How Coronavirus Treatment Can Be Radically Different

  • 05/15/2020
  • Mark Friedman

By Mark Friedman, Columnist

The National Nurses Union, representing 150,000 nurses nationwide, has been organizing rolling protests at scores of hospitals around the country, from San Pedro to New York, demanding safety equipment. See prior Random Lengths articles). A recent press release says:
“Our government must put patients over profits by directing and coordinating the manufacture and distribution of vital medical resources and guaranteeing that everyone is provided the quality health care they need with ‘Medicare for All.’” “This action will tell the world #TheSystemIsBroken and we demand #PPEoverProfit.”

Some countries seem to be weathering the coronavirus pandemic better than others. One country that moved rapidly to deal with the emerging threat was Cuba. In this article we will compare the government’s response in the US, including reports from nurses in San Pedro, Michigan and New York.

Nurses and Front-Line Workers Protest at Trump Golf Course
Theresa Monroe, a nurse at LAC+USC Medical Center for the past 20 years, said she’s never been prouder to be a nurse, but at the same time, she and her co-workers are frustrated, angry and scared.

“Every day when I clock in, I wonder how much more we will be asked to sacrifice without adequate support from Washington D.C.,” Monroe said. “People call us heroes, but to be honest, without adequate support we feel like sacrificial lambs.”

Nurses in multiple cities including LA, report a lack of personal protective equipment, especially masks. Ann Arbor, Michigan, received 22,000 from the federal government that were unusable because they had “expired”. Other cities discarded “expired” masks without having replacements, opening them up to tremendous shortages when the pandemic hit.

In addition, Garcetti’s call for budget cuts and furlough days for city workers, resulting in reduced staffing will result in a lack of access for people who rely on county services as a social safety net. As unemployment continues to grow, people’s health insurance is cut and the demand on the county system will increase.

A long-time nurse, Margaret, working a COVID unit in Michigan, a national hotspot especially amongst Black residents, told Random Lengths by phone.

“So many of us working in health care did not sign up for what the COVID-19 pandemic health crisis brought about: A disease that exposed how broken the healthcare system is and how decades of putting profits over public health now leaves many people at the front lines fighting this disease at risk for their own health and many people who contract the disease to die all alone in a room with no one at their bedside.

Most hospitals do not have safe nurse to patient ratios on a good day, and with this crisis, any thought of people getting good care from their nurses, Dr’s or even a tech are thrown out the window”

A nurse who wants to remain anonymous, told Margaret that when she picked up some overtime from an agency, she was sent to a hospital in west Detroit where she was expected to take 10 COVID-19 positive patients with no tech or assistive personnel for a 12-hour shift. She reports she didn’t see half of her patients because two of her patients were so sick, that a majority of her was spent assisting them trying to keep them from having to be put on a ventilator.

She reports that she had no idea what half of her patients looked like or how sick they were. “Several of my coworkers expressed anger at the CDC constantly changing their guidelines for what is safe not based upon what is scientifically proven to be safe for us taking care of these patients but what is ok, with the supplies we have at hand,” Margaret added. This has also been true in Los Angeles; a focal point of nurses protests at UCLA in Santa Monica.

“Many have lost complete respect for an agency many thought would have your back in a time of need. I’ve heard stories at some hospitals where the tech and the RN have to share a gown when they go into a patient’s room, in order to conserve supplies and do not throw it away until the end of their shift or unless it gets soiled. These gowns they wear are disposable and are only supposed to be worn once, by one person and disposed of when you leave the room. One thing that rings true of all staff, no matter where one works – NOT ENOUGH TESTING BEING DONE!” Profiteering on equipment costs has become a new business opportunity for the unscrupulous equipment manufacturers. For example, the gowns usually cost about $0.39 and hospitals are having to pay more than $3.00 for each.

Margaret continued, “Why do we have to wait until we are symptomatic before we are tested? We are being asked to lower the standards of safety for these very sick and contagious patients and only when we feel symptomatic?!!! At the University of Michigan (U of M), the staff is better off than many of our colleagues in other health care systems. When we enter the hospital, we have to put on a disposable mask supplied by U of M. They want us to wear these as long as possible, all day and I can tell you, I feel many wear them too long until they get moist from breathing and their protective quality diminishes, thus making nurses vulnerable to contagion.

U of M recently received a shipment of surgical masks from the government. I’ve read several post on FB where people report the masks breaking after only 1-2 hrs and that they seem to be made of inferior quality. Are these the unusable masks that are being sent to hospitals?

Cuba: World’s Highest Ratio of Doctors to Population
Cuba has several advantages over many states, including free universal healthcare, resulting in positive health indicators, such as high life expectancy and low infant mortality. Many of its doctors have volunteered around the world, building up and supporting other countries’ health systems while gaining experience in emergencies. There are currently over 1500 Cuban doctors and nurses in 23 countries helping to fight the impact the pandemic.

Cuba’s government can mobilize resources quickly. Its national emergency planning structure is connected with local organizations in every corner of the country (unions, community organizations, women’s groups and even the army). The disaster-preparedness system, with mandatory evacuations for vulnerable people such as the disabled and pregnant women, has previously resulted in a remarkably low loss of life from hurricanes.

