Editorial

Integrated Community Work Strategy at Sancti Spíritus University of Medical Sciences during the 2020-2021 academic year

Lizet Guerra González^{1  *} 
http://orcid.org/0000-0002-8335-9232

Idania Pérez Lugo¹ 
http://orcid.org/0000-0003-2636-2125

¹Universidad de Ciencias Médicas de Sancti Spíritus, Sancti Spíritus, Cuba.

Covid-19 is the most recently infectious disease discovered caused by the coronavirus (SARS Cov 2). Both, the new virus and the disease were unknown before the outbreak in Wuhan, China, in December 2019.

The most common symptoms of Covid-19 are fever, tiredness and dry cough. Some patients may experience aches, nasal congestion, runny nose, sore throat or rhinorrhea. These symptoms are usually mild and appear gradually. Some people become infected but do not develop any symptoms and do not feel ill. Most people (about 80 %) recover from the disease without any special treatment. About 1 in 6 people who get Covid-19 develop severe disease and have difficulty breathing. Older people and those with underlying medical conditions, such as high blood pressure, heart problems or diabetes, are more likely to develop severe disease. About 2 % of people who have got the disease have died. People with fever, cough and shortness of breath should seek for medical attention. ^1,2,3,4,5

Today, daily increase of Covid-19 cases is a reality for the world. This disease shows no preference for age groups, social classes, climate and its clinical presentation varies according to the immunological strength of each human being. It has broken epidemiological concepts, and its prevention and control has become a challenge for the medical and scientific community. ^1,2

The World Health Organization (WHO) is studying the ongoing research on the ways in which Covid-19 spreads and will propose arguments on the updated results.

Till 15 April 2021, 139 million 420 thousand 133 cases were reported worldwide; 59 million 961 thousand cases in the Americas region, 2 million 992 thousand 390 people of the total number of reported cases worldwide are dead, for a case fatality rate of 2.15 %. ^1,2,3,4

Cuba has complied with the Covid 19 Prevention and Control Plan, today the country has a significant number of provinces in the stage of limited autochthonous transmission, where all sectors of society have key tasks to stop the pandemic spread. ¹

The Covid-19 Action Protocol is implemented and checked at all levels of health care (primary, secondary and tertiary).

Epidemiological surveillance is used to prevent and control the disease. aimed to detect cases with infection and to demonstrate any evidence of sustained human-to-human transmission also to determine risk factors and risk areas for transmission. ^1,2

Precisely, health personnel and students of medical sciences in Cuba have played a leading role with epidemiological surveillance actions through active screening of suspected or probable cases of Covid-19 and promote actions at present within the population.

In Cuba, a Measure Plan for the pre-epidemic, epidemic and post-epidemic stages of Covid-19 disease has been designed. ^1,2

Since the disease´s first case in the country, diagnosed in the municipality of Trinidad, students from the Sancti Spíritus University of Medical Sciences (UCM de SS) have played a leading role in the fight against Covid-19 by participating in the active investigation of suspected or probable cases within the population of the eight municipalities of the province, promoting epidemiological surveillance actions; final years students of each of the Higher Education courses from the Medical Sciences supported the direct care of patients admitted to hospitals and isolation centers; also the training of the population on measures to prevent Covid-19; the subject of Covid-19 was included in the e-learning modality with subjects in the curriculum of each of the Medical Sciences courses in Sancti Spíritus. ⁶

The University of Medical Sciences in Sancti Spíritus mobilized more than 2,500 students and around 200 teachers per day during the Covid-19 contingency; an average of 60,600 homes were visited and more than 182,000 patients were investigated per day in the province. Patients with respiratory symptoms were identified in all municipality communities of, with more than 400 symptomatic cases per day of active screening throughout the province. ⁶

Thanks to the students and teachers’ actions, together with the rest of the medical and nursing staff, Sancti Spíritus was one of the first provinces to be free of Covid-19 cases for more than 4 months prior to the resurgence of the disease in September 2020.

Since March 1^rst, 2021, the province began its third stage to the autochthonous transmission phase, in which medical science students have played a leading role in the screening of symptomatic respiratory patients, with daily monitoring of vulnerable patients, the elderly, bedridden patients, also those diagnosed with non-communicable chronic diseases, as well as pregnant women and children. ^1,6

Considering the hygienic and epidemiological situation in the province, with the resurgence of Covid-19, integrated community work (TCI) started again for students of medical science university courses, except for those belonging to the final academic years of all courses, types of training and professional technical education, as indicated by the Medical Teaching Management of the Ministry of Health (Minsap). ⁶

Sancti Spíritus university has established guidelines for the organization and evaluation of students participating in TCI, based on the Minsap resolution 132/20, MES resolution 3/21, new indications from the Minsap National Teaching Management, and the experiences of previous stages.

