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  Number 466 | Mayo 2020
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Nicaragua

“The Coronavirus has lain bare the tragedy we’re experiencing”

This molecular biologist and vice rector of the Central American University, offers his analysis of the microorganism that is devastating the planet today and evaluates the Nicaraguan regime’s disastrous approach.

Jorge A. Huete Pérez

NICARAGUA


Jorge A. Huete Pérez


Our world has experienced pandemics of different magnitudes over the last hundred years. All have allowed us to learn. This is the most aggressive one since the one in 1918. Back then we didn’t know about antibiotics, much less about Deoxyribonucleic acid (DNA) as hereditary material. Its structure wasn’t discovered until 1953. Nor did we know about Ribonucleic acid (RNA), which is the genetic material of this virus rather than DNA. We are thus obviously better prepared to deal with it now.

What we know about COVID-19


Only two weeks after the coronavirus, whose technical name is COVID-19, was declared a pandemic, we already knew it has an RNA genomic sequence of 30,000 base pairs, whereas the human genome has 3 billion. We also knew it has a protein layer that protects it from the elements. How long the protection lasts is being researched but we know high temperatures can degrade that layer.

Once the virus’ genome was known, there were hundreds of descriptions of its RNA, allowing its comparison with other similar viruses we already know and showing its origin. Each day we’re learning new information about this virus that is causing a new disease.

We now know its structure has two regions of variations relative to other viruses. In one it is able to adapt to existing receptors in human cells in an amazingly efficient way. And the other allows it to open up to enter into the cells of our organism to replicate. We know that it’s transmitted mainly by contact or closeness between people through saliva we expel when we cough, sneeze or even speak. The micro-particles of saliva are a wet medium that protects the virus. They can stay in the air for some time and the wind can carry them great distances.

We know that drops of saliva from someone who’s infected stay on surfaces and when we touch them then touch our mouths, nose or eyes we can get infected without even having any kind of contact with anyone.

We also know that an infected person can infect up to eight other people, which explains the speed with which the disease is spreading and shows us that the most important measure to stop infection is social distancing.

Theses on the origin of this virus


The experts who identified the two mutation regions of this virus say that such variations are possible within natural evolution and that this coronavirus has similarities with viruses of a variety in bats and in pangolins, an Asian anteater. But since virological sciences and techniques have advanced so much and many laboratories now have an enormous capacity to alter viruses, speculation has emerged that it escaped from a lab.

As we await new information, there is an aspect that has not yet been discussed much within the scientific community, but is very important. We can’t discard the idea that the natural evolution of this virus’ mutations may be a result of the disconnect between humanity and nature, part of the planet’s destruction. We’ve been bent on entering areas that have never had “human visitors,” if one can call it a “visit” when we bust into a corner of the planet to destroy jungles, forests, habitats to extract minerals, build big infrastructures and in doing so destroy nature and expose ourselves to new forms of life we don’t know, to organisms our bodies aren’t prepared for or have antibodies against.

This coronavirus may have its origin in a zoonosis, as we call this “leap” of microorganisms that normally live only in animals but pass to humans and make us sick. Our destruction of the world’s forests and penetration of its jungles might be the cause of this disease.

It is speculated that SARS had its origin in bats fleeing their destroyed habitats and being forced to live among humans. The HIV virus “leaped” from a monkey species to human beings. These “leaps” cause mutations in the virus’ genome for them to adapt to the other organism.

Sometimes those mutations happen in the animal itself, as was the case with HIV. Invariably, however, there is always a genome modification in the virus, an adaptation that helps it lodge within human beings.

There have also been infections caused by viruses from animals closer to us, such as pigs and birds, that “leaped” over to us. The NIPAH virus was an epidemic that went from pigs to humans and caused encephalitis. The H1N1 was an epidemic that went from bats to pigs and humans. We are also exposed to viruses and other germs in animals we eat and raise to eat.

We know all this today. But in 1918, when the “Spanish flu” caused millions of deaths, all people could do was resort to magical thoughts: ask for supernatural powers to stop a phenomenon they thought to also be supernatural.

