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Nicaragua has unusually low number of COVID-19 cases

Government presents statistics excluding deceased, recovered cases, while not conducting massive testing

Wilfredo Miranda Aburto   | 21.04.2020
Nicaragua has unusually low number of COVID-19 cases

MANAGUA, Nicaragua

Confirmed cases of COVID-19 in Nicaragua continued to decline Tuesday.

The Ministry of Health (Minsa) reported a single new case April 19 and Monday, an additional case was also reported, while in previous weeks the number infected have been maintained at three.

According to official figures, Nicaragua would only have 10 cases in total of COVID-19.

For epidemiologists, it is not only difficult to understand but also how statistics presented by the Sandinista government work.

The reason lies in the way Minsa and first lady and Vice President Rosario Murillo handle statistics. They exclude from the total of positive cases, patients who died or recovered from the virus.

“Coronavirus situation, as of April 19, 10 A.M. Today we have 1 person with Covid-19: 59-year-old man, contact with other nationalities, who is in recovery,” said the head of Minsa Carlos Saenz,.

The government maintained a figure of two infections the previous day, but the reduction occurred due to the death of a patient.

Official figures from the Pan American Health Organization (PAHO) indicate since March 18 there have been nine positive cases of COVID-19 in Nicaragua, of which two patients have died. Although it is the same government that provides data to PAHO, the figures used by both entities are different.

Leonel Argiello, the most consulted epidemiologist in Nicaragua, said a positive case can never be erased from the registry, regardless if the patient recovered or died. “That is like having a newborn delete their birth certificate. All those who are confirmed ill continue to keep the number. They are never erased,” he said.

Experts in Nicaragua agree the government uses confusing arithmetic for propaganda purposes and to reinforce the idea that the health system has controlled the pandemic.

When he reappeared after a 34-day absence in the midst of the health emergency, President Daniel Ortega maintained the virus had been contained “with the limited resources” of Nicaragua and “with patience.”

The reduction of figures is not limited only to positive cases. Statistics are also applied to suspicious cases, so data is also always on the downside.

“Yesterday, we had 11 people in responsible and careful monitoring. Of these, four people have complied with the regulatory period, and are now under house protection. There are therefore seven people left, to which five more are added, for a total this morning of 12 people in care.”

That is how the government reported April 19.

The opacity of the government around figures forced a group of Nicaraguans to try to understand Sandinista statistics. The group presents data clearly daily and directly from official figures and what they managed to corroborate in territorial networks.

“We report to date (April 19) a cumulative of 245 cases: including nine cases confirmed by MINSA, 12 suspected cases of MINSA and 224 suspected cases verified by the Citizen Observatory,” it said in its document.

Epidemiological blindness

Beyond the set of figures with COVID-19 cases, the secrecy of official information extends to the number of tests carried out. Scientist and molecular biologist Jorge Huete assured that the “true dimension of the epidemic is not known with rigor,” because the government has not carried out massive sampling.

Other experts added that in the absence of massive tests, Nicaragua suffers from “epidemiological blindness,” which could be serious in following the trail and curve of contagion of the virus.

At all times, Sandinista health authorities deny COVID-19 has entered the community contagion phase. However, the Cuban government said five of its nationals who returned from Managua tested positive. That contradicts Minsa.

Various sources of the public health system told Anadolu Agency that in the National Center for Diagnosis and Reference (CNDR), only between five and 10 tests are performed daily.

Doctors also said Minsa performs laboratory tests of COVID-19 patients only with severe symptoms. Instead, the health authority rejects those with mild cough and fever, despite doctors who refer patients on suspicion of coronavirus.

The results of the tests are not officially communicated to doctors, and the CNDR only communicates the result verbally. There is no written record in hospitals.

To date, the Ministry of Health has not revealed how many tests have been carried out in total. Due to pressure from independent experts for a larger sampling, Dr. Carlos Saenz was forced to give an answer. But it was a hesitation more than an exact number. “It can be around, I couldn't tell you at the moment, it was like ... more or less, 200. A hundred and something,” he said.

For Huete, “about 200 tests” is an insufficient number. Instead, he recommends testing 10,000 weekly. Although the government received a donation of 28.000 rapid tests April 7 from the Central American Bank for Economic Integration, authorities have not begun to apply them.

Another concern for specialists is the outbreak of “atypical pneumonia” that is registered in Nicaraguan hospitals. “In my consultations I have noticed many atypical pneumonias for this time of year, and they are not declared as suspects for coronavirus,” said private pulmonologist Jorge Ivan Miranda, who treated two of the nine positive cases of COVID-19 registered by the government.

“The fact that patients with atypical pneumonia are not tested for COVID-19 creates an underreporting that could explain the few positive cases of contagion in Nicaragua, unlike other countries in the region where the numbers are increasing,” he said.

In its last epidemiological bulletin March 2020, Minsa revealed there are 24,107 cases of pneumonia and 70 deaths from the same pathology, but did not reveal the cause.

*Daniela Mendoza contributed to this note.

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