The Integrated Community Work (TCI) is basically dedicated to the active investigation of manifestations of Covid-19, in people from community and other spaces or institutions where indicated, organized to be initiated within the first 72 hours the territory being declared in this phase. ⁶

Sancti Spíritus province has total eight municipalities, the students and teachers participating in the research process in their municipalities were located in the health areas close to their residence. ⁶

Professors, together with the heads of the teaching departments in each health area, are responsible for the students and their placement in the different family doctor and nurse offices (CMF) in the corresponding health area to control all the indications issued by the University to be complied with. Teachers take students daily attendance and data corresponding to the daily report table, informed to the pertinent authorities. (Puesto de mando de la UCM de SS).

Students were placed in a stationary universe. The work schedule is from Monday to Saturday from: 8:00 am to 12:00 m, continuous, based on the premise of visiting 100 % of the houses assigned (other centers exceptionally) to investigate each day, the recovery of those not checked due to any eventuality is guaranteed at the end of the day or in the early hours of the following day, until all blocks are closed. The number of houses (or centers) to be visited must be evaluated in each place in accordance with the distances to be covered, estimated at an average of 80, which may be reduced or increased in some cases, as appropriate.

The students were placed in pairs. A brigade is made up of 10 student-pairs, one of the students is designated as the leader and the other as a substitute.

The exceptional possibility of the student-pair being made up of a student with a community leader was also indicated, and must be certified in all cases by the organizations (CDR, FMC, zonal nucleus, or others).

Student-pairs make their work according to the administrative organization of the health areas and the family doctor and nurse offices (CMF), the work basic unit in Primary Health Care (PHC), as they are the receptors of the information on the identified cases. Family doctors and nurses are responsible for the care and epidemiological work, depending on whether it is a traveler, contact or suspected case of Covid-19, or whether it is another acute respiratory infection (ARI) or illness that should be reported, in compliance with the protocols declared for this purpose. ⁶

In all cases, a professor was selected by the faculty as the person responsible for coordinating, together with the health professional (doctor or nurse) selected by the health area where the students were assigned, to coordinate the work to be develop during the duration of the TCI. This teacher was responsible for organizing the daily concrete work, controlling discipline, supervising the work in the area, checking the information quality issued by the students at the end of each day, ensuring the biosafety measures are complied with by all students and teachers, among others. ⁶

The teacher consolidates the information that the student-pairs attend to, recorded and captured in the following way: the number of people investigated is noted down, out of the total number of people investigated, how many have Covid-19 manifestations is noted down; out of the people who have Covid-19 manifestations, the name and surname, age, sex, CMF that the person belongs and home address are noted down. The date and time when the health authority was identified and notified must also be recorded; the consolidated report by the student-pairs, under their responsibility, will be delivered by the teacher to the Department of Medical Records and Health Statistics of the area, before 2:00 pm each day; in case of an incidence, the information will be delivered immediately by the student to the doctor or nurse of the corresponding CMF; students make a copy (it can be a photo on their cell phone) of this report and file it, for possible verifications in the management of suspected positive cases that may be made later; it should be noted that case reports seen are based on who is at home or locations at the time of the visit and could be contacted physically. It is not acceptable for the student to include all the inhabitants of the house in the report without being there, as this would be considered false. The objective is to know the reality of the epidemiological hygiene situation. Respiratory and other types of manifestations are included in the models, as a person with smell or taste disorders, diarrhea, makes him/her a suspected case of Covid-19, although they are not considered respiratory manifestations as such. ⁶

Training was provided to students and teachers, these aspects were detailed, and scientific information on the evolution of this disease in the world, in Cuba, in the province and in the territory, as well as in the area was given, they were also prepared on the specific section where they are going to conduct the investigation, there the family doctor and nurse play an essential role.

Exceptionally, students can develop the TCI by performing other tasks, and it is insisted this must be done voluntarily by them, and set out in their Informed Consent.

In Sancti Spíritus, they have made activities such as: thermometry at access points to institutions, health work in isolation and for suspects centers, even in the red zones of patient care, mainly if they are from higher years of careers related to this activity, and having the necessary skills for it. Due to the experience acquired, the students have also helped with data management, laboratory work, preparation of hypochlorite or other solutions, specific interventions or some others related to their training profile (hygiene and epidemiology, radiology, nutrition, medical statistics, among others), as long as it is a demonstrated need.