We’re living a reality
of such backwardness


Nowadays, we know that, to be effective, the approach to stop any epidemic must be scientific. Everything we’ve learned and the scientific knowledge and techniques we have at hand to deal with this pandemic makes it particularly distressing that the Nicaraguan government has decided to disregard this knowledge and stick to quasi-religious beliefs and political interests.

The Coronavirus has lain bare the tragic reality we’re experiencing in Nicaragua. It’s a reality of such backwardness, such disregard for knowledge, of imposing the ideas and interests of the few over the interests of society, which has been left out in the cold.

During the last three or four decades, other pandemics have appeared globally, and although not of this magnitude, they scared us. There was SARS in 2003. Then it was MERS in the Middle East and before that H1N1, which began in Mexico. Although they never were very strong in Nicaragua, it must be said that they were well managed. Being a tropical country we have a lot of experience managing epidemics. We have long co-existed with infectious diseases transmitted by vectors: malaria, dengue, leptospirosis and more recently zika and chikungunya…

Since the 1980s we’ve been building more and better capacities in the country to respond to those diseases. That’s why it’s so disappointing that with all the accumulated experience in the Ministry of Health responding to epidemics, we have fallen into the disastrous policy being employed today.

The government’s
do-nothing policy


The problem isn’t so much what the current Nicaraguan government has done as what it hasn’t done. Its strategy has been to do nothing. Talking about the absence of any public approach here with foreign colleagues experienced in scientific policies, they pointed out that doing nothing is in fact also an approach. It’s a decision that distances the Nicaraguan government from most of the world’s nations and isolates us even more.

Since the virus appeared, governments have called on their experts to decide the measures to take. Many, above all, most of those from developed countries, have committees of scientific experts. In some countries they regularly work with the committees; in others they call upon them each time there’s a need to hear their recommendations.

It’s not strange that these structures exist, because the world we live in is based on science and technology. It’s a globalized world where the development of economies and societies depends on technical-scientific development. In less developed countries the interface between science and political decisions hasn’t been achieved, but even authorities of countries with fewer resources followed the medical-scientific guidelines of international organizations, i.e. the World Health Organization (WHO), and of Science Academies.

WHO is the governing health organization worldwide, but in Nicaragua the government’s decision has been not to allow or comply with its guidelines. It also refused to recognize the guidelines of individual scientists and scientific organizations in our own country or from other countries.

It didn’t close the borders or its international airport, didn’t order social distancing or quarantines, didn’t decree any kind of emergency, and didn’t do any tests to know where there could be outbreaks. It kept public schools and universities open, encouraged hundreds to attend massive events and welcomed cruise ships… To justify what it wasn’t doing it played down the importance of the pandemic, fluctuating between lack of interest and negligence and a triumphalism based on the absurd argument that Nicaragua has the “best health system in the Americas” and a successful community healthcare model.

All this behavior, in my opinion, is flawed from the start. And the flaw is that we are being governed by people who have an anachronistic concept of the world, where there’s no room for scientific knowledge. They aren’t only standing on their ideological and political concepts and their economic, individual and family interests. They also have a magical concept of the world and promote it among the people. My only hope is that when confronted with the reality that will prevail before their eyes, the dramatic and overwhelming reality of the number of dead they will have caused will force them to acknowledge their error and make different decisions.

The community
healthcare model


In his April 15 speech after a never-explained 34-day disappearance, Daniel Ortega made it clear that his strategy was to be different from the rest of the countries. He would not dictate any measures or even declare a health emergency for economic reasons because Nicaragua could not stop producing or working. This is what I understood: for economic reasons we can’t take health measures. And to reassure people, he praised the goodness of the country’s community healthcare model.

