21 de agosto 2020
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In July, Nicaragua entered a phase of apparent calm in the face of SARS-CoV-2. The number of infections and deaths decreased, as reported by both the Ministry of Health (Minsa) and the COVID-19 Citizen Observatory (Observatorio Ciudadano COVID-19). There was a decrease in hospitalizations of coronavirus patients and reports of express burials diminished. At the same time, Nicaraguans have abandoned self-quarantine measures out of necessity or boredom, and have also relaxed their safety measures.
However, this behavior is a natural response to the pandemic that has been seen in several different countries. Given that this behavior is not the result of an effective containment strategy, it is likely that it will generate a new wave of cases larger than the one registered in June, the month in which the highest rate of deaths and infections due to COVID-19 was registered.
“This behavior without any safety measures has two problems: first, a very high cost during the expansion period (...) and the second and current problem: the cases decreased for several reasons, but due to a lack of control, the risk of a new outbreak always exists,” said pulmonologist Jorge Cuadra in a recent interview with CONFIDENCIAL.
Risk factors in the face of a new wave
In the case of a new wave of COVID-19 in Nicaragua, there are five factors that could increase losses and damages for Nicaraguans.
1. Decrease in available medical personnel due to layoffs, deaths, and infections
Health professionals groups have been impacted the most by the pandemic, as they had to work with restrictions and without biosecurity equipment, leading to the infection of almost 800 health workers and the death of more than a hundred.
Added to the casualties are the unjustified dismissals of 14 specialists that worked in public hospitals for over decade (Manolo Morales, Bertha Calderon, and Lenin Fonseca), and whose contracts were terminated in retaliation for questioning the government’s management of the pandemic. With a major outbreak of COVID-19 the capacity of medical care, physical structure, and equipment would be limited.
2. Back to normal: months of preventative measures lost
After three months of social distancing, many Nicaraguans decided to return to the public spaces they had stopped visiting out of fear of being infected, a behavior evidenced by Google’s community mobility reports. An analysis of the variable “retail and recreation”, which includes restaurants, cafes, and shopping centers, revealed an increase in movement from Fridays to Sundays throughout the month of July.
The return to these spaces is also accompanied by a decrease in protective measures such as the use of masks, particularly outside of the capital. In addition, this behavior coincides with the reopening of restaurants, bars, gyms, and other sports activities, such as the semifinal and final of the Germán Pomares Ordoñez Championship.
The return to public mobility without safety measures or restrictions implies a high risk because it would leave the most vulnerable Nicaraguans and the health system exposed to the virus. According to the Texas Medical Association, the places with the highest risk of contagion are bars, gyms, parks, cinemas, stadiums, and buffets.
3. “Epidemiological blindness” persists. Even the Citizen Observatory falls short
Having a real record of how the virus has spread throughout the country, how many people developed the illness, how many cases were asymptomatic, recovered, and deceased is essential so that decisions can be made to flatten the curve. However, Nicaragua has been one of the least transparent countries in providing this information.
The Government has limited the public information and data: it hid the geographical location of the outbreaks, and even stated that the infections are “clearly established”, that is, that there is no community transmission, as the World Health Organization has confirmed.
According to several epidemiologists, the data closest to reality is that collected by the Citizen Observatory, but it is also biased because the collection capacity of the volunteers is limited: there are mild or asymptomatic cases that are not registered and do not have access to COVID-19 tests, which the Government has centralized.
https://www.confidencial.digital/here-was-granada-1856-here-was-nicaragua-2020/
4. The worst recipe: self-medicating and treating severe cases at home
In Nicaragua, the practice of self-medication has intensified with the arrival of COVID-19 for three reasons: lack of trust in medical care, fear of dying away from family members, and self-medication. This has caused many patients to not seek medical assistance until their condition is critical.
“What we have seen is that lately, patients have apparently been self-medicating and they arrive when their condition is critical, when there is not even time left to intubate them”, affirms anesthesiologist Fernando Rojas.
This is a dangerous practice because there are patients, not necessarily infected with COVID-19, who could have been saved if they had received hospital care. In addition, when treated on an outpatient basis, without follow up by qualified doctors, it is possible that patients ingest medicine that puts them at risk or that will become ineffective because they developed an immunity.
“People self-medicate when they have a sore throat and begin using an antibiotic such as azithromycin, when in reality they may have a viral illness. This has contributed to Nicaragua becoming a country with high rates of microbial resistance because the abuse of pharmaceuticals means that we do not have adequate medicine to treat infections that could be curable”, explains Dr. Carlos Quant.
5. The government prefers economic prosperity over life
The Government of Daniel Ortega has completely minimized the impact of the pandemic. While all the nations in the region closed their borders and confined their citizens, Ortega refused to do so in order to not affect the country's economy, which has been in recession for the third consecutive year.
“Staying home destroys the country. The country is destroyed this way” he said in his second appearance after the arrival of the pandemic, on May 1st, when official numbers indicated 14 infections and four deaths.
In the following months, the cases increased, but the state's measures did not change. Although the infections exceeded 3,000 by the time the triumph of the Sandinista Revolution was commemorated and Ortega had to appear, he minimized the deaths by saying that since the arrival of the pandemic more than 12,000 Nicaraguans had died from causes other than Covid-19.
However, on this list, more than 4,429 deaths were removed from the official death count of the virus by attributing them to deaths by other complications such as pneumonia, diabetes, and hypertension. The approach of Nicaraguan authorities could cause a second outbreak to be even more severe due to the lack of extreme measures on the part of the state.
This article has been translated by Ana Maria Sampson, a Communication Science student at the University of Amsterdam and member of our staff*
