29 de mayo 2020
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The newly released publication of guidelines the government has titled: “White book for the COVID-19 pandemic” demonstrates what independent scientists have been pointing out: in the face of the danger of the pandemic, the authorities have oscillated between gross ignorance and boastful triumphalism.
As if that weren’t enough, the report insinuates shamelessly that in facing the pandemic, Nicaragua is following the Swedish model.
Apparently, the official policy of the Ortega-Murillo regime for the pandemic, has been not only to let it be, but also to promote the spread of the virus far and wide with no concern for the number of deaths.
The Swedish model
Comparing Nicaragua to Sweden is beyond absurd. The two countries are diametrically opposed in their essential health indicators. Suffice it to say that according to data from the World Bank, Nicaragua has nine doctors for every 10,000 inhabitants, while Sweden has 40, more than four times as many. The per capita expenditure for health in Nicaragua is US $192 (including what the patient provides), while Sweden budgets US $5,905 dollars per person, more than 30 times the Nicaraguan total. In Sweden, life expectancy at birth is 83; in Nicaragua it was 74, and that figure from before the 2018 debacle.
While it’s true that Sweden’s strategy in facing the Coronavirus has been different from the rest of the European countries, since they didn’t impose a total halt on economic activities, the Swedish government did prohibit mass events, allowing only gatherings of under 50 people. The elementary schools didn’t close, but the advanced secondary schools (students over 16) and the universities went to online modalities.
In addition, they offered sick people incentives to stay home, asked the population to avoid bars and restaurants and to work from home, practicing physical and social distancing. None of these measures from the Swedish model were taken in Nicaragua.
Further, the Swedish model for facing COVID-19 hasn’t been evaluated as successful either. There’s no news of any other European country trying to imitate it. As of May 25, Sweden reported a total of 33,843 confirmed cases and a little over 4,000 deaths from the virus.
For a country of nearly 10 million people, those numbers don’t seem too bad, compared with those of Italy or Spain, countries that were very seriously impacted by the disease. But these same numbers look excessive if compared with the country’s Scandinavian neighbors, Denmark, Finland and Norway, all of which implemented more restrictive measure for containing the virus.
It also doesn’t seem convenient to follow the Swedish model in Nicaragua, because it hasn’t resulted either effective or secure. Although the situation perhaps isn’t catastrophic, Sweden’s relaxed strategy has come under ever more questioning. A numerous group of Swedish scientists have severely criticized the fact that the strategy resulted in too many deaths which could have been prevented.
Sweden has been reproached for not having adequately attended to the population most at risk: those of advanced age, the ethnic minorities and the immigrants. All of this exposes the ethical limitations of their approach of abandoning the most vulnerable to their luck. This has been recognized self-critically by the leader of the Swedish strategy for the battle against the spread of the Coronavirus, epidemiologist Anders Tegnell.
But there’s a distinct element that makes the Swedish model inapplicable to Nicaragua: in Sweden, the decisions regarding health aren’t open to political interference. The Swedish Public Health Agency holds sufficient authority to define the public health strategies, independently of the political elites. Decisions are made in consultation with competent independent experts, reinforcing the agency’s consistence and credibility.
All that is improbable in today’s Nicaragua where there’s not even independent branches of government, and where since 2007 there’s been a systematic process of degrading human rights.
The Ortega-Murillo model: scorn for science
Ignorance of reality and a maximum scorn for scientific knowledge are two of the principal characteristics of the proposed model of the Nicaraguan government for facing the Coronavirus.
From the outset, the authorities underestimated the threat of the novel Coronavirus. Their strategy was that of the ostrich, believing that if they just refused to examine the problem, nothing would happen. They rejected the scientific evidence. In the full throes of the pandemic, a legislator who is a doctor by profession, publicly alleged: “the flu kills more people than the Coronavirus”, when all the studies have demonstrated that the novel Coronavirus is at least 20 times more lethal than the flu.
Scientists recommend social distancing as one of the crucial measures for containing the virus. It’s known that the rapid spread of the virus occurs in large measure through the respiratory droplets of people who are asymptomatic or have very mild symptoms.
However, in Nicaragua, the ministries and other state institutions continue convoking mass activities that bring with them crowds of people. As if it were a small matter, the doctors and health workers were initially forbidden to use facemasks and other protective equipment in order, according to the government, not to unnecessarily alarm the population.
From primitive concepts, they then recurred to magical thinking, according to which it would be enough to invoke the supernatural forces of good to combat the pandemic, a supernatural force of evil. Hence, Comandante Ortega concluded, after a deep reflection that took him 34 days in lockdown, that the Coronavirus was a sign from God.
Then he compared the Coronavirus with the Whooping Cough in the days of his childhood in the 40s, and, from there, he lashed out at the citizens “Stay home” campaign that seeks to lower the curve of infection through physical distancing.
The bottleneck: lack of testing
In their negation of reality, the government has resorted to discarding information or at times to fabricating it, according to whatever they deem convenient. This has been made evident thanks to the work of Citizen’s Observatory which has been documenting thousands of suspected cases, including hundreds of deaths, through reports from the medical associations and denunciations from family members of the victims, something that the government refuses to recognize.