This model consists largely of sending “health promotors” accompanied by political activists to make house-to-house visits around the country: they knock on doors, go inside homes when permitted, and try to engage the family in dialogue. It has been very useful with dengue, an infection whose vector is a mosquito. In that case the health promotor explains to the family that open recipients in their home or yard that capture water are places where the mosquitos lay their eggs. In addition to the Ministry of Health (MINSA) sending out trucks to fumigate from the street, its health promoters carry a product they apply to water deposits at the household level that kills the eggs.

That model still exists, but today it’s quite weak. More important than its weakness, however, is that it’s inappropriate for this pandemic. Since this disease’s vectors of infection are people, the model doesn’t solve anything and can in fact help spread the virus. We know that to avoid alarming the family, they don’t wear masks and limit their advice to “washing hands.” With the coronavirus it’s even more risky for both the promoters and the families for them to go inside houses without protection.

They talk enthusiastically about everything the “good government” is doing to protect us, thus becoming massive transmitters of the virus throughout the country and of inadequate practices to contain it. In this particular pandemic they also do what the Vice President calls “prayer and healing sessions.”

Managing the pandemic
or managing the figures?


Another thing Ortega said that April 15 afternoon was that “they have managed” the crisis very well. No, what the government has actually “managed” very well are the statistics because it has total control over the figures of those infected, hospitalized, recovered and deceased. And it has managed them “well” with its strategy of hermetic secrecy.

The government either isn’t doing enough tests or simply isn’t reporting how many, where or to whom. It’s logical then that with the determination to take no measures and let the virus in, it can’t do any testing or report any results because another reality would be revealed and the government would be forced to acknowledge its error and take measures.

Epidemics need to be controlled from their roots. The best way to do that is to stop their transmission. And for a country with Nicaragua’s fragile economic and financial conditions, and such a weak health system, it should have been a priority to avoid the entrance of the virus as long as possible to buy time and not overload the system. However, the decision was the opposite: they invited the virus in, claiming we are an “open door” country and promoting crowds, especially during Holy Week vacation, thus diverting attention away from the disease.

Given that the government encouraged tourism and kept its borders and both sea and airports open, the virus’ entrance into Nicaragua was probably delayed only because our neighboring countries, Costa Rica, Honduras, El Salvador and Panama, with which we have a continuous flow of trade and people, quickly closed their borders.

Most other countries farther away suspended their few flights to Nicaragua. Thanks to these measures taken by others while Nicaragua was taking none, the virus’ entrance was slowed. But while it took a while to come, its arrival wasn’t avoided. It’s here.

To test or not to test…


Once in the country, the best way to control the virus is to do tests to detect where it is and how it’s spreading inside our territory. This is another disappointing reality because Nicaragua has the means to detect the virus. Since the 1980s it has had the Polymerase Chain Reaction (PCR) technique being used for testing, which is cutting-edge technology. Our country has also trained personnel to administer those tests. Doing the numbers, I would say Nicaragua could be doing about 3,000 tests per week with the PCR technique in eight-hour workdays every day, rotating two teams.

I know there are two teams well trained for this in the MINSA lab, not to mention what could be done with the 26,000 tests the Central American Bank for Economic Integration (CABEI) donated to Nicaragua. These are quick, simple tests that don’t need specialized technicians. We can detect whether a person is positive or negative for coronavirus with a drop of blood. With this donation Nicaragua would have enough for a 2-3 week sampling, which would allow us to establish where the epidemic is within the country.

Although the PCR is the “gold standard test” to detect the virus, there are faster and much cheaper ones that are serological and allow for mass testing. Both have their limitations. It could be that the PCR is applied to a person who still doesn’t have a strong viral load at the time of the sampling, which is done by taking nasal secretions, so the person doesn’t test positive despite having the virus. Likewise, if a person has had it but was asymptomatic, the PCR won’t detect the virus because it isn’t circulating.

The rapid tests have the limitation that they only work when a person has already had the disease for 5 to 7 days because they detect the antibodies the body has produced and it isn’t until some days later that the body reacts to develop them. They are cheaper than the PCR and give an idea of where there’s an outbreak. It’s assumed that after three months the virus is no longer present in the person who had the disease, but that too is under scrutiny because in some people it seems that the load is reduced, but hasn’t disappeared. And there have been people who had the disease and were infected again. All this is being researched. Nicaragua could participate in these studies, researching how the virus advances or not in our country. We have the capacity and interest, but the government isn’t allowing it.

