With the resumption of regular operations this Sunday at Havana’s José Martí International Airport, Cuba opened its main gateway to the country after months of closures and restrictions due to the coronavirus pandemic. Since the previous weeks, other Cuban airports, such as Varadero, Holguín and Santiago de Cuba, had already started operating, with which the flow of international travelers has multiplied throughout the island.
This reopening is necessary to reactivate the hard-hit Cuban economy―and in particular a key sector such as tourism―and to reconnect nationals abroad―immigrants or residents―with the country, with the monetary injection that this represents. But, at the same time, it entails a high epidemiological risk for a nation that, even with its ups and downs, exhibits to this day an indisputable success in controlling COVID-19.
Faced with this dangerous scenario, the health protocols established on the island for people arriving from abroad are gaining relevance. In recent days, the authorities and the press have offered a variety of information on this subject, but concerns and questions persist, which an interview with Dr. Carmelo Trujillo, head of the Department of International Health Control of the Ministry of Public Health (MINSAP), published this Wednesday on the official website Cubadebate, tries to answer.
In it, Dr. Trujillo explains that these protocols are not new, that there is already experience in their application, and they have been designed to act on “any person who arrives through an international entry point and is going to interact with our population,” whether they are tourists, foreign students, Cuban collaborators abroad or other residents in the country who return to their community or non-resident Cubans who come to visit the island.
Its objective, he says, is “to detect in time any sick person who could carry a transmissible disease and complicate the current health situation of the country” and, taking into account the current international epidemiological context, they have been adapted for the specific case of COVID -19 and have been enhanced for the conditions of the new normal that most Cuban provinces live.
Three lines of surveillance at airports
The MINSAP official affirmed that Cuban airports have three lines of epidemiological surveillance, implemented since the influenza A H1N1 pandemic in 2009, which “raise the level of sanitary control of international travelers who arrive in the country through this type of entry point.”
The first of these surveillance lines “is designed to dispatch aircraft entry” and in it “a doctor or a specialist in hygiene and epidemiology performs the dispatch of the aircraft once it reaches the ramp or mobile bridge.”
“This is the first contact with the crew that comes on the plane, precisely for the analysis of documents and the creation of the general statement of the aircraft,” said Trujillo, who noted that this statement “reflects all the general data of the aircraft,” including the model, number of passengers on board, number and condition of the people on board and if there were any incidents on the trip. In Cuba, he added, “great importance is given to the health status of the crew and passengers during the crossing” and to the communication to the crew “of the new measures contained in the action protocols of the health authorities at the border, related to the COVID-19 pandemic.”
“Now, in the new normal, some important elements are included that it is necessary to know in advance, such as if someone comes aboard the aircraft with acute respiratory illness, or some respiratory symptoms, if there is a report of someone who has presented a fever, among others,” he explained, and said that if no incident is reported, then the disembarkation of the passengers, crew, luggage and cargo from the plane is authorized.
The second line of surveillance is activated once passengers enter the air terminal and arrive at the immigration lounge. There, according to the official, all passengers pass in front of a temperature scanner that, without touching the travelers, “allows people with elevated body temperature to be identified promptly” and in the current situation “health epidemiological surveillance actions have been reinforced with personnel through the method of observation, looking for signs and symptoms in all passengers that may suggest having COVID-19, and any other transmissible disease.”
Also at this point, the traveler’s health declaration is reviewed and collected, contained in the model 8233-02 of the Ministry of Public Health, which must be delivered during the trip so that people fill out the data that is requested in it.
In this regard, Trujillo insisted on “the responsibility that all international travelers have to correctly fill in all the data requested in this model” and added that in the document “the passenger is warned that any data that is distorted or does not correspond to reality, may be subject to the application of a measure or requirement from the sanitary point of view, which are established in the sanitary legislation in force in the Republic of Cuba.”
The PCR sample and warning card
According to the head of the MINSAP Department of International Health Control, the declaration of health collected in the second line of surveillance “is a complement to the traveler’s record for taking the PCR sample” and functions “as an identification instrument for international health control” because “the passenger’s sample number, once the test is made and sent to the laboratory, is reflected in one of its corners in order to avoid confusing the samples.”
At the same time, travelers are given a warning card, in which “passengers are informed that they must present themselves, before 48 hours of arrival in the country, before their family doctor or the health area where they reside and declare their status as a traveler, to initiate the established health controls and monitoring in their health area.” This also applies to non-resident Cubans and foreigners who stay in family or rental homes.
In the case of tourists who go to hotels, they are followed by the health teams of the country’s tourist facilities, which are in charge of maintaining epidemiological surveillance, watching out for the results of the PCR test, isolating and performing the first care actions for possible positive cases, and to “timely detect health situations that international travelers may bring from the countries of origin or from the countries through which they traveled before entering Cuba.”
Once the PCR sample is taken, the travelers go to the immigration booths “where the corresponding checkups are carried out” and, after the first customs line, they go to the third surveillance line where their temperature is again taken, this time with a digital thermometer. Only then do they go to the area where they collect their luggage and carry out the rest of the customs procedures, said Trujillo, who, however, explained that the Cuban international health control program also takes into account factors such as the origin of the traveler, the migratory condition of the same, whether Cuban or foreign, “and which specifies acting according to the epidemiological risk that it represents for the country.”
