18 de mayo 2020
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The statistic made public by the Nicaraguan Ministry of Health (Minsa) of 25 patients that have tested positive for COVID-19 isn’t accurate,” a source with ties to the government declares categorically. This source has knowledge of the results of tests processed in the National Center for Diagnosis and Referral (CNDR) located at Minsa headquarters, the “Conchita Palacios” National Health Complex in Managua, where all COVID-19 test processing has been centralized.
“They’re not reporting the truth, nor the true results of the tests processed in the CNDR laboratories,” this government source reiterates, concerned about the advance of the pandemic, now fully in the phase of community transmission, and also worried about “the imposition of political criteria on decisions where science and expert technical and medical experience should prevail.”
Confidencial consulted three sources linked to the Health Ministry, all of whom have partial or total access to the data from the CNDR Coronavirus tests. “The official reports are then painted over according to political criteria. There’s an order to register the results as indeterminate,” they agree, “and not to reflect the laboratory findings.”
1600 positive cases from 5600 tests
A few weeks after March 18th, when the first positive case – “imported” from outside the country – was confirmed, the Health Ministry directed that a maximum of 50 tests be processed daily in the CNDR.
The samples arriving were taken according to quotas assigned to the various hospitals and health centers in different parts of the country, under the direct supervision of the Health Minister. Later, the number of samples was increased to some 300 daily tests, which now arrive from both public and private hospitals, but always under the custody of the highest Minsa authorities, workers at the CNDR confirmed.
A source with ties to the Health Ministry estimates that after increasing the scope of the testing samples, “some 5.900 tests have been processed, of which 4,300 came out negative and 1.600 positive,” for a contagion rate of 27%. “With this tendency, they should be performing thousands of tests daily all over the country to determine the true dimension of the pandemic and above all the number of asymptomatic cases in circulation,” they advised.
This data is in direct contradiction to the government’s official version. The latter have downplayed the impact of the pandemic, refusing to recognize the beginning of the “community transmission” phase, which now has even gone beyond the estimates of the private “COVID-19 Citizens’ Observatory” group, made up of independent doctors. Up until May 13, Citizen’s Observatory had documented 1,270 suspected cases and 266 deaths attributable to the novel Coronavirus.
High-level contagion at the Center
A week ago, Confidencial revealed the existence of a number of positive COVID-19 cases among personnel from the CNDR test processing laboratories, located in the same complex as the central Health Ministry itself. That information was leaked by other workers from the center.
These sources, tied to the Health Ministry, confirmed that the contagion has now extended to functionaries at the highest levels of the Ministry, including the secretary general that acts as director of the CNDR and is also the FSLN political secretary within Minsa.
A CNDR source confirmed that the director tested positive at the beginning of the second week in May. Although he ended up asymptomatic, he appeared at a televised conference on May 11 without wearing a mask or any other protection to avoid spreading the virus. However, in contrast to previous conferences, the room was empty of officials and reporters, and there was only a generic microphone instead of the full battery of equipment from the official publicity outlets.
After implementing the test to all CNDR personnel, the directors of the areas of Bacteriology, Virology, Tuberculosis, Parasitology and Health Chemistry, as well as of Administration, all tested positive for COVID-19 and are now working from home
Laboratory workers affirm that the CNDR space “looks like a huge deserted office,” but that operations are being directed via telephone from the homes of the infected directors.
“The meetings and activities that were already scheduled [for us] continue as if nothing were happening. We workers are under a lot of stress and nervous tension,” stated a source from the CNDR.
The contagion has extended still further among the workers in the area of administration and could be already at 45% of all the scientific center’s 110 workers.
“The cobbler’s children have no shoes”
The contagion at the National Center for Diagnosis and Referral isn’t attributed to problems stemming from the laboratory, but to the “community transmission” that is rapidly expanding throughout the country.
