COVID-19: On the Decline in Nicaragua as its Critics Fall Silent

John Perry

No country can yet claim to have defeated Covid-19, but clearly some are having more success than others. Nicaragua is one of these, and could yet be recognized as a world leader. With under 5,000 Covid-19 cases since the pandemic began, according to official figures, its infection level is far below that of Panama (105,000), Guatemala (85,000), Honduras (71,000), Costa Rica (63,000) or El Salvador (27,000). Of course, it is certain that Nicaragua’s figure, like those of the other countries, undercounts the real incidence of the virus. But even the so-called ‘independent’ Citizens Observatory, which is closely linked to Nicaraguan opposition political groups, only reports around 10,000 cases – still well below the incidence in adjoining countries. And the observatory’s figures – as its website makes clear – are not based on testing but on unverifiable sources, including ‘rumors’ (which it defines as ‘spontaneous public opinions’).

What evidence is there that Nicaragua’s epidemic is under control? Over the past six weeks, since early August, there have been only around a thousand new cases. The weekly level of new cases is down to 143 (mid-September) from a peak of 480 per week at the end of May. This reflects experience on the ground – hospitals are now dealing with a limited number of Covid-19 cases, and the Managua hospital that was dedicated solely to treating the virus, the Alemán Nicaragüense, has opened its doors to other patients. In the streets, while people still take precautions and most wear masks, there is little sense that the pandemic is everyone’s biggest worry, as it was four months ago.

The Pan American Health Organization (PAHO) reports that Nicaragua has the lowest Covid-19 death rate in the Americas. Also, according to Forbes, at the end of August Nicaragua had the best Covid-19 recovery rate in the region, with more than 90 per cent of patients recovered. These are encouraging figures, although truly comparable data will only be available when national mortality rates can be examined for the different countries over the period of the pandemic.

Nicaraguan government policies have differed sharply from those of its neighbors. Nicaragua prepared early – equipping 19 hospitals to handle severe respiratory illnesses, training all 36,000 health staff in dealing with the virus, maintaining strict health checks at frontiers with supervised quarantine for new arrivals, making house-to-house visits with volunteer health brigades dispensing advice (some five million visits in total), tracing the contacts of the vast majority of known cases, and setting up a free telephone helpline to advise people with symptoms.

What it didn’t do was impose a lockdown, arguing that suffering would be much greater if it did, as the many Nicaraguans who need to work to eat each day wouldn’t have been able to do so. The peak of the pandemic coincided with the planting season: how would the 40 per cent of Nicaraguans in rural areas have survived without new crops? In contrast, the adjoining countries imposed strict lockdowns, provoking demonstrations and causing extreme hardship, dealing with violations by tough fines or even by violent repression (bread sellers in Honduras were shot by police for breaking the lockdown; one died). All of these countries have since been forced to relax their restrictions in part because of the considerable damage caused to people’s livelihoods, even as numbers of cases have continued to grow.

What has happened in Nicaragua is not what was supposed to happen, according to opposition media and the international press. Early on, exaggerated figures from the Citizen’s Observatory were given more credibility by international media than the government’s own figures. For example, when on May 26 the health ministry, MINSA, reported 759 proven cases of COVID-19, the observatory was reporting over 2,600 cases with a further 2,000 as ‘suspicious’, none of them based on testing.

Right-wing NGOs and media channels produced forecasts that were clearly intended to scare people, and regrettably a proportion of Nicaraguans did believe them. For example, a report by the notorious media channel 100% Noticias on April 2 predicted that 23,000 Nicaraguans would die from the virus by early May (in fact by early May there were just six deaths). The BBC carried a report which included a forecast by a local NGO called FUNIDES that by June there would be at least 120,000 virus cases and 650 deaths. In the same report the BBC cast doubt on the Nicaraguan government figures, but it reproduced the obviously exaggerated FUNIDES prediction without questioning it. FUNIDES does not work in the health sector and in 2018 it received over $120,000 from the US-government supported agency, the National Endowment for Democracy, to promote ‘democracy’ in Nicaragua and $253,245 from USAID. These and other rumors and predictions have been collated in a video by Juventud Presidente, ‘Falsas matemáticas sobre el Covid-19 en Nicaragua’.

There have also been numerous articles criticizing the Nicaraguan government for its supposed inaction in the face of Covid-19. One of the most influential appeared in the international medical journal, The Lancet. A letter from 13 health professionals, all based in the USA (except for one in Costa Rica), belittled the Nicaraguan government’s response to the epidemic as ‘careless’ and ‘perhaps the most erratic of any country in the world to date’. It drastically understated the availability of a crucial item of medical equipment – ventilators – because it relied for its information on one of the local opposition media, Confidencial.

