16 de abril 2020
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The Ministry of Health (MINSA) issued a new guideline for respiratory monitoring, ordering to “expand the sampling for timely detection of suspected cases of Covid-19,” a measure that epidemiologists and experts have urged the Government of Daniel Ortega and Rosario Murillo to know the true dimension of the virus in Nicaragua, and thus avoid further spread.
However, the expansion of the sampling consists of increasing—from the five to ten tests that are currently carried out—to only “50 daily tests” for coronavirus at a “national level,” a figure that is well below that recommended by scientists.
According to the document leaked to Confidencial by sources close to health authorities, the regime of Daniel Ortega admits for the first time that cases of acute or atypical pneumonia must be tested, a measure that is rigorously carried out in other countries to rule out infections from Covid-19.
MINSA itself reported in its latest epidemiological bulletin available on its website, that until week 14, that is March, 24,107 cases of pneumonia and 70 deaths from the same pathology have been registered.
“Due to that, daily samples for Covid-19 will be sent to the National Diagnostic Reference Center (CNDR), for a total of 50 daily samples nationwide, depending on the SILAIS (health center) assigned, which will be previously informed,” the document states, and it immediately defines the criteria for respiratory sampling.
“At the hospital level, cases of severe or atypical pneumonia will be tested. At the primary care level, patients with an acute respiratory infection with fever 37.5 C or more and one of the following symptoms: dry cough, sore throat, runny nose and dyspnea will be tested, orders the MINSA. “Samples will be taken 80% in adults and 20% in children based on the assigned quantity, they must be sent the day before,” the document added.
If 50 tests were carried out daily, as MINSA mandates in its guidelines, 350 tests per week will be carried out, a figure still much lower than that recommended by experts, to prevent the epidemic from spreading further in the community phase of infections. The scientist, Jorge Huete, an expert in molecular biology, ideally recommends carrying out 10,000 tests a week in Nicaragua, using CABEI’s rapid tests donation to the Government.
“With ten thousand tests a week, in a matter of two or three weeks, the true dimension of the Covid-19 in Nicaragua could be known with rigor. The use of diagnostic kits for mass sampling could provide significant statistical data to the country, making it a powerful tool for multiple reasons,” Huete explained in an article published by this media outlet.
The pulmonologist, Jorge Miranda, who has treated two of the nine positive cases of Covid-19 confirmed by the Government, considers “ridiculous” that a sample of only 50 tests per day is projected. “It is insignificant even for Managua. In that way, very few new cases will be detected,” said the specialist, who alerted “that in practice he has seen a rare increase in pneumonia cases” in the country.
Improve detection of Covid-19
According to the scientist Huete, if the running of tests increases, the rates of contagion and mortality of the coronavirus in Nicaragua would be better determined. He believes the tests would be essential to promote an aggressive detection strategy for cases that have gone unnoticed at airports or anywhere else.
“The main foci of Covid-19 contagion would be identified, and the new data would allow comparisons to be made with other countries in order to consider successful options.” Furthermore, “diagnostic tests would provide crucial information for decision-making on new measures that would allow to mitigate the social and economic impact of Covid-19 in Nicaragua,” Huete warned.
Does not include CABEI donation
Doctors consulted on the MINSA document agreed that the 50 samples that the SILAIS will send daily to the laboratories of the Conchita Palacios Health Complex will be analyzed with the PCR (Polymerase Chain Reaction) method. That is, they do not contemplate using the rapid tests to detect Covid-19 donated last April 7 by the Central American Bank for Economic Integration (CABEI).
CABEI provided 26,000 rapid tests to the Government. However, the administration of tests has been handled with secrecy by the Ortega-Murillo Government and its health authorities. The new MINSA guidelines do not mention anything about the 26,000 tests donated by the multilateral organization.
Given the secrecy about the whereabouts of the 26,000 donated tests, CABEI representatives responded to Confidencial’s queries through a communication signed from Tegucigalpa, Honduras. The Institutional Relations advisor, Salvador Sacasa, explained that “the management and use of the aforementioned inputs is the responsibility of the Governments.”
Jorge Huete said the tests donated by CABEI provide a new opportunity to contain the epidemic in Nicaragua. “The recent donation of 26,000 diagnostic tests made by the Central American Bank of Economic Integration to Central American countries presents the Government with the possibility of correcting the shortage of diagnosis and avoid at the same time greater misfortunes and deaths,” he insisted.
Huete added: “It is true that due to negligence and erroneous decisions they overlooked the exceptional opportunity they had to sample before, in a general way, to block the virus’s implantation on time. However, with this tool at hand, the Government cannot but increase notably the sampling and the number of tests in Nicaragua.”
Despite the new guidelines by the MINSA, the sampling they propose is still below what is recommended by specialists. For example, in countries such as El Salvador, 400 tests are carried out daily, allowing greater clarity on the behavior of the coronavirus.
Until now, the tests in Nicaragua are centralized by the Ministry of Health in Managua, while sources linked to the Ministry of Health assure that the Government continues to carry out between five and ten tests daily at a national level, only for people that present more severe symptoms, what makes it impossible to determine mild or asymptomatic cases, which are usually common in Covid-19 infections.
To improve sampling in Nicaragua, Huete recommended decentralizing the testing and providing private hospitals with rapid diagnostic kits.
“The incorporation of rapid tests obliges the Government to also update its protocols not only in terms of monitoring but also in terms of taking samples and action procedures in the laboratory,” said Huete. “As is known, the MINSA central laboratory has been grotesquely underused and could also increase the number of molecular tests for covid-19. Unless the equipment was damaged, that laboratory has the capacity to carry out at least a thousand tests per week and, redoubling efforts, up to 2,000 or perhaps 3,000 tests,” the scientist affirmed.
