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Home , Artemisa, Bayamo, Granma Province

COVID-19 in Cuban children and adolescents. First report. Epidemiological weeks 12 to 22. June 2020

Luisa Iñiguez Rojas. Latin American Faculty of Social Sciences - . University of

Edgar Figueroa Fernández. Center for Population and Development Studies National Office of Statistics and Information of Cuba

Angel Miguel Germán Almeida. Pedro Kouri National Institute of Tropical Medicine Ministry of Public Health

María Esther Álvarez. Cuba’s National Schools of Public Health. Ministry of Public Health

Lorenzo Somarriba. Director. Centre for Health Surveillance. Ministerial Management Centre. Ministry of Public Health.

Antonio Herrada Hidalgo. Latin American Faculty of Social Sciences - Cuba. University of Havana

Laura Almora Adarcio. Center for Psychological and Sociological Research Ministry of Science, Technology and Environment CONTENT

Description of children and adolescents diagnosed with COVID-19 (according to sex, age and place of residence) | 03

Territorial distribution of COVID-19 cases in children and adolescents aged 0-18 years | 06

Distribution of cases by human settlements | 09

Preliminary considerations | 16 On 11 March 2020, Cuba confirmed the first cases of equal or higher than 10 cases in a few days (6), after the COVID-19. Three tourists from Italy, who were visiting first diagnosis. Figure 1. a heritage city in Central Cuba, tested positive. Ten Date days later, on 21 March, an 18-month-old child, who 21/03/20 was on a family visit with his mother (19) from Spain, 24/03/20 became the first child to be diagnosed, along with his 27/03/20 mother. The time elapsed between entering the coun- 30/03/20 try and showing symptoms shows that they both arri- 02/04/20 ved in the country carrying the SARS-CoV-2 virus. 05/04/20 They were both registered according to the place of 08/04/20 residence of their relatives, in the urban settlement of , from the homonymous municipality of over 20 11/04/20 000 residents, one of the ’s mountainous 14/04/20 municipalities in the eastern Province, 17 km 17/04/20 from the provincial capital . 20/04/20 In the following days, other children travelling 23/04/20 from the United States, Guyana and France were also 26/04/20 diagnosed. Two children from France were consi- 29/04/20 dered as imported cases. They were joined by other 02/05/20 children who were in contact with confirmed cases 05/05/20 from overseas (imported cases) and (indige- 08/05/20 nous cases). Seventy days after the beginning of the 11/05/20 epidemic in the country, 223 children and adolescents 14/05/20 have been diagnosed with COVID-19; four of them 17/05/20 were Cubans residing abroad, two foreign tourists 20/05/20 and one Cuban resident who returned to the country 23/05/20 with her mother. 26/05/20 29/05/20 Description of children and adolescents diagnosed with 0241618 10 2 41618 Cases COVID-19 (according to sex, age Indigenous Imported and place of residence) Figure 1. Cuba. COVID-19 cases by date of confirmation (21 March to 30 May) According to the date of confirmation, the amount Source: Ministry of Health’s daily briefings, Department of of cases per day shows a wide variation with figures Health Surveillance’s Database

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The evolution of the disease during epidemiolo- 2 weeks. This behaviour coincides with the evolution gical weeks1 12 to 22 shows the increase of notifica- of total cases in the country by epidemiological weeks. tions starting on week 13, which reaches a maximum Figures 2a and 2b. number of confirmed cases in weeks 15 (55), 16 (36) and In terms of the weekly evolution of the disease in 17 (39). In the following weeks, the cases are reduced the country, there are no sex-specific differences until to 5 in week 20, with a slight increase over the next week 15. From then on, the highest number of notified cases is reached, the number of infected children in- 1 In general, the term epidemiological week is used in the analy- creases and this trend continues in most of the subse- sis of the behaviour of diseases, especially communicable ones, in accordance with an international calendar quent weeks. Figures 3a and 3b.

Confirmed Percentage cases of the total 250 18

16 200 14

150 12 10

100 8

6 50 4

0 2 11 12 13 14 15 16 17 18 19 20 21 22 Week 0 Cases per week Cumulative cases 11 12 13 14 15 16 17 18 19 20 21 22 Week Figure 2a. COVID -19 cases in children and adolescents by Figure 2b. Percentage of cases in individuals confirmation date. aged 0-18 years. Source: Ministry of Health’s daily briefings, Department of Source: Ministry of Health’s daily briefings, Department of Health Surveillance’s Database. Health Surveillance’s Database.

