Elizabeth Daza and Jose Mireles Alcala are medical students at the University of Health Sciences-Cuban Medical Mission. Daza, who is in her sixth year, studies and works with doctors at the Che Guevara CDI [Integral Diagnostics Center] which is part of the Barrio Adentro Mission. Mireles Alacala, who is a second-year student, works in the San Juan barrio in Caracas. He is Healthcare Secretary for Caracas in the Venezuelan University Student Federation while serving as the Communist Youth’s Political Secretary in Caracas.
In this interview, the two students, who are directly participating in Venezuela’s struggle against the COVID-19 pandemic, talk about the nation’s highly successful strategy to prevent the spread of the virus so far.
Why did Venezuela take such drastic measures in the fight against COVID-19?
Elisabeth Daza (ED): Since the emergence of COVID-19 in December of last year, when it became evident that this would be a global pandemic, epidemiologists made it clear that in the fight against the new coronavirus the key would be to flatten the curve. To do so, two very important factors should be taken into account: reducing the contagion rate and increasing the capacity of the healthcare system. In other words, the objective is to flatten the curve to a level that allows a reinforced healthcare system to attend to all the cases.
That is why, early on, the Venezuelan government decided to adopt strategies that would tend to flatten the curve.
The plan began, very early on, with a strict quarantine. The government guidelines were the correct ones, and the people have followed them with a fair amount of discipline.
Also, the facemask became mandatory in all public spaces from day one. This is important because – even though surgical and fabric facemasks are not perfect because they permit certain particles to enter – they reduce the spread of the virus.
Additionally, the house-to-house visits have become very important in allowing early detection. Every household in Venezuela is to be visited by a medical team with a double function: informing the population about hygienic and protective measures, and early detection.
Of course, one of the keys in the fight against the pandemic is testing. Venezuela is well above the Latin American average in both symptomatic and asymptomatic testing. This helps locate epidemiological foci and break the contagion chain.
How is medical attention provided to COVID-19 patients in Venezuela?
ED: An important step was that in the early stages, when the first cases were detected, primary and secondary health centers were equipped for rapid testing and to attend noncritical COVID-19 cases, isolating them.
At the third and fourth level healthcare centers, such as hospitals and intensive care units, many beds were made available throughout the country, and equipment was imported, including respirators and protective gear from China. We also received medication from Cuba, particularly Hydroxychloroquine. In fact, for now, we are stocked with the World Health Organization’s treatment protocol, which also includes Remdesivir (an antiviral), and Amoxicillin (an antibiotic for complex pneumonia cases).To prevent severe respiratory problems, we are using Cuba’s Interferon for asymptomatic and light cases. The medicines and medical equipment come from both China and Cuba.
Finally, and given the healthcare system’s limitations, the government signed agreements with private clinics that are better equipped to attend patients with more severe respiratory symptoms.
An important point regarding Venezuela’s strategy: testing, medical attention, and treatment are all free in Venezuela.
How is the medical attention to COVID-19 patients being carried out?
Jose Mireles Alcala (JMA): The plan goes as follows: In the first phase, 46 hospitals at the national level were designated as “sentinel hospitals.” An isolation area was prepared in all these hospitals for exclusive attention to COVID-19 patients with acute symptoms. When a patient arrives, in addition to receiving immediate care and testing, the staff there gathers information regarding possible contagion sources and the patient’s own sphere of relations to detect focal points of infection.
In the CDIs, there are also isolated areas for care and rapid testing. Additionally, as Elisabeth said, there has been an alliance with private clinics that have isolation areas with respirators apt for COVID-19 patients. The state provides tests for private clinics.
Regarding treatment, CDIs and hospitals have access to experimental medication kits that have been successful in the treatment of COVID-19. This includes Interferon combined with other medications and Chloroquine.
Elisabeth mentioned that testing is an important piece in the strategy against the spread of the COVID-19 virus. Could you explain more about how this works?
JMA: Sure. There are two kinds of COVID-19 tests and both are being used in Venezuela. The most widely distributed one is the rapid test, which is applied with a simple portable machine that has a reagent. A small blood sample identifies if the person is positive or negative on the spot.
However, there is a margin of error with this method, so if the person tests positive or tests negative, but has had exposure to Coronavirus or is symptomatic, then they will be referred to a medical center for a final PCR diagnosis. PCR tests are lab-based studies of reactive proteins, and the process is carried out at the labs of the National Hygiene Institute.
Regarding the scope of testing, Venezuela follows the WHO guidelines. In addition to the swift implementation of the quarantine to prevent the expansion of the virus, another WHO guideline for government action is to provide as many tests as possible, both rapid and PCR, to ensure early detection and to prevent COVID-19 spread.
Of course, the sanctions have affected Venezuela’s ability to have access to testing material. However, our strategic alliances with China and Russia, along with the support from the Panamerican Health Organization and the International Red Cross, have allowed us to acquire medication and testing kits.
