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    Home admission: from the protocol in Ciego de Ávila

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    Ingreso domiciliario: del protocolo en Ciego de Ávila

    When Asleidis Hedilia Hernández Pie, a 14 years old girl, debuted last January with symptoms suggestive of COVID-19, her family did not wait to take her to a health center. “She started with a very high fever, we took her to the hospital, they did an antigen test and it was negative, so they sent her home.

    “That was a Thursday, and on Saturday she continued with a fever; we took her back and the same test came back positive, but the other symptoms had already passed,” her grandmother Zoraida O'Farril Heredia says.

    “It was not until Monday that they did a PCR at the polyclinic and it was positive. The girl passed the disease based on herbal infusions and anti-allergic drugs. About three days after that, they came to fumigate the house, and about five or six days later they came from the doctor office, that only time,” she now tells Invasor with the calm that she probably couldn't get weeks ago at her house on the street Joaquin de Aguero, in Ciego de Avila.

    According to O'Farril, the little young woman fell ill due to an outbreak that occurred at the Ñola Sahig Saínz School of Art, in which more than 10 teenagers were involved and, "luckily, none of them became serious."

    “The adolescent still does not have the vaccine reinforcement, because she was medicated with Soberana 02 and Soberana Plus, but the truth is that the disease did not go badly. And we all had the same symptoms here at home; we didn't get tested because we already knew she had COVID-19."

    From Simón Reyes Street, between República and Chicho Valdés, to Damil Leonard Soa, the 47 years old men was so lucky when he was complying with the current protocol for the care of positive patients suspected of having SARS-CoV-2.

    “My wife works in Public Health, she started with a low-grade fever of 37· and a half, an issue that was resolved by a Dipyrone. A quick test was done at the hospital and it was positive. Faced with this alarm, I also went with my two children to be tested and all three of us tested positive for the disease.

    “The only one who underwent PCR was my wife and she had COVID-19. After that they came from Hygiene to fumigate the house and every day in the morning the doctor or nurse from the office came to see us”.

    What does the protocol establish?

    Cuban experts agree that this wave of infections by COVID-19, which, according to statistics, is already on the decline, is associated, in part, with the expansion of the omicron variant, which, they warned, is the one that prevails now.

    For this reason, the Ministry of Public Health adopted measures to minimize infections, follow up on suspect, contact and positive people, and act in correspondence with a different context than the one-experienced months ago.

    Ciego de Ávila citizens are well aware that this disease is not a "common cold" and that is why it is essential to tie up loose ends and obey the most recent update of the procedure for home care for low-risk patients.

    In this sense, Coralia del Pilar García Montenegro, head of Primary Health Care (PHC) in the province, informed Invasor that this readjustment establishes the follow-up that must be given to suspected, confirmed and contacts of positive cases, although it is subject to changes depending on the behavior of the disease.

    “The first thing a person who has any symptoms should do is go to the Acute Respiratory Infections (ARI) consultations located in the polyclinics to do an antigen test. If the result is negative, home isolation is performed and reassessed after 48 hours.

    “If the symptoms worsen, he or she is admitted to an institution to perform PCR. If you maintain mild symptoms, your follow-up is continued, depending on the behavior of your clinical picture, "she said.

    When an antigen test is positive, a PCR and admission to the home is established. Once the result is received, if it is positive, the protocol for confirmed cases is followed, and, if it is negative, follow-up is maintained and the behavior according to the evolution and clinical picture is defined.

    In this sense, she explained that today 70 percent of positive, contact and suspect people are under home admission, while the rest are in COVID-19 patient care centers or hospitals. The trend, she alleged, is for this indicator to remain that way, so the first action will be the one that will predominate in low-risk patients.

    “A patient is considered low risk when they are positive for SARS-CoV-2, but are asymptomatic or have mild symptoms associated with the disease. If, on the contrary, a person has signs or symptoms of aggravation, they must already be referred to a specialized care center,” he stressed.

    For those who remain positive at home, the protocol establishes that when they have clinical discharge criteria (at least 48 hours without symptoms or mild symptoms), with five days of positive antigen or PCR test, they will proceed to discharge clinically, without the performance of another test that confirms its negative to the disease.

    García Montenegro pointed out that, if on the fifth day of the first positive antigen or PCR test the mild symptoms continue, clinical discharge is not proceeded (nor is a microbiological study), but the approved treatment is maintained and reassessed every 48 hours, until that reverses the symptoms.

    For their part, the contacts of confirmed cases must remain in isolation in their homes for 14 days. This requires “daily monitoring with clinical- epidemiological surveillance to identify the possible appearance of symptoms and will be carried out by a doctor, nurse, medical student or designated health worker.

    “If they present symptoms, they will be studied by antigen test (SUMA). If the result is positive, PCR is performed, and if it is negative, it is discarded.

    Likewise, the directive warned that a series of patients would not be subject to the criteria of home admission for different reasons.

    This group includes all children under two years of age, infants with an incomplete vaccination schedule or unvaccinated at all, regardless of their age and clinical picture, and pediatric patients with risk factors that, according to clinical evaluation, are eligible for entry.

    Besides, pregnant and postpartum women, unvaccinated people (for whatever reason) and those who, regardless of age and vaccination, due to their clinical condition and comorbidities, be income taxpayers, will remain at home.

    Regarding medication, the Head of APS in the territory stressed that, in the face of mild symptoms, as occurs with those who remain at home, no type of treatment is necessary, since the doses of the anti-COVID-19 vaccines are a defense that already presents the organism.

    It is a relief to know that our health is not watched from the improvisation, although it is not a secret that at all levels what is written is not followed to the letter.

    What the protocol implemented in Cuba does show is that our vaccines are effective. Even with the high transmissibility of the omicron variant, our country will not experience another wave of infections as aggressive as the one from August to November 2021, according to experts.