key: cord-0895181-0hkti4uh
authors: Salas, Daniel
title: COVID pandemic: updates from Cuba
date: 2020-08-13
journal: Dialect Anthropol
DOI: 10.1007/s10624-020-09607-0
sha: 0d851ebb3c308f16b3b0ccff76b754ca5205c979
doc_id: 895181
cord_uid: 0hkti4uh

nan

work. While Cuba's international closure came a few days after other countries of the region, once the contingency plan was activated, the implementation came swiftly-adding to the notion that the timing and energy invested in early-on mitigation defines the fate of the outbreak.

With the economy in near-hibernation, the authorities activated the defense councils, a decentralized chain of command with power to marshal the full array of public and social resources during catastrophes. Interprovincial checkpoints to enforce mobility bans, screening, and vehicle disinfection popped up. A massive communication campaign called on Cubans to stay at home. By mid-May, the Oxford Stringency Index gave Cuba its highest evaluation for governments' response to the pandemic (Hale et al. 2020 ).

Cuba's primary healthcare workers, supported by thousands of medical students and volunteers, carried out a proactive nationwide campaign of epidemiological surveillance and community outreach (locally called pesquizaje activo). Checking for potential new potential cases, tracing contacts, and promoting healthy habits has required extensive legwork by doctors and students, who perform door-to-door rounds and check on people's health at their doorsteps. Contacts of COVID-19 cases are categorized according to a risk assessment and isolated at home or in government-run facilities (emptied schools and hotels). Tens of thousands of Cubans have spent some time in these isolation centers, until tested negative by RT-PCR or finished a 2-week quarantine period. Due to the virus's ability to spread through asymptomatic cases, the preventive isolation of contacts (pending confirmation or dismissal) has been a critical measure to contain the spread of the virus.

Cuba has also been able to study the contacts for the totality of the cases. In July, health authorities noted that out of a total 2438 COVID-19 cases (July 16, 2020), the chain of infection had been established for 95.4% (Cubadebate 2020) . Meanwhile, as more laboratories across the country entered in service for COVID-19 mitigation, the testing capacity for the virus more than tripled, remaining well in the range recommended by the WHO.

The efficacy of the intervention permitted authorities to avoid enforcing a full stay-at-home order across the island. Strict quarantines have been applied "surgically" to localities with COVID-19 clusters, but their small area allows the authorities to concentrate resources in support of families there.

In their fight against COVID-19, Cuban patients have been supported by the country's pharmaceutical industry, which supplies most of the drugs employed in the treatments (Yaffe 2020) . Some of these products, including the interferon alpha-2b of Cuban formulation, have made headlines after being adopted in international protocols for the treatment of COVID-19. Among the general population, elders and other potentially at-risk individuals have been administered immune system boosters in the form of homeopathic drops.

In addition, the Cuban health system has sent over 2500 health personnel to some 28 countries specifically to fight against the pandemic-this in addition to many thousands more deployed in longer-term "missions." Notably, this is the first time that Cuban health brigades reach the global north, specifically Italy and Andorra. There are calls to grant the Nobel Peace Prize to Cuban medical "cooperantes" (CubaNobel 2020). It is hard to imagine a better contrast to the "wild west" global market for medical equipment and supplies than the solidarity-based approach to global health promoted by the island.

In the social policy front, the Cuban government has deployed supplementary "make live" interventions (Li 2010) , like distributing food bags and managing off-queue access to stores, focused on the population most at risk, including elders living alone and immunocompromised individuals.

The public health crisis has catalyzed a degree of cooperation between small private enterprises, volunteer associations, and frontline public entities like hospitals and community kitchens. Amplified by the media and social networks, the examples of 3D printing shops producing ICU ventilators' parts, restaurants supporting solidarity food networks, and similar initiatives have circulated as symbols of social cohesion.

State workers affected by economic hibernation received their full salary the first month and 60% afterwards. Those who switched to distance work kept their total wages. However, in the space of private labor relations, the panorama has been different. The government ceased taxation over temporarily closed businesses and their laid-off workers. Still, the crisis showed the shortcomings of regulations that lump together owners and workers under the category of self-employed, denying itself the means to fine-tune its potential support to this sector. For those falling through the cracks, a social safety net includes elemental food rations (which everybody receives), social security payments, and offerings of (typically) low-quality public jobs.

