NicaNotes: Is Nicaragua Hiding COVID-19 Cases?

By Becca Mohally Renk

Becca Mohally Renk has lived in Nicaragua for 20 years, working with the Jubilee House Community and its project, the Center for Development in Central America in Ciudad Sandino, just outside of Managua.

Since the announcement of the coronavirus pandemic in March, we have seen opposition media in Nicaragua quoting unnamed “extra official sources” and “informants” saying that there are many more cases of COVID-19 than the Ministry of Health (MINSA) is officially reporting, and these stories are being repeated by international media. Our organization, the Center for Development in Central America (CDCA), has been running a medical clinic in Nueva Vida, one of the poorest neighborhoods in the country, for more than twenty years. We coordinate closely with MINSA in that work and have been coordinating with local health officials on COVID-19 and the current nation-wide vaccination campaign, so I can tell you a little about MINSA protocol and the way they report illnesses.

Each MINSA medical provider at health posts, health centers and hospitals fills out a pathology sheet to report what they are seeing in their patients, and MINSA uses those numbers to track illnesses nation-wide. Anyone who has ever been in an examination room at a MINSA clinic or hospital knows that the doctor has a long pathology sheet with a list of common ailments and symptoms and as they see each patient they tick off any ailments that apply. The doctor seeing the patient ticks off categories of ailments – respiratory infections, ear infections, fever, gastrointestinal, etc., but these sheets do not have COVID-19 on them because it cannot be diagnosed in an office visit. Any disease that will need a laboratory test of any kind for confirmation is not listed, but rather checked off in broad category or by symptom complaints. Therefore, any patient with symptoms corresponding to COVID-19 will be listed on those pathology sheets as having a respiratory ailment. Pneumonia is a secondary infection associated with COVID-19, not synonymous with COVID-19, therefore any patient who is suspected of COVID-19 but also has pneumonia will in fact be reported as having pneumonia.

The MINSA protocol for the COVID-19 pandemic is this: each health center has one doctor in a separate room assigned to see patients with respiratory complaints. When the doctor suspects a patient of having COVID-19, they call MINSA who comes out to pick that person up, and they are taken in for testing – this is important, because that person is not simply told to go to the hospital on their own (which they might not do, or would do on a bus potentially contaminating other passengers), rather the health center keeps them until MINSA can come get them. The doctor at the health center reports on their pathology sheet pneumonia or respiratory problems or fever or whatever symptoms they saw in that patient.

It is true that MINSA has centralized coronavirus testing, because as far as has been reported, there is only one laboratory in the country authorized to do the tests. It is that lab that then reports the number of positive coronavirus tests, and those are the numbers that MINSA reports in their daily press briefing. In addition to testing patients with COVID-19 symptoms, MINSA is also doing randomized testing of its own staff and of patients not reporting COVID-19 symptoms, in an effort to spot asymptomatic cases before they spread.

While MINSA is not reporting daily how many tests they have done overall, they do report the number of suspected cases they currently have in isolation. This is following the contact tracing protocol that MINSA has been using throughout this pandemic, which has been used successfully in other countries including Germany and Taiwan. (Taiwan has been supporting Nicaragua’s anti-COVID-19 efforts.) This particular protocol is now beginning to be adopted some places in the U.S., such as Massachusetts.* Contact tracing involves finding out whom infected patients have been in contact with, getting in touch with those individuals and testing them. The protocol then calls for quarantining people MINSA thinks may have the virus and hospitalizing sick patients. Nicaragua’s community-based health care system is ideally structured for this type of approach, as MINSA has tens of thousands of trained “boots-on-the-ground” health promoters around the country who can do follow up in their own neighborhoods to track down potential cases.

