|2Harris arrives in Singapore, kicking off Southeast Asia visitAn Alabama man who called himself the ‘vaccine police’ told pharmacists at …a man and a woman sitting on a chair: Photograph: Alexandre Meneghini/Reuters© Provided by The Guardian Photograph: Alexandre Meneghini/Reuters

Julia, a community doctor in Havana, was drafted to the intensive care unit soon after Covid-19 first reached Cuba.

Last week, her cousin died from the virus. This week, she also tested positive amid a surge in cases which has pushed the island’s vaunted health service to its limits and prompted rare public criticism from Cuban doctors.

“It hurts to see people die from this terrible virus,” she said, recovering at home from nausea after being injected with an immune booster. “The mood among doctors gets worse by the day.”

After recording one of the world’s lowest Covid rates last year, Cuba now has one of the western hemisphere’s highest. The island, which reported 12,225 confirmed cases in all of 2020, has reported almost 50 times that so far this year. And with the Delta variant having taken root, a lack of medical supplies is crippling the medical response.Raul Castro et al. sitting on a chair: A woman has her temperature checked after receiving a dose of the Abdala vaccine at a vaccination center next to an image of Cuba’s former president Raúl Castro in Havana this month.© Photograph: Alexandre Meneghini/Reuters A woman has her temperature checked after receiving a dose of the Abdala vaccine at a vaccination center next to an image of Cuba’s former president Raúl Castro in Havana this month.

“There are no antibiotics, no painkillers, the basic list of medicines is almost all out of stock,” said Daniela, a family doctor in Havana who has hardly had a day off since the pandemic began.

In the face of extreme scarcity, doctors are increasingly prescribing herbal remedies. Mortuaries are overwhelmed. The country’s main oxygen factory recently broke down, compounding the intensive care crisis.

Cuba last year hospitalised everybody who tested positive for Covid, including asymptomatic cases. But even for a country with the world’s highest doctor-to-patient ratio, average daily case loads of 9,000 have made that protocol unworkable. Now children, the elderly, pregnant women and severe cases are hospitalised, while others must isolate at home.

Hundreds of doctors have been brought back from international “missions” abroad – a major hard currency generator for the state – to support exhausted colleagues. But the move has not been enough to stop the system, which last year was a model of test, track and isolate, from fraying.

“I was at home for eight days and nobody came to see me,” said Oscar, a hotel worker from Cienfuegos who came down with Covid last month.

Related: ‘New wave of volatility’: Covid stirs up grievances in Latin America

The pandemic, which eliminated tourism, and US sanctions have knocked billions of dollars from state coffers, creating a dire economic crisis and contributing to unprecedented political unrest on the island. Strapped for cash, Cuba’s public health system has been forced to perform triage: focusing on expensive vaccine production at the expense of other medical supplies.

The prime minister, Manuel Marrero, last week recognised the depth of the crisis in uncharacteristically forthright language.

Provinces “lack antigen tests [and] medicines”, he told party officials in Cienfuegos. “But there are more complaints about subjective problems than objective problems. When you add up the [complaints about] lack of medicines, they are less than the number of complaints about mistreatment, lack of care, and home visits.”

His comments provoked outcry on social media, and 23 doctors in the eastern province of Holguin posted a video rebuttal on Facebook.

“We want to keep saving lives,” said Dr Daily Almaguer, a heart specialist, in the video. “We are not the ones responsible for our country’s healthcare collapse.”

The doctors have since been summoned by authorities.

The spike, unimaginable last year, comes as Cuban scientists race to achieve immunity through vaccination. Cuba is the smallest country in the world to have developed its own Covid vaccines. Both Soberana 2 and Abdala have an efficacy rate of over 90%, according to clinical trials.

But US sanctions – supercharged by Trump, left in place by Biden – have slowed rollout.a person holding a frisbee in the street: Children wearing masks as a precaution amid the spread of the new coronavirus run across a street in Havana. Photograph: Ramón Espinosa/AP© Provided by The Guardian Children wearing masks as a precaution amid the spread of the new coronavirus run across a street in Havana. Photograph: Ramón Espinosa/AP

Since the outgoing Trump administration designated Cuba as a “state sponsor of terrorism”, firms have taken fright and just a handful of banks in the world will now transfer funds from Cuban entities, complicating imports.

Cuban scientists say industrial scale production of Soberana 2 was stalled for weeks as they could not source an essential component.

“The lack of one small ingredient or one small control item can really throw production off,” said Gail Reed, executive editor of Medicc Review, a peer-reviewed health journal.

“US sanctions have had a nefarious, even lethal, effect on Cuba’s ability to face down the latest surge.”

Though slow out of the starting blocks, Cuba now has the third highest vaccination rate in Latin America (behind Chile and Uruguay). Twenty-seven per cent of the population have now been fully vaccinated, and 44% have received at least one dose.

Come September, scientists say, the island will have produced enough doses to vaccinate the whole population.

“We remain in combat against the pandemic,” said Dr Gerardo Guillén, Abdala’s lead developer. “The vaccines are working, as the data is now showing,” he added, referring to falling infection and mortality rates in Havana, where the mass vaccination campaign began.

Until millions more are fully vaccinated, the country’s exhausted army of underpaid doctors must trudge on.

“We are doing the impossible,” said Julia, the community doctor still mourning the death of her cousin. “Despite the lack of medicines, gloves and oxygen, doctors are fighting to save lives. They really are heroes.”

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