Cases Cumulative per week cases 60 250

50 200

40 150

30 100

20 50 10 0 0 Date 12 13 14 15 16 17 18 19 20 21 22 23 24 Week 4/05/2 0 9/05/2 0 21/03/20 28/03/20 31/03/20 03/04/20 06/04/20 09/04/20 12/04/20 16/04/20 19/04/20 23/04/20 28/04/20 13/05/20 18/05/20 22/05/20 26/05/20 29/05/20 Total Female Male Female Male Figure 3a. Cuba. Distribution of COVID-19 confirmed cases Figure 3b. Cuba. Dynamics of COVID-19 case by sex and epidemiological weeks. confirmations by sex. Source: Ministry of Health’s daily briefings, Department of Source: Ministry of Health’s daily briefings, Department of Health Surveillance’s Database. Health Surveillance’s Database.

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The distribution of children and adolescents confirmed cal week 15 (5 – 11 April), and week 16 for the 0-5 age with COVID-19 by age group shows the highest number group. Up until week 15, a similar behaviour in terms of cases among children aged 12–18 years. A comparison of age groups is observed, as the distribution by group between the proportion of population and the propor- is varies in the following week. tion of cases in each group indicates a smaller impact on The distribution by sex and age shows a relatively the 0-5 age group, a similar one in the 5-11 age group and homogenous behaviour of cases by sex in the age higher in the 12-18 group. Figures 4a and 4b. group 12-18. Boys are predominant in week 15 and gir- The highest numbers of confirmed cases in the age ls in week 17. The behaviour by sex is irregular in the groups 12-18 and 6-11 were reached in epidemiologi- rest of the groups. Figure 5.

Cases Cumulative per week cases 60 250

50 200

40 150

30 100

20 50

10 0 Date 0 11 12 13 14 15 16 17 18 19 20 21 22 Week 21/03/2 0 28/03/2 0 04/04/2 0 11/04/2 0 18/04/2 0 25/04/2 0 02/05/2 0 09/05/2 0 16/05/2 0 23/05/2 0 29/05/2 0 0-5 years old 6-11 years old 12-18 years old 0-5 years old 6-11 years old 12-18 years old

Figure 4. Cuba. Distribution of COVID-19 confirmed cases by age group: a) cumulative number of cases per week, b) cumulative number of cases per day (confirmation date). Source: Ministry of Health’s daily briefings, Department of Health Surveillance’s Database.

Confirmed cases 18 16 14 12 10 8 6 4 2 0 12 13 14 15 16 17 18 19 20 21 22 Week 0-5 years old female 6-11 years old female 12-18 years old female 0-5 years old male 6-11 years old male 12-18 years old male Figure 5. Cuba. Cases of COVID-19 in children and adolescents by sex and epidemiological week. Source: Ministry of Health’s daily briefings, Department of Health Surveillance’s Database

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Territorial distribution of COVID-19 In some provinces, confirmed cases of COVID-19 in cases in children and adolescents population aged 0-18 years are concentrated in cities. aged 0-18 years In others cases, are more prevalent in rural settle- Up to 30 May, the last day of epidemiological week 22, ments, like in the Güanes municipality, Pinar del Río at least one child or adolescent had been diagnosed Province (66.6 %), where 10 out of 15 cases confirmed with COVID-19 in 63 out of 168 municipalities in the are found in rural settlements. The distribution of ca- country (37.5 % of the total). Rural settlements registe- ses by province shows that just over 50 % of cases are red2 13.45 % of cases and urban settlements registered concentrated in 2 of the 15 provinces in the country, 86.54 %. The urban incidence rate doubles the rural La Habana (34.53 %) and Villa Clara (16.14 %). one (10.57 per 100 000 and 5.77 per 100 000 children According to the rate of territorial distribution, and adolescents). which considers Cuba=1, six provinces in the country From another territorial perspective, the highest have been at a disadvantage compared to the general percentage of cases is concentrated in municipal cen- evolution of the epidemics in the country. The provin- tres and the capital. Figure 6. ces above register the highest numbers, with a rate of 2 or above, the rest of the provinces are in a favourable Figure 6. Distribution of cases by type of settlements. situation, with registering the lowest rate. SETTLEMENTS TOTAL CASES % OF THE TOTAL The province of , with values close to 1, is ba- Capital 77 34.53 lanced in relation to the spread of the COVID-19 in the Municipal centres 91 40.81 country. Figure 8. Other settlements 55 24.66 Source: Ministry of Health’s daily briefings, Department of 0.09 Health Surveillance’s Database. Index of Human Settlements. Las Tunas Cepde – ONEI 2017 Granma 0.11

The distribution of cases according to the category of Guantánamo 0.17 settlements shows the highest percentages in the ci- ADVANTAGE 0.37 ties. However, thirty cases of individuals aged 0-18 have been recorded in rural and scattered villages and 0.4 communities. Figure 7. Holguín 0.52

2 The information is supplied by place of residence; in the case Camagüey 0.53 of the population studied it is unlikely that the infection had taken place outside the settlements. 0.62

