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COVID-19: Cuba offers UK salutary lesson in ‘shoe-leather’ epidemiology

Cuba’s successful containment of COVID-19 through door-to-door screening of every home in the country, shows how ‘shoe-leather’ epidemiology could have averted the dramatic failure of the UK’s response to the pandemic. In Cuba there have been 2,173 confirmed cases and 83 deaths, with no reported deaths throughout the first week in June.

The term ‘shoe leather’ epidemiology, where much of the work is carried out on foot in the community, was first demonstrated during the Soho cholera epidemic in 1854.

Writing in the Journal of the Royal Society of Medicine, Professor John Ashton describes how, when China first reported the emerging epidemic in Wuhan in January 2020, Cuba promptly drew up a cross-government contingency plan. When the first cases of the virus were confirmed in the country among three tourists from Italy on 11 March, the plan was immediately put into action.

Screening was carried out in Cuba by tens of thousands of family doctors, nurses and medical students on foot, with testing, tracing and quarantining of suspected cases in state-run isolation centres for 14 days.

Prof Ashton said: “Cuba has long been renowned for its ability to turn in world beating health statistics while continuing to struggle economically. With a health system grounded in public health and primary care, the country invests heavily in producing health workers who are primarily trained to work in the community. Their efforts with COVID-19 have been outstanding.”

He added: “Cuba was one of the first countries to send health workers to support the control of the epidemic in Wuhan, back in January, just one example of its unrivalled commitment to international solidarity in humanitarian disasters.”

Notes to editors

Shoe leather epidemiology in the age of COVID: lessons from Cuba (DOI: 10.1177/0141076820938582) by John Ashton will be published by the Journal of the Royal Society of Medicine at 00:05 hrs (UK time) on Wednesday 15 July 2020.

The link for the full text version of the paper when published will be:

For further information or a copy of the paper please contact:

Rosalind Dewar
Media Office, Royal Society of Medicine
DL: +44 (0) 1580 764713
M: +44 (0) 7785 182732

The Journal of the Royal Society of Medicine (JRSM) is a leading voice in the UK and internationally for medicine and healthcare. Published continuously since 1809, JRSM features scholarly comment and clinical research. JRSM is editorially independent from the Royal Society of Medicine, and its editor is Dr Kamran Abbasi.

JRSM is a journal of the Royal Society of Medicine and it is published by SAGE Publishing.

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