We saw this community approach in action in Nueva Vida earlier this month when dozens of people arrived back in the community from Costa Rica. When Nicaragua’s neighbor nation went into quarantine, many Nicaraguans working in the service industry there lost their jobs and wished to return home, but Costa Rica had closed its borders and they were unable to leave. So folks we know from Nueva Vida did as many others did – they crossed back into Nicaragua without passing border checkpoints, so MINSA had no record of them; therefore MINSA couldn’t follow up as they have been doing with people entering Nicaragua at immigration checkpoints. In Nueva Vida and around Ciudad Sandino, however, we know that neighbors have informed MINSA about people who’ve come from other countries without being registered, and MINSA has followed up with those people, asking them to self-quarantine for 14 days and calling to check on them regularly during that time.

Is it possible, as the “extra official sources” say, that there are more cases of coronavirus in Nicaragua than we know about? We know that many people with coronavirus show no symptoms at all, and of course if people aren’t feeling that bad, or don’t recognize the symptoms, they will not go in to the doctor, so there are surely cases that even MINSA doesn’t know about.

But is there a big cover-up in MINSA? Let’s take into account what we are hearing from other countries: from the U.S. I am hearing directly from friends and family members who have all the COVID-19 symptoms, they have called their doctor who has agreed that the symptoms sound like COVID-19, but due to a shortage of tests and low risk for that patient, they’ve been told just to stay at home. Therefore, we can assume that the number of COVID-19 cases in the U.S. is much higher than is being reported, but due to lack of testing, we don’t know exactly how many people have had it.

Similarly, if there were currently a widespread outbreak in Nicaragua, would we not be seeing, hearing, reading about people with the symptoms who were told to stay at home or were refused tests? I’ve yet to see any reports like this, even from opposition media, which would surely be eager to print such a story.

To put this in context, the year that Zika virus hit Nicaragua, there was an alert and the government was reporting every day on how many pregnant women had Zika and when their babies were born if they were born with birth defects. Similar to coronavirus, because Zika was a new disease, no one had immunity to it and so it spread quickly through the community. BUT there was a shortage of reagents to test, therefore unofficially, tests only administered to pregnant women or those with other conditions that made them vulnerable. My kids and I had all the symptoms, I went to MINSA and was told I had a rash and was not given a test (later I tested positive for Zika antibodies). I talked with countless others with the same story, including a family from the same house with two teenagers, and adult and a baby, and only the vulnerable baby was given the test. At that time, you could have asked in any neighborhood and everybody had a Zika story to tell.

Ask around now? Nobody has a coronavirus story to tell that hasn’t been forwarded to them from someone who forwarded it (perhaps from an “informant”?) on WhatsApp. Maybe we should also consider contact tracing inflammatory messages before we forward them along.

*Source: https://www.newyorker.com/science/medical-dispatch/its-not-too-late-to-go-on-offense-against-the-coronavirus

 

Ben Linder’s Legacy Remembered

This week Nicaragua launched its annual national immunization campaign, expecting to vaccinate 2 million people against 12 diseases in the next few weeks. It is appropriate that this coincides with the annual remembrance of Ben Linder – today [April 28] marks the 33rd anniversary of his death.

Ben Linder was a young clown, unicyclist and engineer who came to Nicaragua from his native Portland, Oregon in 1983 in support of the Revolution. One of the contributions Ben made was to dress up as a clown and ride his unicycle through the streets, gathering a following of children like the Pied Piper and bringing them to the local health center where they would be vaccinated. As an engineer, Ben worked building micro-hydro systems to bring electricity to rural areas in the war zones – it was harder for the Contras to attack if there were lights in the villages. After completing a system in El Cua, Jinotega, Ben and his colleagues began work on another system in San José de Bocay. On 28 April 1987, Ben and two Nicaraguans, Sergio Hernández and Pablo Rosales, were scouting a construction site for a new dam when they were ambushed and murdered by the US-directed Contra. Ben was the only U.S. citizen to be killed by the Contras during the war, and his murder coincided with the investigation into the Iran-Contra Affair, which fueled the debate in the U.S. over the covert war in Nicaragua.