The government hasn’t even informed its citizens what kind of tests it received from the CABEI. Seeking information in other Central American countries that received the same tests, I was able to identify them by reading the instructions. They are Korean. It is an immunochemical test that detects antibodies for the virus left in the blood. It only requires a drop of blood from a finger to take a sample. Any lab technician in any clinic can do it.

MINSA’s lab technicians don’t know what’s going to happen with these tests, since this issue is also managed with inconceivable secrecy. And even though Taiwan made a donation of necessary equipment to the government, it’s said that it’s all in storage, which is unacceptable.

The thousands of donated rapid tests could be a fundamental tool to learn how we’re doing with the pandemic, where we stand. If tests weren’t done before receiving the CABEI donation because the PCR is too expensive and the government didn’t want to spend money or because its application is too complicated, this donation no longer allows such excuses.

Those tests could be done in all the hospitals and with a research design to go out and find where there are outbreaks. We would discover through antibodies who has gone through the disease and who hasn’t. This hasn’t been done. They have no more excuses to deceive us and hide reality from us. As of today, April 21, we still don’t know the magnitude of the epidemic in our country and can’t find out.

The virus came late
to Central America…


Certainly, the virus had a delayed arrival in all of Central America compared to South and North America. Other countries in our region acted immediately and are controlling it. Costa Rica has done this quite well.
Despite Nicaragua having done nothing to mitigate the virus’ spread, there’s the sensation at this moment that “very little” is happening here and that the health system will be able to deal with whatever occurs. While the latter assumption is false, several external factors did help delay the virus’ entrance to the region as a whole, above all the early decision by neighboring countries to close borders and airports. That reduced the entrance of people carrying the virus and international trips by residents of the region.

Specific to Nicaragua, this pandemic followed two years of economic crisis derived from the political crisis that started in April 2018, which caused a drastic decrease in tourist traffic here, which also helped.

The advance of the virus could still be mitigated here, but everything has continued to be managed with total secrecy, with information that is in no way transparent and with misinformation. Only the medical associations and civil society organizations have stepped up to inform citizens what the disease is about, giving recommendations based on the scientific information we are getting.

To date, the government has denied that there is “local community spread,” wanting to give the impression that the few cases it has admitted are “imported.” According to the Multidisciplinary Group formed for this, today we are in the stage previous to the explosion of intense community spread.

…and Nicaragua came late to science


On this occasion one must say, and we’d only be repeating it once again, Nicaragua has come too late to science. Nicaragua’s Academy of Sciences is scarcely ten years old, no time at all in relation to the history of science, while so many other countries started about 500 years ago. All Latin American countries began to strengthen their scientific institution¬ality back in the 1950s. During those years they all formed National Councils of Science and Technology. The only country that didn’t was Nicaragua.

The idea to form it here only dates back to 1995, and it didn’t come from the government, but was a recommendation from the Inter-American Development Bank (IDB) when it called a meeting to establish collaboration among countries on scientific issues. Since Nicaragua had no representative, an official from the Ministry of Commerce was sent to the meeting. And that’s when the IDB suggested the idea.

Finally, the idea became action and the National Council of Science and Technology (CONICYT) was formed a few years later. It’s unfortunate that it was created like that, without an autonomous, endogenous decision, or with any consciousness that it was a national need. After that, the CONICYT has made leaps in its development but it must be acknowledged that no authority from any government has ever taken on the idea that science has an important role in running the country.

Our scientific strong suit
now is infectious diseases


It was not until the 1980s that interest in research began to develop in Nicaragua. And international cooperation abounded, especially from Sweden, but also from Germany, Spain and the US, to reinforce higher education needed for the formation of national scientists.