Categories Matanzas 0.94 Ciudad de La Habana 77 BALANCE CUBA 1 Otras ciudades 78 Mayabeque 1.18 Pueblos 30 1.28 Poblados urbanos 8 Pinar del Río Poblados rurales 24 Sancti Spíritus 1.33 DISADVANTAGE Caseríos 5 Ciego de Ávila 1.57 Dispersos 1 La Habana 1.97 Cases 0 30 60 90 Villa Clara 2.56 Total of cases Percentage Figure 7. Distribution of cases by category of settlements. Figure 8. Rate of territorial distribution of cases by Source: Ministry of Health’s daily briefings, Department of province. Health Surveillance’s Database. Index of Human Settlements. Source: Ministry of Health’s daily briefings, Department of Cepde – ONEI 2017. Health Surveillance’s Database.

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The distribution of confirmed cases by municipality in central Cuba, regarding the amount of confir- shows Santa Clara, in central Cuba, with 14 cases. med cases. This municipality has the highest number of ca- In four municipalities in Havana, nine cases have ses, which coincides with the highest number of been recorded, which represent the highest amount in confirmed cases in total population for the period the province with most cumulative cases. Only in the of time analysed. Santa Clara is followed by other municipality of Cotorro, one child under 18 had been two municipalities – Taguasco and Camajuaní - also diagnosed up to the date of the analysis. Figure 9, Map 1.

Cases 16

14 Santa Clara (14)

12 Taguasco (11) Camajuaní (10) 10

8

6

4

2

0 Municipalities WEST EAST Figure 9. COVID-19 cases in children and adolescents. Each bar represents a municipality (21 March – 30 May). Source: Ministry of Health’s daily briefings, Department of Health Surveillance’s Database.

Map 1. Cuba. Incidence of COVID-19 in children and adolescents. (March 21st – May 30th).

NORTE

04 8 kilómetros

Total cases confirmed (21 March to 30 May) 14 7 1

Municipalities without con rmed cases: 105 075 100 (see box for cases from 15 municipalities in Havana) kilómetros

Provincial capitals

Sourse: Ministry of Health’s daily brie ngs. Digital cartographic database 1:1000 000 Geo Cuba. Author: Luisa Iñiguez Rojas, FLACSO, University of Havana Ángel Miguel Germán Almeida. IPK. MINSAP

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In 59 % of the municipalities where cases have No cases have been reported in municipalities been reported, the incidence of COVID-19 is 1 or less from provincial capitals in Artemisa, Santi Spiritus, per 10 000 children and adolescents. Four munici- Ciego de Ávila and Las Tunas. The rest have rea- palities in central Cuba report the highest numbers, ched relatively low rates, except for San José de las and all of them coincide with local transmission out- Lajas, provincial capital of Mayabeque. Figure 10. breaks. Map 2.

Rate per 10 000 18 Taguasco (16.66) 16 14 12 Florencia (12.10) 10 Venezuela (10.05) 8 6 4 2 0 Municipality WEST EAST Figure 10. Incidence of COVID-19 in population aged 0-18 per municipality. Each bar represents one municipality (21 March to 30 May). Source: Ministry of Health’s daily briefings, Department of Health Surveillance’s Database.

Map 2. Cuba. Incidence of COVID-19 in children and adolescents (21 March – 30 May).

NORTE

04 8 kilómetros

Rate per 10 000 minors under 19 years old 9.55 to 16.67 (4) 3.2 to 5.68 (7) 1 to 2.95 (23) 0.19 to 99 (14)

Municipalities without conrmed cases: 105 075 100 (see box for cases from 15 municipalities in Havana) kilómetros

Provincial capitals

Sourse: Ministry of Health’s daily briengs. Digital cartographic database 1:1000 000 Geo Cuba. Author: Luisa Iñiguez Rojas, FLACSO, University of Havana Ángel Miguel Germán Almeida. IPK. MINSAP

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Number Percentage The highest rates, close to or over 10 cases per of cases of cases 10 000 people aged 0-18 years, were registered in 4 30 70 municipalities. These cases represent more than a 60 % of total confirmed cases in the municipality of Taguas- 61.1 25 60 co, or 25 % in Florencia. Figures 11 and 12. 25

Figure 11a. COVID-19 rates and number of cases in children 50 and adolescents from selected municipalities. 20 18 18 TOTAL TOTAL RATE PER MUNICIPALITY 40 POPULATION CASES 10 000 16 40 Taguasco 6 602 11 16.66 15 33.3 30 Florencia 3305 4 12.1 11 25 10 Venezuela 5970 6 10.05 10 20 Camajuaní 10 468 10 9.55 6 Source: Ministry of Health’s daily briefings, Department of 5 4 Health Surveillance’s Database. 10

In these four municipalities, distribution by sex 0 0 shows differences, with a prevalence of females in Taguasco Camajuaní Venezuela Florencia Camajuaní and Taguasco, and males in Florencia. Municipalities Similarly, the distribution by age group is irregular, Total cases Proportion of the total with a predominance of the age group 12-18 in Ta- Cases in population aged 0-18 years guasco (91 %) and Camajuaní (70 %), while the age Figure 12a. Proportion of confirmed cases in children group 6-11 prevails in Florencia (75 %) and Vene- and adolescents out of the total confirmed cases in the municipality. zuela (67 %). Source: Ministry of Health’s daily briefings, Department of Health Surveillance’s Database.