The hydroelectric plant in San José de Bocay was eventually finished by others, and today APRODELBO generates and distributes electricity for much of the region. The hydroelectric plant itself is a testament to reconciliation, run by ex-soldiers – both Sandinista and Contra. Each year the electric company remembers Ben, Sergio and Pablo with a public celebration complete with clowns and unicycles. Each year they reach out to invite the former Contra member whom they know carried out the orders to kill Ben. So far, he has not taken them up on the invitation, but they continue extending it. Two years ago my juggler husband and I were lucky enough to accompany the workers, clowns and a passel of children on a walk to the beautiful spot where the three were killed. The rocks are painted with “Benjamin Sergio Pablo Presente!” Those rocks that once echoed with ricocheting bullets now echo with laughter.

In Managua, there is a house that bears Ben’s name, Casa Ben Linder. The Casa was originally purchased in 1988 by the Committee of U.S. Citizens Living In Nicaragua (CUSCLIN) who opposed the U.S.-directed Contra War and organized demonstrations against the war in front of the U.S. embassy in Managua every Thursday morning. When the Contra War ended in 1990, the group began hosting regular Thursday morning talks at Casa Ben Linder that lasted for nearly 25 years.

The Casa has beautiful murals, most of which were commissioned by Father Miguel d’Escoto, including four murals that honor Ben’s life. Although Managua was once covered in Revolutionary murals, the murals at the Casa Ben Linder are some of the few remaining in the city done in the Revolutionary-art style, and have cultural and historical significance. Most of the murals in the house are in need of restoration.

In 2018, the group who owned the house chose to donate it to the Jubilee House Community and its project the Center for Development in Central America – a non-profit working in health, organic agriculture & sustainable development in Ciudad Sandino since 1994. The JHC-CDCA has taken over operations of Casa Ben Linder with a vision to preserve and promote the spirit of the Revolution. We are renovating the house to become the vital heart of international solidarity, education and art in Nicaragua while generating enough income to cover its own operating costs, improvements, and mural restoration. We have turned several rooms into a guest house for international travelers as well as Nicaraguans traveling to the capital. The revenue generated by the guest house is put towards restoring the rest of the property, including setting up an artisan shop and a solidarity museum. Although due to coronavirus we are not hosting large gatherings at this time, we hope to soon resume our regular art classes for all ages and children’s activities with the Guachipilin Puppet Theater. We also hope to welcome you at the guest house when you are able to visit Nicaragua!

 

BRIEFS

By Nan McCurdy

Nicaragua with Lowest Covid-19 Contagion in Americas
The Health Ministry confirmed on April 28 that there is still no local community transmission of Covid-19. There have been a total of 13 cases of Covid-19. Currently there are three active cases in treatment. Responsible and careful follow-up is given to those who deserve it, either because they were in contact with citizens of other nationalities or with the cases that have been confirmed. Nicaragua is the country in the Americas with the fewest cases of Covid-19 and only three deaths, and the lowest contagion rate, thanks to the actions that the Sandinista government has been implementing to prevent the pandemic. (Radiolaprimerisima, 4/28/20)

Public Outreach and Sanitation Measures Continue
Vice President Rosario Murillo said April 28 that in the three cycles of visits made by medical brigades and community networks nationwide, they have visited 3,844,762 homes, and verified that prevention and precautionary measures against COVID-19 are taken. The educational campaign will be reinforced through the media and efforts will be made to disinfect interurban, urban, interdepartmental transportation, as well as bus stops, markets, study centers, work centers, homes and neighborhoods. (Informe Pastran, 4/28/20)

IDB to Provide Technical Assistance
The Inter-American Development Bank (IDB) will provide technical assistance to Nicaragua, Belize and Honduras to address the Covid-19 which has left 549 dead and 14,597 infected in Central America and the Dominican Republic through April 27. The latest SICA report states, “A meeting was held with the IDB on Technical Cooperation for Belize, Honduras and Nicaragua in response to Covid-19, prioritizing the PPE requirements of these three member states, and establishing administrative coordination for the formalization of the first disbursement.” The report goes on to say, “SICA, like the IDB, is aware of the need to work in a coordinated manner to provide more effective responses and maximize the impact of resources.” The Dominican Republic and Panama are the SICA member nations with the highest incidence of Covid-19, followed by Costa Rica, Guatemala, Honduras, El Salvador, Belize and finally Nicaragua. (Radiolaprimerisima, 4/28/20)