Many were formed abroad and so new scientific capacities were created in the country, very modest but real. Today we have more Nicaraguan scientists of international stature working abroad than in our country. In spite of it all, we have research groups with a trajectory in some issues.

Ironically, the issue we are strongest in is the treatment of infectious diseases. Sweden invested a lot of money in the formation of these researchers, especially in the National University, both UNAN-Managua and UNAN-León, where there are scientists who know a lot about health matters and epidemiology and who the government could have called on to form an emergency committee to support it regarding measures to take regarding the virus. The universities are abjectly subordinated to the government so it wouldn’t be hard to call on those scientists to contribute to the strategy the government could have structured. But it didn’t happen.

The unfortunate posture of
the government and the CNU


Many people have taken it upon themselves to assume social distancing measures, including students since the public schools and universities haven’t been closed. A few days ago, the National Council of Universities (CNU) sent a statement ordering university students to return to their classrooms. The government, represented by the CNU, wants to avoid promoting online classes at whatever cost. It seems to want to promote people gathering in masses. In its statement, the CNU justified its position arguing that the “good government” has put together a “successful” strategy against the coronavirus. It literally states this.

The CNU’s posture of denial is reminiscent of the one it had a few years back when the topic was the interoceanic canal. Back then, the CNU wanted to get all the universities in the country involved in the fantasy and demanded that we all contribute. In fact, they dedicated a slice of the CNU’s budget specifically to promote everything regarding the canal in the universities. They wanted all of us to teach Chinese and to change the curricula so all the subjects taught were related to promoting the construction of the Grand Canal, a project that never existed and never will exist because it was a big farce to divvy up the money and the country.

The posture of denial by both the government and the CNU is unfortunate because new and huge opportunities have opened up at this moment to leverage countries’ scientific development. Big consortiums and research groups have been formed all over the world that would allow Nicaragua to play in the major leagues of science, contributing from our knowledge to the research on how an epidemic happens at a national level. The coronavirus has been described and we know of eight different types of it; there must be different manifestations of those types in each country, even in each zone. What types are circulating in Nicaragua? Given our climate conditions, our demographics, are there variables with respect to other countries or not? If so, what are they?

Someday we will
be able to find out


There’s a lot to learn and we could also teach, but without testing there’s no possibility whatsoever of doing research or knowing anything. Surely, therefore, as already happened with the canal, there won’t be any national research of this pandemic either.

This government forbids everything, controls everything... If someone today would like to do epidemiological research, could he or she go into a barrio and take samples or do surveys without being persecuted? No way. It’s hard to do research that way. How the epidemic developed here is going to be almost impossible to learn because there are no records and nothing has been veraciously quantified. But we will learn even though the government is hoping what happened here is never known because they were able to cover up the facts for reasons that make sense only to them. Eventually, in the area of molecular biology, I know we can determine a posteriori what the pandemic’s situation was in Nicaragua. There are techniques that allow for determining even many years later how many people acquired the virus and had the disease.

Our scientists can only
study neighboring countries


Has the heat contributed? This virus disintegrates at 60-70 degrees Celsius, a temperature no country will ever reach. It is said that in hotter countries the virus is less effective, but like many other aspects, it’s still being studied. It’s not known for sure yet.

Given the lack of trustworthy data I believe that we must guide ourselves by what’s happening in the other Central American countries to have an idea of how the pandemic is developing in Nicaragua. They are the countries and populations most similar to ours. There’s a hot climate in many parts of the region that’s similar to ours. There are also similar genetic and demographic factors. There’s no zone in the world more like ours in history, culture and customs than the rest of Central America.

Therefore, to know how the virus is spreading in Nicaragua we should see what it has done in El Salvador or Costa Rica. The latter is one of the countries that have best developed detection techniques. Knowing how many people have the virus, where they are and how they were infected is the first step to being effective.

If Costa Rica is in the community spread phase, we should also be in ours. In that phase, transmission happens in neighborhoods and homes, among family members. Someone of the family goes out, is infected by someone then returns home and passes it on to relatives and the infection spreads. That phase will make the virus spread in our country, where many families have numerous members and live in crowded conditions.

