The first indication was a slight sore throat, but Marivis Rosa Pérez did not imagine that SARS-CoV-2 was beginning to attack her body. The discomfort was attributed to a cold or the exhaustion of a whole week of work at the Ambulance Center in this city.

Las Tunas, Cuba.- But it turned into suspicion when on the morning of Sunday, February 28, she received the news that one of her co-workers had tested positive for the virus. Then she did feel danger too close and worry came over her.

She says that she went to her health area and a negative quick test left her a thread of hope. However, since she was one of the direct contacts, she had to enter the Los Cocos isolation center, where, she emphasizes, received careful attention. "A wonderful staff who assisted me from the moment I arrived; I am very grateful."

On March 2, the positive result of the PCR would bring back a terrible fear, the same that she had tried to dispel at all costs. Now her illness was a certainty and she couldn't stop thinking about the implications.

Her many years in Nursing and what she experienced during the last calendar in the command post of the Integrated Medical Emergency System (SIUM), had given her the experience to face different situations; but now she was on the other side, and perspectives change from the patient's gaze.

“When I told my daughters the diagnosis they didn't believe it; it was too difficult. One of them is a neonatologist nurse and that is precisely why from the beginning I ran to the polyclinic; and of course, she remained isolated too. Luckily, none of my contacts were positive.

“You have to be afraid of COVID-19. I always warned of the danger and adopted biosecurity measures; nevertheless, I caught it. This disease has no face and no one is exempt from suffering from it.”

“You have to have a lot of confidence in Cuban medicine and value how much we have, which is not little. This pandemic has ratified the priority given here to the health of citizens,” Marivis says.

DAYS OF TENSION

The SIUM headquarters in the provincial capital was the first health institution to report an outbreak of COVID-19; of which the nurse Marivis, a doctor, and a paramedic driver (the index case) were positive. This upset the dynamics, but the collective effort allowed the population to barely perceive the "hole" in services. This was assured to 26 by Omar Villafruela Pupo, an Emergency Specialist in the Provincial Health Directorate.

The first confirmed, he explains, was in the red zone, specifically at the Los Cocos isolation center, when he began with symptoms (fever, respiratory manifestations…), “he was admitted after testing positive for the rapid test. The crews of the two ambulances that were at that place were also isolated and after disinfecting both vehicles, other colleagues assumed the responsibility.”

“After confirmation of the PCR, 60 contacts were identified, including those from the SIUM headquarters, six of them with symptoms. It is important to highlight that this place has a significant number of workers since it is the largest base and where the vital support is.”

Among those isolated, there were 16 doctors, which is why they requested the help of doctors from the Puerto Padre Ambulance Center. "Despite the preparation of these professionals, the task was a challenge, taking into account that the maelstrom here is greater," he commented

The center was reincorporated by personnel who, during the days of the event, were carrying out other missions. The activity was also supported by those who did not coincide with those involved in the same place, due to the organization of the work by shifts system.

Finally, only two contacts of the index case were diagnosed with the disease and received care at the Fermín Valdés Domínguez hospital, in Holguín. "We lived some very tense days," summarized the specialist.

BACK TO NORMAL

"Although the human resource was affected, the service was never paralyzed and we met our goal of not to unprotect, at any time, the population," Villafruela Peña said.

The contacts who tested negative for the PCR returned to their normal tasks after completing the epidemiological surveillance.

Since the beginning of the pandemic, the SIUM has assumed the transportation of suspected, contacts and positive patients for COVID-19. Ambulances were made available for the task, according to the needs of the territory.

“They have been located in isolation centers and the personnel in charge have maintained a different job rotation from the rest, to reduce risks. The supply and repair system for vehicles has also had its peculiarities.

As part of the provisions, the closure of the SIUM Provincial Base for ambulances from the municipalities was declared, and it was determined to carry out the usual procedures by telephone since the coordinating center is located there.

To this, the placement of the footwear baths was added, the health inquiry among the staff, and others. Now, after the event, those provisions are reinforced.

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At this time, perhaps, Marivis fulfills new missions from the command post, or assists the transfer of a patient in one of the ambulances; either way, she will do it with love for a profession to which she has dedicated her life and, above all, with extreme care.

She and everyone there know that there all precaution is little in the face of this disease, as Villafruela Pupo assures. "This experience shows us that we must be much more rigorous to avoid similar situations that compromise the operation in Las Tunas of a center as sensitive as the SIUM is."