All this has allowed us to massively expand testing and guarantee greater epidemiological control.
House-to-house visits are another element in the Venezuelan strategy against the spread of COVID-19. How do they work?
JMA: There are thirteen thousand health teams sweeping through every household in the country. As we mentioned before, the objective is prevention and early detection.
The teams have a diverse composition. They include people from the community, particularly health committee members and communal council spokespeople; doctors, nurses, and occupational therapists either from the Cuban Mission or from the Venezuelan Barrio Adentro Mission; and medical students from the University of Health Sciences such as Elisabeth and myself.
In these visits, a household census is carried out. Questions include if someone has traveled abroad or had contact with people who came back to Venezuela recently, and if any of the household members have had symptoms resembling those of COVID-19. If anyone has symptoms, they are referred to a nearby CDI for a rapid test. If the person tests positive, they are hospitalized and a blood sample is sent to the National Hygiene Institute lab for PCR testing.
Elisabeth, as a sixth-year med student, you directly participate both in house-to-house visits and in-patient care in your assigned CDI. This must be quite a learning experience!
ED: Yes it is! The objective of house-to-house visits is early detection, at the same time as we work to diagnose the population’s general health conditions.
My Community Integral Health Area is El Recreo, a populous parish in Caracas. It is interesting because there are diverse socioeconomic levels in the area, including upper-middle class, lower-middle class, and poor people.
Each social class receives us in a different manner, but our objective is always the same: early detection of any COVID-19 cases. In the more humble communities, we are very well received: they give us the information we need, and in some communities where the people have come to know us, they even prepare lunch for us! The welcome from other social classes is not so warm: they meet us at the doorstep or they don’t open the door at all. Regardless, the door-by-door visits are carried out extensively.
In addition to early detection, the visits are also educational: we tell them about the attention provided in our CDI and inform them that the quick test is available should symptoms emerge. We also give a brief prevention talk.
As medical students, we are assigned to a CDI early on in our university careers. I’m at the Che Guevara CDI in the Pinto Salinas Barrio in El Recreo. The CDI is divided into two areas: one for COVID testing and suspected or confirmed cases, and the other for all other pathologies.
At the CDI, as advanced med students, we have weekly 24-hour watches. I haven’t seen any COVID-19 cases yet, but I have learned a lot about epidemiological care and prevention strategies.
Jose, you have worked with repatriated Venezuelans, including those coming back from countries with much higher incidences of COVID-19. What is Venezuela’s strategy to ensure that the virus doesn’t enter the country this way?
JMA: There are two methods of repatriation. First, there is repatriation through the Return to the Homeland Plan, which is a government project so that people who left Venezuela and wish to return can do so in flights provided by the government. Once they arrive in Venezuela, they are tested [with a rapid test] and undergo a medical examination. After that, they are taken to quarantine centers near the airport for five days. Next, they go to quarantine centers in their states of origin. PCR tests are done at this stage to guarantee that they aren’t positive and after two weeks of isolation they are released.
Second, there is the repatriated population that comes to Venezuela through the Colombian or Brazilian frontier. The process is basically the same: a quick test is done upon arrival and they are interned in quarantine centers in the frontier for five days. After that, they are taken to centers in their home states and given the PCR test. After two weeks, and if they have tested negative, they can go back home.
Venezuela’s Homeland System also plays a role in the COVID-19 detection strategy, doesn't it?
JMA: The Homeland System plays a role in Venezuela’s social protection program. It’s an online platform that preexisted the pandemic. When the coronavirus crisis hit Venezuela, the platform was used to carry out an online survey. The survey requested information about the health of family members and also about exposure to folks who might have returned from abroad. The data for flagged households is then transferred to the local Integral Health Area and a medical team visits the household to determine if testing is needed.
When a case is detected, an epidemiological enclosure is set in place and a broader testing process is initiated.
This has helped to detect positive cases. However, a large percentage of the Venezuelan population has no computer or internet access, so the system only gives a partial picture of the situation. That is why all households are visited by medical teams.
So far Venezuela has under 800 confirmed COVID-19 cases among a population of some 30 million. Of course, Venezuela is less transited than other countries (with fewer international flights arriving to Caracas in one year that arrive to Frankfurt in one hour) and that has limited the entrance of the virus. However, the Venezuelan health strategy has also played a key role in containing the virus. To what can we attribute this success?
ED: The countries that have confronted the COVID-19 pandemic in a more human and solidarious way have also had the best results.
In recent years, many countries’ healthcare systems have suffered from budget cuts. Their main objective isn’t to care for the population. Instead, they are designed for profit. In the face of the COVID-19 pandemic, those systems are the ones that have collapsed most rapidly.
In the case of the Venezuelan healthcare system, which has undoubtedly been hit by the sanctions, the government placed the task of protecting the population above all other things. That is why the numbers are low and we can say that, so far, the strategies to flatten the curve have been successful.