But the pandemic comes at a particularly difficult time, as tightened US sanctions have sharply cut earnings from tourism and other services, deterred foreign investment, hampered trade (including medical equipment imports) and attacked countries that have contracted with Cuban doctors for assistance. In addition, the US government has done everything it can to prevent medical equipment and especially ventilators from reaching Cuba.

Cuba’s reaction to the coronavirus threat was swift. A “prevention and control” plan, prepared in January 2020, included training medical staff, preparing medical and quarantine facilities, and informing the public (including tourism workers) about symptoms and precautions. So, when the first three reported cases were confirmed on March 11, arrangements were in place to trace and isolate contacts, mobilize medical students for nationwide door-to-door surveys to identify vulnerable people and check for symptoms, and roll out a testing program.

On March 20, with 21 confirmed cases reported, the government announced a ban on tourist arrivals, lockdown for vulnerable people, provision for home working, reassignment of workers to priority tasks, employment protection and social assistance.

When face-masks and physical distancing proved insufficient to keep public transport safe, services were suspended and state and private vehicles and drivers were hired to transport patients and essential workers. To reduce crowding in shops, the distribution system was re-organized and online shopping introduced.

How are the Cubans responding to the pandemic in their own country?
Third, fourth and fifth-year medical students are the ones knocking on the doors to make sure no one has flu-like or respiratory symptoms that are specific to the coronavirus. When they encounter a person with those symptoms, they make a point to get them to a place where they can be screened to make sure they don’t have COVID-19. People who test positive are sent to one of the tropical medical centers where they are treated.

The government urged physical distancing, masks while around others, and that people not participate in gatherings. For at least a month tourists would not be allowed in the country to make sure to get a damper on the cases of COVID-19 that they have now. (Cuban cases of Covid-19 came from foreign tourists and Cubans returning to the island.

Cuba’s use of Interferon alpha2B
Interferon is a product that acts directly to make the immune system respond, activating the mechanisms of viral inhibition. It has been used in previous epidemics, says Dr. Eduardo Martínez Díaz, president of the large scientific-business conglomerate BioCubaFarma. “Normally the number of patients with Covid-19 who go into a serious or critical state is 20 percent.

In Cuba, the number that reaches that stage is half, compared to the indicators at the international level. Our country’s death rate is 2.7 percent. Cuba produces the necessary INF for local use, as well as meeting the growing number of international requests that have gone along with special medical brigades to more than 23 countries in Europe, Latin America, Africa and the Caribbean.

Cuban Trained Doctors Working in the Bronx
In the South Bronx, Dr. Melissa Barber is putting into practice lessons she learned more than a decade ago from her training as a medical student in Cuba at the Latin American School of Medicine, or ELAM as it’s known by its Spanish initials. Over the past two decades, more than 75 US students have taken advantage of free medical training in Cuba because they cannot afford the $250,000+ medical tuition here.

For Barber, healthcare doesn’t start with an ambulance ride to the hospital but with community organizing and a deep familiarity with the needs of one’s neighbors. Barber is also the coordinator for the U.S.-Cuba scholarship program that provides free medical school training in Cuba for aspiring doctors who commit to return and serve in their communities.

“Here in the South Bronx we’re dealing with the same thing as other cities and states: a rising number of cases, super-packed hospitals that cannot hold the quantity of people that are coming in to be treated or assessed with fever symptoms, or pneumonia and flu-like symptoms. Many of us who are at the super-local level are taking a community-organizing approach. We’re galvanizing all our supplies and resources so that we can be a source of support for what’s going on in the community. We have a coalition of groups —that have gotten together.”

“Anyone who has been trained in the Cuban health system knows how to assess a community’s health and in emergency situations survey what’s going on. It’s about being able to assess who are the vulnerable people that are susceptible to this disease and keeping an eye out in case that may arise.

But inside hospitals, medical staff are continuing to fight for their basic rights and protections while on the job. After a weeks-long effort demanding more personal protective equipment, New York City health workers now have a new challenge ahead of them: a new policy at the city’s public hospitals that requires medical workers who call in sick to produce a doctor’s note.

So reported ER pediatric nurse, Sean Petty, on Democracy Now, who helped organize protests. He’s a member of the board of directors of the New York State Nurses Association.” As of last week, healthcare workers can finally get tested. But prior to that, we have been denied those tests. So, the thousands of — the thousands of healthcare workers, the 77% of our members who have been polled who have been exposed to this coronavirus, have not been tested. So, they have no idea who is actually COVID-positive and who is not.”

He added “Every single policy that’s been implemented by the federal government, the state, the city, has been based on shortages, not based on science.

Mayor de Blasio reported the horror of the hundreds of people daily who are dying at home, so many of them undocumented immigrants. Hundreds of people a day, when the average before was something like 25, even afraid to go to hospitals because they might meet ICE.

Read here about the federal government’s missteps and CDC errors from the beginning in dealing with the coronavirus outbreak. A result of putting business interests, the stock market and Trumps hallucinations ahead of human needs.

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