There are at least two certainties that, at the height of week 29 of the year 2022, Domingo Molina Hernández, head of the Arbovirus Program in Ciego de Ávila, ponders: no deaths from dengue or patients in serious or critical stages have been reported; however, when you delve into the statistics, the happiness lasts a "blow of an eyelash", because in the last 15 days the reactivity grew by nine percentage points, compared to the previous fortnight, reaching 45.4 percent.
It could be said that, silently, but constantly, the figures are rising and the report of 740 unspecific febrile cases, which led to 185 confirmed cases, only ratifies this. At this rate, the incidence rate is 15 percent, with worse behavior for the municipalities of Majagua, Ciro Redondo, Primero de Enero, and Morón, where, contradictorily, there are few patients admitted.
Therefore, when the specialist talks about the availability of supplies for analysis, work in real time in laboratories and their decentralization, so that IgM tests can be carried out anywhere in Ciego de Avila, it is clear that we have gained speed. From the taking of the sample to the diagnosis, 72 hours do not pass.
“The difficulties for the diagnosis are associated with the equipment, not with the supplies and reagents. These days, they work hard in Majagua, with the highest incidence rate in the province, 60.2 percent, although the active labor has had ups and downs due to the availability of resources.
However, as a rule, the blocking of the case is maintained, that is, fumigating the houses surrounding the confirmed case, radioactive investigations and biological studies in large water tanks; all this depending on the risk stratification. Where there is no confirmed case, no action will be taken, more reason not to hide the symptoms.
It will be necessary to understand that killing the mosquito that flies with the adulticide treatment and not destroying the larva in a water tank, leak or garbage dump is like shooting with "raw bullets", and the same thing happens when clipping the wings of the Aedes aegypti is not assumed as an inter-sectoral task.
If we take into account that dengue has been under the scrutiny of the highest health authorities in the country for weeks, a headline like this had been slow in coming. On the other hand, in the Provincial Directorate of Health, the news is not new and the strategies to deal with a possible epidemic are already being organized.
Osvaldo Ondarza Vergara, deputy director of Medical Assistance in the territory, breaks down the work to be carried out into three main guidelines: not to affect the rest of the Health services for the population, the Family Doctor and Nurse's Office will be the fundamental axis of the confrontation, and home admission will be used extensively for those without complications.
“Multidisciplinary teams to be created in each health area with volunteers from the International Red Cross, people not linked to medical assistance or with those professionals who are not essential in their posts. The indication of the Ministry of Public Health is, for example, not to stop a rehabilitation room to use the premises as an isolation center or its workers in the investigation, as happened before.
Similarly, these days there is a maelstrom in both provincial hospitals with the aim of having beds to form conventional rooms, intensive care and intensive care for dengue patients; all this in the midst of the constructive actions that are carried out. The ratio of doctors and nurses per bed in these enabled spaces is supposed to go from one to 20, from one to 10, and from one to two or three; therefore, the reorganization of human resources will be a major challenge from now on.
To achieve this purpose and, incidentally, "unlock" medical care in Morón, deliveries and caesarean sections will be carried out again in the southern part of the province at the Doctor Antonio Luaces Iraola Provincial Hospital, which is reinforced with the delivery, recently repaired, of the Gestante A room, and with the preparation of a room for these purposes in the curettage room.
The Guard and Emergency rooms will also be reinforced, and the admission criteria, both for adults and for pediatric ages, are defined.
In hospitals there will be people with alarm symptoms (bleeding from mucous membranes, intolerance to the oral route, sudden drop in temperature, abdominal pain, petechiae); children under two years of age and those who have had COVID-19 in the last three months or experienced the severity of the virus; pregnant and postpartum women, and those with a history of chronic decompensated diseases.
The existing isolation centers, one in each municipality, will be visited by people who do not have the conditions to comply with home admission or who have symptoms that, without being serious, warrant continuous monitoring.
For the deputy director of Medical Assistance, the correct classification of cases, or what is the same, identifying in time who needs hospital admission and who can stay at home, depends on the satisfactory evolution and recovery.
If up to this point it seems that we are being alarmists and that the measures have arrived before the explosion of cases, it is enough to stop in front of the graph that Dr. Domingo Molina Hernández makes every week to define the prognosis of the disease. The worst numbers are yet to come.