Nicaragua at OAS calls for End to Sanctions
At the Organization of American States, Nicaraguan Ambassador Luis Alvarado stated, “The voices of peoples such as the Nicaraguan people and nations of the world are still echoing, demanding an end to the illegal unilateral policies called sanctions that are in contravention of international law and the principles of the Charter of the United Nations, and this transgression endangers international peace and security.” He stressed that Nicaragua will continue to work for peace, protection of life, health and security. “These are times of profound changes working towards solidarity and peace among the peoples of the world. It is the call of nature, it is the call of God, to humanity for a change of heart,” he said. He also pointed out that the COVID-19 pandemic has revealed that in developed countries, health systems were not designed to serve the impoverished population or protect workers, but only to serve the wealthy people who can pay the onerous health expenses of these systems. (Radiolaprimerisima, 4/24/20)

Medical Screenings, Contact Information at All Borders
The Director General of the Immigration and Citizenship Bureau, Juan Emilio Rivas, and Carlos Sáenz, Secretary General of the Health Ministry (MINSA), attended a virtual meeting April 22 with the Iberoamerican Network of Immigration Authorities to evaluate protocols established at borders to control the spread of CORONAVIRUS and identify technical and financial resources to strengthen prevention protocols at points of entry. During the meeting, Rivas explained the measures being implemented in Nicaragua to protect immigration personnel, including hand washing, social distancing, as well as the use of gloves and masks. Dr. Sáenz explained that medical screenings have been established at border posts including temperature checks, medical history queries, collection of contact information and home isolation for a period of 21 days with daily monitoring by MINSA. (Nicaragua News, 4/22/20) [Note from Nan: I can verify this as I entered the country from Mexico on March 31 and doctors called to check on me every other day.]

Military Detachment Locates Citizens Crossing Illegally
From April 20 to 26, 2020, in compliance with the State Border Protection Plan and in support of the Ministry of Health’s (MINSA) COVID-19 Protocol, military personnel from the Army’s Southern Military Detachment, located and held 71 Nicaraguan citizens in the sectors of the Palo de Arco, La Ñoca and San Pancho military border posts, San Carlos, department of Río San Juan, who entered through unauthorized crossings from Costa Rica. The citizens were handed over to the corresponding authorities in order to comply with the established health control. Thirty-five military personnel were employed during the detention. (19 Digital, 4/28/20)

Thermometers Donated by Taiwanese Company
Five hundred infrared digital thermometers donated by the Taiwanese pharmaceutical company Chia Fong were received on April 21. Taiwan’s Ambassador to Nicaragua, Jaime Wu, noted, “The company made the donation as part of its commitment to corporate social responsibility and is an expression of solidarity with the Nicaraguan people.” (Nicaragua News, 4/22/20)

Nicaraguan Boxing Broadcast by ESPN
History was made at the new Alexis Argüello Sports Center on April 25, with the first boxing evening at the new building in the capital. All preventive measures against the coronavirus were taken. The people were asked to wear masks and the distance between them was always maintained. On entry everyone’s temperature was taken and alcohol gel was placed in their hands as a precaution. The most striking thing about the evening, besides being the first in the capital, was that it was broadcast by the international television network ESPN for Latin America. After 8 rounds Robin Zamora took the victory by unanimous decision over Ramiro Blanco. In the semi-final, Freddy Fonseca beat Alain Aguilar by a technical knockout in the fourth round. Gabriel Escalante kept his unbeaten record by knocking out Mario Mairena in the fifth round. (Canal 8, 4/25/20)