Half-truths, myths…


To justify the government’s lack of action, it attributes the scarce number of cases it admits to the heat, the young age of our population and the routine vaccination campaigns MINSA organizes. The government’s Radio YA said, for example, that some scientists say the coronavirus has no impact in countries where the vaccine against tuberculosis, BCG, has always been applied. That would be the case in Nicaragua, where this vaccine is applied regularly.

What they say has some logic, in the sense that it’s been known for a while that this vaccine generates a direct response against the tuberculosis bacillus and also has another response: it creates a non-specific immunity against other pathogens, strengthening the body’s defenses. However, it doesn’t immunize against the coronavirus. Until there’s a vaccine specific to this virus, nobody will be immune because it’s the first time human beings have been exposed to this microorganism. And there have already been cases of people in the North, where the tuberculosis vaccine is not usually given, who have worsened when vaccinated against TB as a treatment against coronavirus.

Nonetheless, Radio YA’s propaganda concludes that the “good government” also applies free vaccines against tuberculosis—which, by the way was already being done by previous neoliberal governments—so “thanks to the comandante and the compañera” Nicaraguans are immune.

The government’s triumphalist messages discourage people from learning reality, understanding it and of course from being concerned. They are misinformed. The government doesn’t even recommend the use of masks to avoid getting infected and infecting others. This has reached the extreme of not allowing doctors and nurses to use them to avoid “alarming” people who go to the hospitals, putting them at serious risk and risking the population they tend to.

…and scientific searches
for remedies underway


There are about a hundred medications that are being tested for the treatment of those infected with coronavirus. And the list is growing. Logically, they are resorting to medications that already exist, because to invent a new one, such as vaccines, could take a long time.

Knowing that it’s a virus from the coronavirus family, scientists are searching the records of medications to find which existing ones may work. They are testing retrovirals used for HIV, as well as hydroxychloroquine which is used against malaria. Also azithromycin, and interferon Alfa-2b, the antibody Tocilizumab and Remdesivir, which was used against Ebola.

By the end of April, clinical trials of eight drugs, among them these mentioned above, should be done. There’s a big worldwide clinical trial in an international program promoted by WHO called “Solidarity” in which hundreds of countries are participating. There are doubts and questions about each of these medications. The main question is at what moment each medicine will or will not be beneficial for the patient, because some have very toxic side effects. Also in some countries they are doing clinical trials to see the effectiveness of giving patients in serious conditions plasma from people who have recovered from the disease because the antibodies they produced are in it.

Many things are being tested, always starting first with what is already known, which is medically logical because it can stimulate the immunological system. Vaccines for influenza also can at least prevent co-infection.

We must remember that vaccines against influenza from one year don’t always work the next year when another influenza virus is circulating. That’s also the problem with dengue. Four serotypes of dengue are known, some more harmful than others. Sometimes it’s not known which type is circulating.

What’s important is to be able to count on a specific vaccine for this specific coronavirus. It’s expected that in a year to a year and a half we will have one, but since this COVID-19 is from the same family that caused influenza, this could be followed by another mutated coronavirus, which could be stronger or weaker than this one. All these possibilities need to be considered because Darwin taught us that that’s how life works. Life is Evolution.

Consequences left by the virus are also being studied. Taking into account that this is a new virus that causes a new illness, we are barely starting to obtain the first worldwide data about how the virus and the disease it produces behave. We have learned a lot in four months and we already have scientific information, but it’s still very fresh. It has to be contrasted, applied and demonstrated… that’s how knowledge is laid down.

Does the government
actually have a strategy?


What will happen with the approach started in Nicaragua based on this erratic behavior? The only document we know of with a “strategy” is the one leaked from MINSA to Confidencial. It’s a technical document about how to approach the epidemic in case there’s an outbreak. There are numbers in it that are minimums in case a serious outbreak occurs.

That document stated that after six months of the virus’ presence in Nicaragua 32,500 will have been infected, 8,125 cases would be serious and 813 would die.