Students from the final academic years of all degree courses, who continue the educational teaching process in a face-to-face manner, were exempted from carrying out this activity. This includes those in the final year of the Técnico Superior de Ciclo Corto (TSCC) and Enseñanza Técnica Profesional (ETP), with ninth and twelfth grade entry, who are doing their pre-professional practice. ⁶

For academic purposes, this activity is compulsory for students selected by the Faculty's management and is considered as part of the annual evaluation of the university student (integral process) also for the final grade of the subjects associated with it and developed by e-learning modality during that period. ⁶

Students justified for health reasons, especially with chronic illnesses, unable to take part in the active survey were evaluated, and other equivalent tasks to those foreseen for the TCI were selected to them, rather in the polyclinic of their residence area, including activities such as collecting and processing the survey information, distributing the teaching materials prepared by teachers to the students assigned to that polyclinic, among others. In case of students with an acute illness, who were unable to participate in the survey, they presented a medical certificate to the polyclinic teaching department. Those with personal problems were sent to the SS University of Medical Sciences to be assessed by the dean.

For the final evaluation, criteria determined by the Vice-Dean of the Faculty of Medical Sciences were taken into account together with the criteria from the professors in charge of the work teams in the province health areas to develop the Integrated Community Work (TCI):

• Excellent rating (E): Student with no any absences to the TCI, discipline and punctuality; excellent performance in developing the TCI; cleanliness and transparency in data collection during the active and effective research work.

• Good (B): Student with a non-justified absence to the TCI; discipline and punctuality; good performance without reaching excellence; cleanliness and transparency in data collection during active and effective research work.

• Regular (R): Student with two non-justified or unreported absences to the TCI; unstable discipline and punctuality; regular performance without reaching the rating of Good; poor transparency in data collection during the active and effective research work.

• Bad (M): Student with three non-justified or unreported absences to the TCI; indiscipline and unpunctuality; poor performance; superficiality in data collection during the active and effective research work.

Until April 24, 2021, the 1,596 students and 214 professors from the Sancti Spíritus University of Medical Sciences have screened a total of 107,628 people and have identified a number of 2,117 patients with suggestive symptoms of Covid-19. These have contributed to the active and effective screening conducted, with total of 75 positive PCR being taken and an average of 308 people admitted to isolation centers.

Teachers and students, with prior informed consent, have also been a workforce in the isolation centers in Sancti Spíritus province. ^1,2,3

The students and professors´ work from the Sancti Spíritus University of Medical Sciences is and will be essential to achieve the hygienic-epidemiological control of Covid-19 in the province; a disease that at present has enforced the greatest challenge to the world scientific community.

REFERENCIAS BIBLIOGRÁFICAS

1. Castro Peraza M, Jiménez Perez NA, Cabrera Marquetti MR. Capacitación para la COVID-19: experiencias del Instituto de Medicina Tropical “Pedro Kourí”. Rev Cubana Hig Epidemiol [Internet]. 2020 [citado 15 Dic 2020];57. Disponible en: Disponible en: http://www.revepidemiologia.sld.cu/index.php/hie/article/view/669/1035 .

2. WHO. Home care for patients with suspected novel coronavirus (nCoV) infection presenting with mild symptoms and management of contacts [Internet]. Geneva: WHO; 2020. [cited 2020 Dec 15]. Available from: Available from: https://www.who.int/publications/i/item/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts

3. WHO. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected [Internet]. Geneva: WHO; 2020. [cited 2020 Dec 15]. Available from: Available from: https://www.who.int/publications/i/item/10665-332299

4. Chen Z-M, Fu J-F, Shu Q, Chen Y-H, Hua C-Z, Li F-B, et al. Diagnosis and treatment recommendations for pediatric respiratory infection caused by the 2019 novel coronavirus. World J Pediatr [Internet]. 2020 [cited 2020 Dec 15];16(3):240-6. Available from: Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7091166/pdf/12519_2020_Article_345.pdf

5. Shen K, Yang Y, Wang T, Zhao D, Jiang Y, Jin R, et al. Diagnosis, treatment, and prevention of 2019 novel coronavirus infection in children: experts’ consensus statement. World J Pediatr [Internet]. 2020 [cited 2020 Dec 15];16(3):223-31. Available from: Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7090771/pdf/12519_2020_Article_343.pdf

6. Cuba. MES. Resolución No. 3/21 [Internet]. La Habana: Ministro de Educación Superior; 2021. [citado 29 Ene 2021]. Disponible en: Disponible en: http://media.cubadebate.cu/wp-content/uploads/2021/01/Resoluci%C3%B3n-No.3-del-2021.pdf

Received: May 22, 2021; Accepted: June 28, 2021