandemic, caused by a variety of Influenzavirus A, which according to international data claimed the lives of thousands of people worldwide. However, very few were registered in Cuba and only eight in Camagüey, when we reported thousands of cases. Due to COVID-19 we had only one deceased, but the number of infections has been very different, only 73 cases to date.
“And I mean this because that of 2009 was more akin to young people and we dedicated ourselves to teaching how to work outbreaks in schools and by stopping it in children and young people they did not take it home and contagion was avoided to their parents and grandparents, the transmission chain was cut.
“Now it is the opposite, there are many work centers with outbreaks in the world and in Cuba as well, despite the good control of the disease, while the same has not happened in child care centers and schools, quite the opposite.
“If young people are infected, they take the virus home, where the situation is complicated with the elderly, due to their high morbidity and mortality due to everything I have mentioned.
“Although I am an epidemiologist, not a clinician, I have lived together with these specialists, that COVID-19 most attacks the respiratory system, with serious complications in the lungs where it leaves disability, if it does not die, because the lung tissue is necrotic and the cytokine storm leads the patient to trigger a critical condition or death. This happens when the cytokines that increase immune activity become too abundant, the immune system may not be able to stop. Immune cells spread beyond infected parts of the body and begin to attack healthy tissues, devour red and white blood cells, and damage the liver.
“COVID-19 can cause massive thrombosis at all levels. If it touches the heart, a heart attack comes; if it is in the lung, pulmonary thromboembolism occurs; in the central nervous structures, it provokes a cerebrovascular accident; or the collapse due to generalized sepsis and those are the routes to death ”.
-Symptoms?
—Neurological manifestations such as loss of smell and taste. There are those who do not realize it and pass as asymptomatic until the body clears the virus or treatment is applied if it is detected by PCR, for its acronym in English (real-time molecular biology technique), but if there is no transmission and are not tested, they may be infected and not know it. Sometimes asymptomatic patients are reached by control of the focus in those who have been diagnosed with the disease.
"The symptoms have been reported and are related to a dry cough, fever, general malaise, very similar to the flu, and others that are not related to it."
- What happens with positive cases of which the source of infection is never reached?
"That is a controversial issue for the population." It is possible that when the focus control is done, the source of infection is no longer there. The other thing is that if we use the means of containment, probably someone infected is kept with a nasobuco and washes their hands and does not transmit the disease or with whom they share, comply with the directed measures and avoid being infected. All this can happen and attracts attention, which is logical. COVID-19 is self-limited if we comply with all the established measures, that is proven.
—Many people associate intubation with death ...
—This is not always the case, although they are usually patients in critical condition, there are always those who save their lives, of course. On the other hand, the person may be in serious condition and there is no intubation criterion.
—How are patients classified in Cuba?
—The asymptomatic, slightly asymptomatic because they report something mild, some with more florid symptoms, others that are more frequently complicated by pulmonary affections although not exempt from others, who reach a critical state and even death.
“Over the months, lethality has decreased in the world due to the treatments approved and used, and the sooner the case is captured, the less difficulties are, and much more favorable if it is detected when it is asymptomatic because it is treated and it is eliminated as a source of infection. In Camagüey, for example, the fatality rate is 1.4 ”.
"How do you proceed with those who recover?"
—They are followed by a multidisciplinary team of specialists, to look for the sequelae, if any, and the end of the disease that is not yet known. This procedure is done with children and adults.
- Do you think it is important for the person who suffered from COVID-19 to make it known to the doctor when suffering from some other disease over time?
—It is important and not only because of the SARS-CoV-2 coronavirus. It is vital to know the history of the previous diseases and this one that is even more unknown. To make a good diagnosis, the patient must be questioned and he must say it even if he is not asked, the time that we have been with this ailment in the world is very little.
“There are those who have sequels such as cystic fibrosis or pulmonary emphysema, but in the case of our province it is not abundant because the patients have been treated promptly ”.
"Why is it so intense in its transmission?"
—Because it is transmitted directly and indirectly. The first from person to person by means of respiratory droplets expelled when speaking, singing, coughing or sneezing and the indirect appears when it falls on surfaces, we touch them and we pass our hands over the mucous membranes, such as the mouth, nose and eyes.
“The intensity of the contagion of the germ of the current coronavirus is immense, its power to spread is very high among people. These are the reasons why a distance between people of no less than one meter must be maintained ”.
"How long does the virus stay on surfaces?"
—It depends on the temperature, humidity and environment, and the type of surface, there is no defined time, hence the importance of keeping them clean and disinfected.
"How true is it that heat weakens the virus?"
—It has been shown that during the summer it has not been like that, that is, it survived and now we will reach the winter stage and that is its favorite. Already in Europe they are facing the second wave, one of the characteristics of pandemics. The virus is controlled and it goes down, and it goes back up because it is always waiting for the opportunity.
"Can you define that opportunity?"
"The one we humans give it." Because if we already know what the protection measures are to avoid contagion and we do not comply with them, there it will find the first gap.
"What is the possibility of reinfection?"
—Infectious diseases have the characteristic of reinfection; however, in the face of COVID-19 there have been reinfections worldwide, but not in alarming amounts, they are not comparable with the number of millions of people who have suffered from it - more than 45 million infected until this October 30.
"What types of immunities can you mention?"
—The herd, applied in some countries and is that each person faces the health situation at the expense of their body responding favorably or not; the one that originates in the person who suffers it according to the defenses of himself; and the preventive vaccine for healthy people.
"And meanwhile do we wait for the vaccine?"
—Until the long-awaited vaccine arrives, we are exposed to the waves of contagion; of course, minimized if the measures we know are complied with, serve as a barrier to disease.
"The proper use of the mask prevents the entry of microdroplets of saliva, the distance of not less than an equal meter and the frequent washing of the hands that kills the virus and thus we do not pass it to the mucous membranes or the face , without forgetting the corporal bath and the washing of the clothes.
"If these guidelines are met, the waves could be so small that alarms would be avoided and healthy vaccination could be achieved."
- Is the so-called new normal due to the experience acquired during these months?
—And what happened in the world. Despite certain criteria against China, the contribution to humanity has been great and if the indications derived from its experiences had been followed, this catastrophe would have been somewhat constrained.
"We have been seven months with very limited socioeconomic activities, and in Cuba, as in all countries that have gone through this, economies have decreased. It is time to take everyday life with logical sense, what we cannot stop insisting on is what to do to avoid contagion, not hugging or kissing, something that is difficult for Cubans, social distancing as I mentioned before, and hygiene.
—Although it seems a bit morbid, will COVID-19 have any positive impact on humanity?
—There are already modifications, and for the better, since people have a perception of collective risk like never before, they even require strangers when they walk without the mask, they avoid the approach of others, the collective conscience has increased. From a medical point of view, we have seen that acute diarrheal and respiratory diseases decreased, which is due to better hygiene.
“Children will be adults who take better care of themselves, human protection has been added to school education as never before, even from the kindergarten, and that is not forgotten. They are going to see these measures as something natural, which sometimes seem exaggerated to us ”.
—If I ask you as a patient, what would you advise me not to forget?
—Keep in mind that COVID-19 is here, it has not gone away; that at the slightest oversight it can be infected, go to the doctor at the slightest symptom or if you have been in contact with a patient, and do not forget that we still do not have the preventive vaccine.
Translated by Linet Acuña Quilez