Fortunately, the editors of The Lancet were happy to publish a response. This set out some of the steps the government had taken, challenging the original letter-writers to accept that they were wrong in calling Nicaragua’s approach ‘careless’, even if they didn’t agree with it. They then replied, but did not address most of the key points made in contesting their original arguments. They quoted the PAHO as criticizing Nicaragua – but while there was specific disagreement on the advisability of a national ‘lockdown’, the Nicaraguan government has been working closely with the PAHO (part of the World Health Organization) since a joint commission was established to confront the epidemic on January 30, when it was one of the first countries outside Asia to recognize the potential impact of the virus.

Not surprisingly, the international bodies that have constantly criticized the Nicaraguan government used the pandemic to renew their attacks. For example, the Inter-American Commission on Human Rights, in a lengthy missive on May 29, concluded by expressing ‘their concern over the Nicaraguan population’s access to the right to health,’ apparently unaware that Nicaragua has far more free, public hospitals than neighboring Honduras (which has a 50% higher population level), that 19 of these had been built since 2007 when the Sandinistas returned to power, and that Nicaragua spends a bigger proportion of its government budget on health than practically any other country in the Americas. The Inter-American Development Bank recently ranked Nicaragua second in Central America and fourth in all of Latin America in health investment.

Amnesty International, also quoting the Citizens Observatory figures, has used the pandemic to renew its criticisms of Daniel Ortega’s government, this time (in August) focusing on prison conditions. It continues to argue that there are 80 political prisoners in Nicaragua, despite the various amnesties that the government has held, and ignoring the fact that those who have been arrested in recent months (many of whom were previously amnestied in 2019) have committed serious crimes. Certainly the most egregious of these was the murder of two children in Mulukukú; the accused (now arrested and charged) had taken part in the opposition attack on the police station there in June 2018, in which three police officers were killed. While prison conditions in Nicaragua have attracted Amnesty International’s attention, it has ignored the far worse conditions in Honduran prisons where, indeed, there have been many Covid-related deaths, including those of political prisoners such as dissident journalists.

There are some signs that Nicaragua’s success is, at last, gaining some appreciation. The left-wing website, Toward Freedom, ran an overwhelmingly biased article about Nicaragua’s approach to the pandemic in June, Coronavirus met with denial and silence in Nicaragua. But they are now apparently having second thoughts (despite rejecting a response jointly written by the late, great Kevin Zeese, which instead was published in Popular Resistance). The website New Humanitarian published a similarly biased piece, using largely opposition sources, in September. It has now agreed to take a second look at the issue.

Most encouragingly, a health worker in the UK, Rita Drobner, a biomedical scientist in a London hospital, says that the correspondence in The Lancet, including the detailed response to the criticisms from the doctors in the US, has been important in dealing with unfounded criticisms of Nicaragua in the UK. Her view is that The Lancet was in error to publish a piece that was ‘so scientifically light-weight and unsubstantiated’ but that now there has been some public discussion in a prominent place, ‘where the arguments of a poor country mounting a measured and responsible public health campaign come out stronger and clearer.’

It can only be a matter of time before Nicaragua’s effective response to the pandemic is recognized by the corporate media, especially as it is in such contrast to the experience of most other Latin American countries, and of course that of the US and the UK. In the meantime, opinion polls show that Nicaraguans’ trust in their health service, undoubtedly affected by the opposition propaganda campaign earlier in the year, has recovered substantially. It is also clear that Nicaragua is resuming its economic recovery, after the severe damage cause by the 2018 attempted coup, again despite the opposition’s forecasts of impending economic disaster.

(John Perry lives in Masaya, Nicaragua and writes about Central America for The Nation, Counterpunch and Council on Hemispheric Affairs.)

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Nicaragua, the Country that Didn’t Swallow the Covid Blue Pill

Jorge Capelán

No curfews, no lockdowns, no “stay at home”, no psychosis, no covid-calamities. There has been much talk about the Swedish corona strategy but the strategy of Nicaragua has been by far more successful, with many fewer deaths, no “economic rescue” for big banks and only limited damage to small and medium sized businesses.

In the midst of the worldwide economic debacle caused by covid hysteria, food self-sufficient, small business based, impoverished Nicaragua, has seen its exports grow over 10% the past 8 months because it did not shut down its economy. Precisely because it sustained its economy, it has not had to take on huge loans in order to face the emergency. Thus, its foreign debt levels remain within a readily manageable range, below 50% of GDP. (On the other hand, the economies of neighboring countries such as Costa Rica, El Salvador, Honduras and Guatemala, are hurting badly with debt levels soaring).

I went out on Sunday afternoon in the barrio where I live in Managua. Bars full of people, even small family-run restaurants full of guests. No masks. The local convenience store which still has the “only-masked-customers-allowed” sign hanging from the door no longer refuses to let maskless people in.