These calculations are projections, models, considering many factors of the virus itself and also our population’s factors: how many people are of a certain age, how many are likely to have certain preconditions, etc., to show the calculation of infectious capacity to expect in the country. However, these numbers fall short if there’s an uncontrollable explosion of the pandemic, which naturally would collapse our limited health system.

Could the strategy
be “herd immunity”?


Some have asked if the Nicaraguan government, by doing nothing about the virus and letting it spread freely, is, without declaring it, gambling on the strategy known as “herd immunity.” Put simply, this consists of letting everyone get infected, because deaths will be few and everyone who survives will be immune quicker and the country will end the problem sooner.

Great Britain wanted to do that at the beginning but its scientists warned that it was a risk, as it’s not yet known how immunity is acquired—if it in fact is acquired—or how long it lasts. It’s also a risk because “herd immunity” doesn’t take into account that when everyone is infected at the same time, as predicted by the speed of the coronavirus infection, the health system doesn’t have the capacity to take in so many sick people at a time and tend to them adequately.

All epidemiologists, even the British, have stated that when the curve of so many infected at the same time is reached the strategy is to flatten it, because everything that goes over it represents people who will be left to their fate, without medical care. In other words, it won’t necessarily be the fittest who survive, but to some degree those who get to the health system before it collapses.

The Nicaraguan health system’s capacity


Surely, one could think that maybe this strategy was quietly adopted by the government, assuming that whoever is meant to get sick will and whoever is meant to die will. They could have calculated that those most likely to die are over the age of 60, which in Nicaragua is only 7% of the population. If that is what they were thinking, the government and its spokespeople seem to have been blinded about the national health system’s capacity to care for a massively infected population.

They praise the community health system more than the hospital system. If it matters more to them than the clinical system, it would explain the current disaster of hospitals. Bu this triumphalism about community healthcare deflates seeing the history of the dengue epidemic in Nicaragua, which took over the country in the 1980s. In 2019 Nicaragua was one of the three countries in the Americas with the largest number of dengue cases, far behind Brazil and very close to Honduras. We’ve climbed up to 180,000 dengue cases per year, including hemorrhagic dengue fever, the worst type, and many of all ages have died of it every year. Moreover, as I explained above, community healthcare won’t work with this pandemic.

As for the hospitals, anybody with half a brain not to mention anyone who has actually been to a public hospital knows we don’t have “the best health system in the Americas,” as Ortega said.

So where do we stand?


Is there a visible outbreak of the pandemic? Some organizations are trying to obtain data beyond the scarce and questionable official numbers that could bring us closer to what’s really happening. The most recent information, which is that MINSA would be doing 50 tests daily, hasn’t appeared in the official media, which suggests that it too was leaked from inside MINSA.

Only by reporting on the tests done and their results can we see a panorama closer to reality. But the government isn’t releasing the results, assuming tests are actually being done. It wants this information to be its secret so it has denied private hospitals, private labs and many private neighborhood clinics the right to do their own testing. If we had all of them doing the tests we would have clearer ideas.

The explosive phase…


In all countries fear itself is collapsing the health system. To avoid it, quarantines and social distancing have been ordered. It is not so much to avoid infections, which are impossible to suppress completely, but to keep them from happening so intensively that they overload the given health system’s ability to treat the cases. This is what is meant by trying to “flatten the curve.” If 60% of the population in a country is going to get infected, we need to avoid them getting infected all in the same week and try to spread out the infections over a six-month span. Actually, the best thing would not be to “flatten” the curve but to “squash” it. By only flattening it we will have sick people for a long time whereas what we want is to fight the virus and avoid a greater number of infections and deaths.

It remains to be seen if in Nicaragua the health system will collapse. Since people here decided on their own to self-quarantine and so far there have been no official measures to avoid explosive infections, it’s very possible that sooner or later we’ll come to the explosive phase.

…followed by endemic co-existence?