Number Percentage of cases of total cases 8 100 77

80 6

60 4 4 4 33 40 2 2 20 1

0 0 Taguasco CamajuaníVenezuela Florencia Taguasco Camajuaní Venezuela Florencia Municipalities Municipalities Female Male 0-5 years old 6-11 years old 12-18 years old

Figure 11b. Children and adolescents diagnosed with Figure 12b. Children and adolescents diagnosed with COVID-19 in selected municipalities, by sex. COVID-19 in selected municipalities, by age. Source: Ministry of Health’s daily briefings, Department of Source: Ministry of Health’s daily briefings, Department of Health Surveillance’s Database. Health Surveillance’s Database.

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Distribution of cases by human Havana, which is considered a single settlement settlements by the country’s Human Settlement System,4 accu- By looking closer at the localization of cases by place of mulates 77 cases (34.53 % of the total) distributed residence and using the Index of Human Settlements across 15 municipalities. The concentration of cases as a source, it was confirmed that cases in population in the municipalities of Centro Habana, Cerro, San aged 0-18 years had been confirmed in 59 out of the Miguel del Padrón and Arroyo Naranjo is evident. 7 014 settlements in the country.3 Urban settlements Maps 3 and 4.5 reported 53 of them, while 16 were registered in rural settlements and 1 in spread population. 4 Institute of Physical Planning 2012. 3 Index of Human Settlements. Population and Housing Census 5 Due to the cartographic scale of representation, Havana is 2012. CEPDE-ONEI 2017. shown separately from the rest of Cuba.

Map 3. Cuba. Confirmed cases of COVID-19 in population under 9 years old (21 March – 30 May).

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Cases in rural settlements 5 3 1 Cases in urban settlements 14 Main roads 7 Settlements 075 100 1 Imported cases kilómetros

Sourse: Ministry of Health’s daily brie ngs, Ministry of Health’s Database. * Noti ed by place of residence or visit. Index of Human Settlements. Population and Housing Census 2012 ** The nearly one hundred cases in Havana are represented ONEI 2017.Digital Cartographic base 1:1000 000 GeoCuba. in a different map due to the need to change the scale. Autores: Luisa Iñiguez Rojas, FLACSO, Universidad de La Habana, Edgar Figueroa Fernández. Cepde ONEI 2017.

Map 4. Children diagnosed with COVID-19 in Havana.

NORTE

25 0 2.5 5 kilómetros Confirmed by PCR 2 Sourse: Ministry of Health’s daily brie ngs. Base: 1:2000 GeoCuba. 1 Authors: Luisa Iniguez Rojas, PhD. Cartographic information: LLaura E. Almora Andarcio, BS; Municipal limits M.Cs. Antonio Herrada Hidalgo, MS.

-10- Preliminary considerations tal, and a second one in rural towns and communities. In the period analysed, no significant differences by It is significant that, in many municipalities, confirmed sex have been found in confirmed cases of population cases are not located in the centre but in small villages, aged 0-18 years. The highest number of cases has been relatively distant from the centre. Although the urban registered among ages 12-18 during several weeks and incidence rate per 10 000 among ages 0-18 doubles the cumulative cases. rural rate, the latter would increase significantly if ca- Cases have been confirmed in all 15 provinces, in 63 ses in small urban settlements were considered. of the 168 municipalities (53.38 % of the total) and in 59 A second report in preparation studies the results of the 7 014 human settlements in the country (0.84 % in more detail, analyses spreading of COVID-19 in the of the total). country, identifies spatial clusters and types, and co- No relation has been established between the vers up to epidemiological week 30. amount of child and adolescent population in the mu- The figures used in this report are preliminary. nicipalities and the amount of COVID-19 confirmed ca- They could be susceptible to variations, as repairs are ses. The absence of confirmations in in 4 of the muni- made in the databases. cipalities in condition of provincial capitals proves that a higher concentration of population, does not always 110 June 2020 take part in the spatial diffusion. First task report of project “COVID-19 The localization by human settlements shows two in children and adolescents in Cuba”. patterns of spatial spreading of the COVID-19. The first Health and Social Sciences Topics. FLACSO-Cuba. one is the concentration of cases in cities and the capi- University of Havana

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