The stubborn reluctance of the government from the first weeks of the pandemic to realize enough diagnostic tests should be considered a huge mistake in tackling the Coronavirus in Nicaragua.
In epidemiology, time is critical. Every minute lost can mean the loss of hundreds of lives. In that sense, the authorities have left the country in the dark and alone, or – as I’ve said before – in complete diagnostic blindness before a frightening reality. They kept us from knowing the real degree of contagion and thus establishing the corresponding measures in time.
The Nicaraguan government’s “White Book” doesn’t explain why they dismissed the central recommendations of the World Health Organization in terms of the need to perform diagnostic tests: “testing, testing and more testing”, to detect the COVID-19 outbreaks in the national territory.
The epidemiologists have explained that the most direct way of detecting the presence of a pathogen in a population is through laboratory exams of suspected cases, since the opportune detection of cases is fundamental to slow the advance of any epidemic.
While the pandemic lasts, the diagnostic tests will continue being a pending debt and a primary bottleneck, because if it’s unknown where the outbreaks of the virus are occurring in the territories, then contagion can’t be slowed.
The recent data revealed by the media regarding the tests realized in the central laboratories of the Ministry of Health reveal that only the tiniest sample of Coronavirus tests have been performed. However, although insufficient, they do highlight the important data that we’re missing, demonstrating the secrecy and lack of transparency that have characterized the activities of the authorities.
The alteration of the results and the data has led to a complete disconnect in the government statistics, as far as the number of positive cases and of deaths goes. In the first days of May, they were showing an unbelievable mortality rate of 27%, among the highest in the world. In the same way, due to the biased sampling and the lack of a sufficient tracking of cases, until mid-May the data from the central laboratory showed a worrisome contagion rate of 27%. To top it off, on May 19, when public pressure caused the government to finally release more data, in just one week, Nicaragua officially went from 25 cases of COVID-19 to 279, an increase of 1000%, another pandemic world record.
Nicaragua will continue to be at the tail end of the continent for Coronavirus testing, as long as the testing process [currently done only in the central laboratory of the Health Ministry] is not decentralized to involve many more diagnostic centers, including hospital and private laboratories.
An arrogant position
The Swedish authorities have explained that their actions have scientific backing and are not just blind kicks. The Swedes wouldn’t be pleased to find themselves mentioned in the same paragraph with some other governments that lack legitimacy and are internationally accused of serious crimes and human rights violations.
The comparison with Sweden has already become the object of memes and mockery. It’s been said that it’s all a misunderstanding: it’s not that the Nicaraguan authorities are following the Swedish model, but they’re “making like a Swede” with the Coronavirus, a play on words involving the expression in Spanish “hacerse el Sueco”, meaning playing dumb so as to elude responsibilities. The new Sweden, then, just north of Costa Rica, the Switzerland of Central America.
Comparing Nicaragua’s incompetence with the Swedish model isn’t only arrogant, but also completely incompatible. If the authorities wanted to look for a realistic model for facing the pandemic, they should review the experience of Vietnam, which has stood out for its excellent management.
At the first news of the epidemic, the Vietnamese quickly established a set of simple but rigorous actions, thus managing to limit contagion to less than three cases per million inhabitants and zero deaths, a true feat for a poor country. The strategies of Greece and the neighboring Costa Rica have also been successful, with important therapeutic advances using plasma from recovered COVID-19 patients as an effective treatment for patients seriously ill.
The failure of Ortega’s family-community model
The government’s family-community model fell flat with Covid-19. The best strategy for Nicaragua was to stop the virus from spreading at all costs, a goal that would suppose a model focused on preventive measures, not on hospital attention, as has had to be done now with hundreds of people sick at the same time.
The boasted-about model, which should have been focused on prevention, couldn’t be correctly implemented, because from the beginning it crashed against the rocks of the slogan “No type of quarantine”. With that type of closedmindedness, they eliminated with the stroke of a pen the most common actions for any epidemic.
The decision to let the virus enter and spread uncontrolled, also implies that the authorities must project the contagion of 60 – 90% of the population, the level necessary to reach herd immunity. In addition, they must estimate that some 20% of those infected will be seriously ill, and that, assuming a fatality rate of 2.3%, approximately 17,000 – 27,000 people could die from COVID-19, an unnecessary and a totally immoral sacrifice.
Those who promoted the Ortega-Murillo model were surely aware of these projections that were repeatedly presented by different epidemiologists. They should have asked themselves about the morality and legitimacy of their decisions that have led to hundreds of deaths.
The pandemic has revealed that in Nicaragua, science and knowledge are relegated to one side in favor of the political interests of those governing. Vice President Murillo does wrong when she insults the independent experts with epithets like “a few miserable souls” and “deformed brains”.
Although in their “White Book” the government may sing victory over the Coronavirus and allege to have the pandemic under control, Nicaragua is moving in the direction of presenting one of the greatest indexes of death from Covid-19 in Central America, with over 2,500 positive cases and 400 deaths as the phase of community spread takes off. Without knowledge and without science, without a true strategy for mitigation, Nicaragua won’t be able to overcome the threats of the pandemic.
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* Author Jorge A. Huete-Perez holds a PhD in Molecular Biology