I believe what’s happening in some African countries—Rwanda, Congo, Tanzania, Madagascar—with very few reported cases, 200 more or less, is simply that they lack an adequate detection system. If cases aren’t detected through tests…there are no cases.

I also think it’s possible that there are demographic conditions and other factors and peculiarities in each country that contribute to the less dramatic progress of the disease. I further think that in these countries the cases won’t appear in a short period of time, but over a longer term, not as a “curve” but as a prolonged “plateau,” which could even become permanent.

That’s the fear I have for Nicaragua: that after the explosion this virus will stay here in an endemic form, as another epidemic we have to co-exist with. That’s what has happened in our country with all other epidemics; they enter the country and never leave and cases constantly continue to crop up. That’s what happened with dengue, despite all the resources invested to control it.

Not just saliva but
also feces and urine?


The Central American winter, the rainy season, could accelerate the epidemic’s explosion. And in regards to the rains, there is more worrying information: several studies on means of transmission other than coming into contact with infected people’s saliva have discovered the virus in some patients’ feces. It’s therefore possible, and is being studied, that people can be infected through contact with feces.

We already know how many places have water contaminated with feces due to the lack of good sewer drainage. The rains increase the possibility that hospital waste water and the feces of sick people who don’t go to the hospital end up in zones where people go for water, favoring this other form of transmission. One study also confirmed that in 1% of the cases studied the virus is also found in the patient’s urine, but the percentage is much higher—30%—in the feces cases studied.

It’s been left in our hands
and there’s a lot we can do


In Nicaragua we have a political leadership whose power is based on guns, on repression that’s hard to oppose and in addition doesn’t allow action, as was the case of prohibiting Bishop Rolando Álvarez from creating prevention centers in his diocese in Matagalpa.

The government’s irresponsible response to the pandemic is causing international human rights organizations to react. If the right to life is the most fundamental human right, it’s being violated in Nicaragua by leaving its citizens unprotected and forced to take on our own healthcare.

We must realize that there’s no leadership in Nicaragua that will responsibly assume what needs to be done in the face of this pandemic. It’s all in our hands.

On a personal level, there’s a lot we can do to avoid becoming infected and infecting others. A lot of people can’t stay home so we’ll have to find ways to help and advise them. A woman who sells tortillas can be in the street with a homemade mask, washing her hands, carrying soap and water, covering the tortillas in a way that whoever buys them from her can see that this woman is taking all the measures. And the same with many others.

On a societal level, he best way to face this crisis would obviously be with a national leadership that assumes healthcare regulations that would protect us and economic and financial measures that would help people with scarce resources and informal workers who survive with their daily income. They are tasks that correspond to government authorities and the Ministry of Health.

I don’t want to take importance away from what we are doing and can do, but without government leadership, what society can do is limited. Lacking that leadership, however, we can still all do something.

First, people need to be correctly informed, scientifically, without forgetting that we’re proposing that citizens take care according to their possibilities knowing they’re up against a great governmental force that’s going against the current by promoting infectious activities and in many cases prohibiting rational prevention measures.

Many medical and scientific organizations are giving information through the media so people can take their own measures. Different businesses are as well. Each one is doing their part.

All this is hard to do only as society, but we know that an organized and creative civil society can always do more. We’re in a situation that forces us to be more responsible and more creative, aware that we don’t have a national leadership that responds, as is its mandate, its obligation.

As I said, my hope is that when the government has before it a large number of deaths, it will act differently. But that too remains to be seen. The tragedy of a large death toll could make much more of the population react consistently, because there will be dead Sandinistas, dead Blue and Whites and dead apoliticals.

Concluding: the coronavirus has lain bare the tragic reality we’re experiencing today in Nicaragua. We are facing authorities with an anachronistic and non-scientific vision of the world, a predatory vision of nature, an opportunistic and economistic vision of a problem that is its responsibility to solve because it affects all of society. We’re facing authorities who act based on their own interests, without taking the nation into account. The coronavirus has unmasked these authorities’ priorities to stay in power and maintain that power through control and repression. Through arms.




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