In Cuba, as everywhere else, the pandemic has come to amplify preexisting social inequities, disproportionally affecting those in the most precarious position.

Most of the communities first hit by local transmission were located in privileged corridors connected to international tourism. Mitigation and adherence were relatively easier to achieve there. Once the virus penetrated the inner city and peripheral barrios of Havana, it has proven to be harder to control-as poverty, overcrowded housing, and ingrained bodily habits hard to negotiate with physical distancing contribute to its circulation. Thus, not only the risk of illness, and the inconvenience of quarantine, but also the downsides of increased state surveillance-precisely upon those more dependent in the informal economy-have put in sharp relief the geographies of inequality.

The pandemic shock has taken shortages and queueing for just about everything to a new level, placing inequalities in the daily "struggle for consumption" (Pertierra 2011) once again in the front burner. The scarcity of food and essential goods, a weak e-commerce infrastructure, free time, and no strict stay-at-home order for many have pushed thousands upon thousands of Cubans onto multi-day queues. "La cola del pollo"-the line for frozen chicken in hard currency stores-has risen to archetype level. The renewed saliency of queueing registers the inequality between those who need to stand in line, exposing themselves to the sun and the virus, and those who can pay for products at a premium from their homes and also between those who queue because they have no choice and those for whom queuing to resell in the black market is a lucrative occupation. The paradox, of course, is that those most visibly engaged in the queuing-reselling business-the villains of the day, targets of moral attacks, and increased policing-are disproportionally themselves racialized people, women, and, generally speaking, the losers in the long-term social competition for wealth and status.

Before the pandemic, the Cuban economy was already under high stress. The Trump government scrapped the Obama's approach to Cuba and fully applied itself to asphyxiate the island. Cuba's reform towards a mixed economy bogged down under the weight of its contradictions through the late 2010s. The national food system is stuck in an unfinished transition that keeps private and cooperative producers under the yoke of bureaucratic controls of supply, distribution, and investment. The Venezuelan ruin and the right turn in Latin America have affected Cuba's regional articulation. In 2019, the government was already talking about a "critical conjuncture;" and then the pandemic brought tourism to halt.

The challenge demands a dramatic change in attitude by the state apparatus. Relieving social productivity across all forms of property from overregulation and bureaucratic parasitism is imperative. In line with this, the authorities announced in late July the legalization of private SMEs, an expansion of cooperativization, channels for imports and exports by the nonstate sector, and a shift towards the indirect regulation of markets-long-awaited measures that can improve the economy (Torres and Brundenius 2020) . The Cuban president Miguel Díaz-Canel accompanied these announcements with declarations that nobody would be abandoned, echoing Fidel's words in the 1990s and Raul's in the 2010s. The problem is that, in some practical senses, there are people already abandoned in the country. The contemporary Cuban society carries the scars of the long-term operation of contradictory spheres of value centered on hard and soft currencies (Salas 2019) . While the logic of such economic architecture responds to the state's commitment to redistribution and basic welfare, the everyday experience of the dual economy is one of social stratification drawn around racial and spatial lines (Hansing 2017) . Out of necessity, the latest policy package includes further steps towards dollarization that will contribute to the gap around hard currency. As authorities steer the country down the path of crucially necessary structural reforms, they must be mindful that the long-term viability of the model will depend on the empowerment of working people, including those occupied in reproductive labor, and the roll out of social policies that focus attention upon those with greater disadvantages.

The Cuban authorities managed to initially control the pandemic and seem to have drawn lessons about the synergies between effective decision-making, science, and innovation during the health crisis (Diaz-Canel and Nuñez 2020). Amid an impending international recession and with the US extraterritorial sanctions in place, the country is getting back to the business of putting in practice the program of change outlined in official documents, including a new constitution approved in 2019. All the wisdom will be required, and some luck, to successfully carry out the transformations. But in truth, it will not come as a total surprise if the country finds a way forward. Not for nothing did Fernando Ortiz (Ortiz 2014) wonder almost a century ago: Might it be true that Cuba is-unstable but unsinkable-an island made of cork?

Conflict of interest The author declares that he has no conflict of interest.

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