There is no mask-wearing official policy in Nicaragua except for a recomendation that only patients with respiratory conditions or personnel taking care of them should wear masks. The wearing of surgical gloves by patients, on the other hand, is strongly discouraged as it poses a serious risk of contagion both of coronavirus and other respiratory deseases. In hospitals and health care units most people wear masks, be it out of precaution or out of plain courtesy. Otherwise, in offices and shops handwashing and alcohol hand sanitizers are readily available practically everywhere.

No restrictions have been put in place for public meetings and sports championships such as the popular local baseball league have taken place without problems, as well as scores of local fairs and other traditional activities that take place weekly.

Few massive activities have been cancelled due to covid, especially Catholic Church processions, most notably the traditional 10-day-long celebrations of Saint Dominic in Managua, for which thousands of people gather every year. For the most part, people have moved around, going out or heading to the beach as normal. Over the last 3 weeks, an all-time record number of over 83 thousand people visited the Salvador Allende Port and its lakeside promenade – a big and popular public leisure complex in Managua–, according to the authorities.

Schools haven’t closed down, which is very good for the country’s school children, since they provide a nutritious meal a day to 1.2 million children, a food security measure contributing greatly to improved public health for families across Nicaragua.

Yet, with just 2-3 covid-19 deaths per week the last couple of weeks (147 in total as of September 22nd), Nicaragua is by far the least affected country in Central America. Belice has only 19 deaths so far, but on the other hand, its population is a fraction of Nicaragua’s.

As in Germany and other countries, Nicaragua’s Health Ministery does differentiate between deaths of patients “with covid” and “from covid”. That is, a person can be with covid-19 but in the last instance die from an acute heart attack, while someone else who also has covid-19 can die “from covid-19” because of an upper lung condition typical of viruses that cause Severe Acute Respiratory Syndrome (SARS), such as SARS-CoV-2. That is the official explanation given by the authorities in a white paper on Nicaragua’s public health response to the pandemic issued last May.

Athough increased mortality due to pneumonia has been noticed (last week, 26% fewer pneumonia cases were reported, but with an increase of 8% in deaths – related but not directly caused by covid), the situation in the hospitals, health care centers, funeral parlours and graveyards is totally normal. No collapse anywhere.

By the end of April and the beginning of May, when the majority of covid deaths were reported, many people lost acquaintances, relatives or friends with comorbidities, but not even back then did the situation reach the kinds of scenes taking place in other countries. The health system never came even close to saturation point at any time.

In the Western press Nicaragua has been portrayed as a country that “did nothing” to divert the pandemic, which is totally false. Very early on, on January 21st, while the wealthy countries of North America and Europe dallied, Nicaragua declared a national epidemiological alert. That was the day after the Chinese authorities reported that country’s third death from covid-19. Some weeks later, Nicaragua’s national covid response committee elaborated a detailed protocol based on strenghtening the public health system and informing the population on a mass scale.

The strategy followed by the Nicaraguan Government was based on informing the population, taking care of the elderly and frail and strengthening the public health system, specially via enhanced control of the many diseases already threatening the population such as zika, dengue, malaria and chikungunya. The ordinary public health campaigns never stopped, with fumigation of areas with high prevalence of mosquitoes as well as routine annual vaccination programmes for children and the elderly.

The population was recommended to intensify hygiene routines and those in the high-risk groups were recommended to avoid crowds. Every institution devised plans and protocols to meet the covid emergency and in industrial complexes such as the free trade zones plans were agreed between employers and the workers’ unions in order to ensure that any eventual interruptions to production would not leave working families without an income (luckily, as it turned out, for the most part production was not very seriously affected by the pandemic).

The Ministry of Health from the very beginning has provided epidemiological surveillance for people affected by epidemic diseases typical for the time of year: dengue, malaria (both vivax and falciparum), chikungunya, zika, pneumonia, tuberculosis, H1-N1, leptospirosis, chagas disease, as well ensuring care for chronic diseases, for example cancer treatment, renal dialysis or cardiology conditions.

People with respiratory problems, cough and flu, are being given special attention and follow-up, to determine if they need further monitoring depending on their corresponding chronic condition: diabetes mellitus, chronic kidney disease, stroke, hypertensive disease, chronic obstructive pulmonary disease, pneumonia, among others.

A very successful initiative now being implemented is the program “My Hospital My Community” by which all public hospitals mobilize their specialized health care units out into their respective communities in order to actively reach out to people with various chronic conditions who for various reasons may have difficulties going to their local hospital –among them persons who are afraid of getting covid-19 if they go to a hospital.

As mentioned earlier, schools and universities have remained open because on-line distance learning is not an option for people on low incomes. However, because some parents were reluctant to send their children to school a specially designed series of television classes on all subjects have been produced and broadcast both on public television channels and on radio so that children could make good any classes they may have missed.