Textile Companies Making Medical Garments for US
The Nicaragua Textile and Garment Industry Association (ANITEC) announced April 21 that various Free Trade Zone companies are readjusting their operations to produce insulated scrubs, medical clothing and masks that will be exported to the United States. ANITEC Executive Director Dean García stated, “Four companies are awaiting contract approval for production and export of insulated scrubs, another four will begin production of masks next week and one is already in production.” He also noted that ANITEC has held meetings with the National Inter-Institutional Commission to Articulate Actions against the Coronavirus, supplying local hospitals with insulating scrubs and masks. (Nicaragua News, 4/21/20)

Growing Milk Production Allowing Stable Prices
Minister of Agriculture (MAG) Edward Centeno reported that milk production was 83.9 million gallons during the first quarter of 2020, 12% higher than the same period in 2019. He also noted that milk collection was 42.5 million gallons between January and March, registering a 16% increase compared to 2019. “The amount of milk produced and collected in the country during the first three months represents 51% of national production, allowing the country to guarantee supply and stable prices of milk and dairy products.” (Nicaragua News, 4/21/20)

Forest Fire on Honduras Border
A fire that burned more than 770 hectares of pine forest in the mountains of Icalupe in the Department of Madriz has been put out. Some 200 men and women, part of the fire-fighting brigades, battled to put out the fire that raged for eleven days on the border between Nicaragua and Honduras. Thirteen communities lost their pine forest. On April 13, the fire was reported in Cerro del Arpa; from that moment on, members of the Nicaraguan Army were activated to help put out the fire. (Radiolaprimerisima, 4/24/20)

Femicides are Down by Half
There were four femicides in the first three months of 2020; four less in relation to the same period of 2019, reported Commissioner Vilma Rosa González, director of Public Relations of the National Police on April 22. The murders occurred in Granada, Carazo, Boaco and the South Caribbean Coast. Three of the murderers are serving sentences; police continue the search for the fourth. There was a 20% increase in reports of violence against women in the first quarter of 2020 compared to the same period last year, said Gonzalez. 5,034 complaints were registered, of which 1,497 corresponded to crimes, the rest, or 70 percent, were misdemeanors. She said 55% of the cases of aggression occur with the spouse, ex-partner or boyfriend, 35% among family members and 10% with strangers. (Radiolaprimerisima, 4/22/20)

Over 1.2 Million Receive School Meals
Vice President Rosario Murillo announced that April 28 the second distribution of food for school meals in all public schools in the country will take place. She explained it is estimated that 50,000 hundredweights of rice, 50,000 hundredweights of cereals, 36,000 hundredweights of beans, 49,000 hundredweights of corn, 6,000 hundredweights of flour, and 183,000 gallons of oil will be distributed to schools. Murillo stressed that the school lunch covers all students in the modalities of pre-school, primary and education in the countryside, as well as teacher-training schools. (Radiolaprimerisima, 4/22/20)

Nicaragua Leader in Good Roads
The Ministry of Transport and Infrastructure (MTI), is currently executing 71 projects, with an investment of US$617 million, said Minister Oscar Mojica on April 23. 515 kilometers of roads are being added to more than 3,150 km of new roads built during the Sandinista government. The road-building generates 5,574 new direct jobs. Mojica said that this year the Road Maintenance Fund (FOMAV) and the MTI are repairing and maintaining 3,830 km of road. “It is not enough to build the roads, it is also necessary to give them proper maintenance, proper care, always ensure the excellent condition, because that is our job,” he said. There are already 137 municipalities connected to the national road network; by the end of 2021 it will be 145. (Radiolaprimerisima, 4/24/20)

Drinking Water for Waspam
With an investment of US$3.3 million, the Sandinista government on April 24 inaugurated a mega drinking water project in the municipality of Waspam in the Northern Caribbean, which will benefit almost 8,000 people. The water system has a dam, a wet well, a control house, a treatment plant, two storage tanks, 935 connections made, and 32,463.18 meters of pipes. (Radiolaprimerisima, 4/25/20)