“This wasn’t bad management of the laboratory samples, nor poor practices on the part of the professional lab technicians; the cause is the impact of community transmission on personnel,” declared a source with ties to the Health Ministry.
The first positive case in the center was detected on Tuesday, May 5, in a worker from the area of administration. From that moment on, more workers tested positive. During that week, not even those charged with performing the COVID-19 tests in the Virology laboratory were using protective facemasks.
According to sources from the Complex, there was a general failure of the CNDR management to alert and orient workers about the need to implement preventive and protective measures. “The cobbler’s children had no shoes,” laments the source. “They came to work with infections from their neighborhoods and communities and infected many others. That was the determining factor, until they began sending the positive cases home,” they added.
Those who test positive in the CNDR are being sent home for 14 days, with medical treatments that include: paracetamol, azithromycin and chloroquine, (a medicine used for malaria). However, for those in the focal points of contagion, the conditions for safety and protection have not improved.
“Since before the COVID-19 crisis, the Ministry already had some deficiencies, it’s hard for them to improve, especially at this moment,” another laboratory worker affirmed.
The laboratory itself less affected by contagion
The CNDR laboratory where the COVID-19 tests are processed is the area with the fewest absences from ill workers, despite the fact that the head of Virology tested positive and now directs the laboratory by telephone.
Sources linked to the Health Ministry affirm that the laboratory is staffed by experienced professionals, prepared to process the COVID-19 tests, and that they continue doing so in the normal way. Nonetheless, they’re afraid that the increased volume of contagion in the Complex could slow the realization of tests at a time when the country needs to greatly increase the testing.
This week, the laboratory personnel that were tested for the virus had to wait a little over 24 hours to receive their results, while the people that took the test the week before got their results in the evening of that same day. “They’re assigning priorities and tests are accumulating,” declared a CNDR worker.
The team includes three persons who are responsible for analyzing the results, while others are responsible for coding, introducing and digitalizing the samples, or isolating the RNA, or genetic information, using the Polymerase Chain Reaction (PCR) to amplify the genetic information and diagnose the results.
“The reading of the results alone takes over three hours, not including the rest of the procedures. There are three machines for the PCR diagnosis which can each process 25 tests at a time,” states a source from the laboratory.
Scientific center under political control
The CNDR has been classed as a “third generation” laboratory by the Pan-American Health Organization, with advanced diagnostic instruments “for responding to alerts with precise, efficient and cost-effective techniques.” Nevertheless, the workers at the CNDR affirm that the political side of Minsa and the government are dominating and overshadowing the center’s scientific nature.
“In the CNDR there are highly trained personnel with decades of experience, well-qualified scientists that have been made to submit to political orders. Science should be the dominating factor so the CNDR can continue at the service of the population’s health and the prevention of the epidemic,” commented a source tied to the Health Ministry.
In a video about the CNDR installations put out by the official media, the Virology director specifies that the tests are processed in the center under two different protocols: that of Hong Kong and that of Germany.
The use of two protocols, a scientific expert asserts in the video, should assure that the results of the tests are correct. “If both methods show a positive, you have more confirmation than one positive result, so there’s no margin for error,” he explains.
The information circulating in the official reports of the Health Ministry, the same information that the Presidency manages, is dominated by results classified as “inconclusive”. “An inconclusive result should be sent back to be repeated, because it indicates that there was some presence of the virus, but not enough for the team to mark it as positive,” indicated the scientific source.
The tests are based on detecting the presence or absence of genetic material from the virus. The PCR also allows quantification of the sample, so that the result is positive or negative – it can’t be “indeterminate”.
However, the line of command from the National Center for Diagnosis and Referral isn’t coming from the Health Ministry, but depends on Rosario Murillo, the wife of President Daniel Ortega and Nicaragua’s vice president. “She gives orders to the Minsa secretary general, who in practice is the CNDR’s general director, and the others are obligated to comply with these orders,” concluded the source tied to the Health Ministry.