Facing the recurring risk of volcano eruptions, earthquakes, hurricanes as well as all the various kinds of tropical diseases, countries such as Nicaragua very much need to develop a routine system for early warning and management of emergencies, simply because those events are part of our everyday reality.

Nicaragua is among the countries most threatened by global warming and has been able to deal simply and readily with covid because since 2007 it has developed an integral civil defence and public health philosophy based on broad popular participation, a highly operational public sector and a system trained and ready to articulate cohesively all the available resources.

Whether addressing natural disasters or national public health challenges, Nicaragua over the years has built up an unrivalled organizational infrastructure that quickly mobilizes thousands of volunteer activists and public sector employees. So covid didn’t take the country unawares.

During the past 13 years Nicaragua has experienced dramatic advances. Back in 2006, before the Sandinistas returned to power, overall poverty was 48%. Today it is 24.6%. 54% of people had no electricity. Today, 98.5% have it. 70% didn’t have running water. Today 93% have it. Infant mortality was 29 per 1000 infants born. Today it is down to 12 per 1000 – a reduction of over 60%. Almost 9 out of 10 births now take place in health centers while before most children were delivered at home. In 2006 the country had 2044km of roads (only 30% in good condition). In 2019 the paved road network was 4590km (all in good repair). The economy grew from USD 6.7bn to 12.5bn in this period.

Amidst this development in a region cursed by neoliberalism, public health has played a central role in Sandinista policies. From the outset, privatization of health care was stopped and rolled back. A new, community and family-based preventive health model was developed using sector based territorial health areas grouping together communities of between 600 to 1,000 families, equivalent to 3,000 to 5,000 inhabitants, depending on whether the sector is rural or urban.

In each of these territories, so-called “cabinets for the family, community and life” have been organized incorporating socially-engaged members of society who effectively monitor the local health situation and are able to address not only sanitary and medical issues, but also the social aspects of public health, of particular importance.

For example, the program “Todos con Voz” (“Everyone with a Voice”) assesses the overall situation of each person with disability in a household and assists, not only with wheelchairs or therapies, but also with economic support and training in order to improve the economic activity available to the whole household. The program “Amor para los más chiquitos” (“Love for the littlest ones”) promotes better care in the family for very young children. Other programs are aimed at helping poor families with children in school age so that they don’t have to send their children to work and so on.

Public health investment has also seen a dramatic increase from USD 32 to USD 70 per capita (2018). Total health care expenditure went from USD 111.9 million to USD468.6 million in 2020. In 2006 there were 22,083 health workers; in 2020, there are 36,649, including doctors, nurses and technicians, many of them educated in Cuba and other countries.

The Sandinista government has built 18 new hospitals and there are plans to build 15 more, 6 of which are already under construction. The total health infrastructure of the country comprises 143 health centers; 1,333 medical posts; 178 maternity homes and 66 mobile clinics – way ahead per population of its Central American neighbors.

All this investment has a strong technological component as it shortens hospitalization periods, in many cases is much safer and makes more rational use of available health personnel. Among recent hi-tech investments are two linear accelerators to treat cancer (one of them has already been set in place, one is about to be installed) and the widespread use of laparoscopic surgeries and other modern techniques.

Recently, a molecular biology lab was inaugurated capable of analyzing evidence of several diseases, including COVID-19. This lab is the second most advanced in the region and has been recognized by the WHO as having Level 3 Biosafety.

Also, the Russian Mechnikov medicine factory was inaugurated, which can produce 12 million influenza vaccines per year. The Cuban drug Interferon Alpha-2B (successfully used to treat patients with COVID-19) is expected to be produced in this lab as well as the Russian Covid vaccine.

All this high-tech investment does not exclude the widespread use of traditional or natural medicine. A public health sector “Pain clinic” has been built to give treatment in acupuncture and many other traditional therapies, and specialists in those treatments are available in many health care facilities all over the country.

Nicaragua is a country where 80% of farmland holdings are under 875 acres, worked by small and medium sized producers. It is a country where small-scale family businesses drive the economy, controlling over 60% of disposable income, providing around 80% of the country’s employment and producing 90% of all the food it consumes. So while it simply cannot afford to “lock down” or “stay home”, conversely it didn’t need to take “extraordinary measures” to face the covid emergency because it already had an immensely resilient system designed and in permanent readiness to face any and every kind of emergency.

For Nicaragua, the “blue pill” of lockdown or “stay at home” would have been pure cyanide, and since its leadership long ago took the red pill, it was able to discern the true interests behind the phony rich-country pandemic discourse and its hidden “great re-set” agenda.

(Jorge Capelan is a Nicaraguan journalist.)