Also by sea
Regarding international ports, marinas and cruise terminals, the official confirmed that “an action protocol has also been structured for three surveillance lines similar to that of international airports” and pointed out that “all crew members of commercial and recreational vessels arriving in the country who are going to a stay longer than 24 hours, should have a PCR test if they are interested in going ashore” and “be subject to isolation until the result” of this test is ready. Only then “will they be able to perform all the actions they had planned.”
As for the lines of surveillance, in the case of ports the first is in the entry dispatch of the vessels in which “a series of actions related to the documentation that the crew has to present is carried out,” the vessels are inspected, and it is checked whether the crew and passengers on board are in optimal health.
“The means of transportation must comply with certain sanitary conditions established to avoid the entry into the country of sick people, vectors or hosts of diseases that are now exotic to Cuba. It also has to comply with the pre-established hygienic measures on board that guarantee the good health of the crew members,” said the specialist.
Then, the second line of surveillance “is the epidemiological surveillance of the vessel during its stay in the country,” said Trujillo, who said that it “is characterized by monitoring the means of transportation while it is docked in Cuba” and that “the actions carried out will depend on the stay and will be directed by a health team made up of doctors, nurses and technicians/graduates in hygiene and epidemiology” in charge of “ensuring the application of all measures designed to maintain a good hygiene and life on board” and function “as a focal point to detect any problems with the crew in time.”
Finally, the third line of surveillance “is activated when the crew or passengers are going to get off the boat” and in it “a temperature control is carried out, through a temperature scanner or thermometer, depending on the physical conditions and technologies at each of the entry points; an epidemiological observation of the crew members who go ashore and the traveler’s health declaration is filled out where the person certifies their state of health.” Moreover, as an additional action the temperature is also taken when returning to the vessel.
As for marinas and cruise terminals, they also have a specific “very well designed” protocol, according to Trujillo. The former “have schemes very similar to those of international ports,” he affirmed, although he said that they have “the particularity that epidemiological observation is daily, which means that the protocol corresponding to the third line of surveillance is applied every time the crew member or passenger of the recreation boat is going ashore” and that “additionally, there’s a checkup every time they are going to get on the vessel.”
In the cruise terminals, for their part, PCR tests cannot be carried out, since most of these vessels that arrive on the island do so only for a few hours. This is why “we work with the cruise lines for them to offer a documentary guarantee that all crew members and passengers who come aboard one of their ships have undergone a PCR test and are in good health. Based on this information, the Cuban health authorities could make an assessment of the health status of that vessel and of everyone who comes aboard it,” he specified.
In addition, all persons who go ashore “must pass the third line of surveillance, where necessary controls and checkups are carried out” and “the method of observation is applied, looking for symptoms in each of the crew members or passengers and taking their temperature.”
In the communities
As the card issued at the airports warns, all travelers arriving in Cuba are obliged to present themselves within 48 hours of arrival at the health area of the place where they reside or are staying, and “declare their condition of traveler, to initiate all the actions that are related to the international health control and epidemiological surveillance.”
Trujillo pointed out that, according to the provisions of Cuban protocols, “each person who enters the community must be in isolation in their home for 10 days until the result of the second PCR arrives, which is carried out on the fifth day in the community, coordinated with the health area.”
“When that result arrives, which should take between 24 and 48 hours, the person must have been in the country between 7 and 9 days. Therefore, the epidemiological surveillance established in Cuba for COVID-19 lasts 10 days,” explained the official, who stressed “the importance of the person remaining in isolation and complying with all the additional measures that have been established in our protocols, such as the use of means of protection, social distancing and minimal contact with family members.”
Only with the result of the second negative PCR test is it possible to have a normal mobility within the country, the specialist reiterated, while emphasizing that “all international travelers are obliged to report immediately to any health institution if they present symptoms of any transmissible disease.”
This protocol not only applies to resident Cubans who return to the island, but also to foreigners residing in the country and non-resident Cubans, “but who go to their family’s house, a rental house, that is, in the community.” In addition, it is valid beyond COVID-19 because, according to Trujillo, the traveler “may come from a region of the world where there are certain diseases, which in Cuba are subject to international control or are exotic to the country” which is why, regardless of the pandemic, “the Cuban health system monitors them carefully, so that they do not become a health problem in the national territory.”
The health fee
Finally, the head of the MINSAP Department of International Health Control referred to the health tax announced days ago, and that will begin to be charged to all travelers who arrive in Cuba as of December 1. In this regard, he acknowledged the existence of concerns and questions about it, among them that, “if Cuba in its Constitution guarantees a universal and free health system, why are PCR tests going to be charged.”
In response, he said that with said tax “the PCR is not being charged” and its implementation “is not related to the medical care that a Cuban may receive.”
“Health fees are designed to regulate the costs involved for any state in the world to apply protection measures to its population and health control measures at its entry points,” said Trujillo, who stated that their application “has been very well analyzed in detail from all points of view, and in no way violates what is established for Cubans in the Constitution.”
The tax, which has a value of 30 USD and will be charged within the price of the ticket, as reported at the time by the Cuban authorities, “was implemented to regulate the costs of the health measures that the pandemic has forced us to impose at the border,” which, he said, “represent an outlay by the Cuban state to implement them.”
The application of the tax “supposes a protection for the Cuban population, but also for any Cuban or foreign person who arrives in the country” and, at the same time, “avoids in the long term an outlay of large financial burdens to be able to face an event of public health that would be much more expensive,” concluded the official.