Epidemiologists in Nicaragua: “Signs of Community Transmission”

Several people keep the social distance as a preventive measure against coronavirus, on Saturday April 25, during a boxing evening organized by Bufalo Boxing Promotions, in Managua (Nicaragua).  Photo: EFE / Jorge Torres

Although the Government denies it, independent doctors maintain that the country has already entered the phase of local transmission of Covid-19

By Keyling T. Romero (Confidencial)

HAVANA TIMES – The outbreak of a pandemic contagion in Chinandega, which reportedly left several dead and infected medical personnel in that western Nicaraguan city, and the growing report of suspected cases of Covid-19 in various departments, confirms that the country is in phase four of the pandemic: the community transmission of Covid-19, alert doctors and independent specialists. 

Meanwhile, the Ortega government and its Ministry of Health continue to deny that there is this type of transmission in increasingly brief and confusing reports, which are widely questioned.

“The most important thing to say about this is, and it’s not to generate alarm, but for people to know that we do not know who may be infected and that means that we have to take extra preventive measures. Everyone is a potential carrier,” warned the Nicaraguan epidemiologist, Rafael Amador.

The community transmission phase of Covid-19, according to the World Health Organization (WHO), means that the health authorities can no longer identify the patient’s epidemiological link. This occurs, for example, when a confirmed person with Covid-19 has not traveled outside the country, has not had contact with any imported case, nor with any “non-imported” or “secondary” cases.

Despite the fact that the MINSA insists that there are no cases of community transmission of Covid-19 in Nicaragua, a massive testing has not been started to confirm this, and this has prevented the analysis of the actual behavior of the virus.

The contradictions and silences of the Government

This Tuesday, May 5, after more than 24 hours of state silence on the status of the Covid-19 pandemic in Nicaragua, the MINSA added a positive case and four suspected cases in its official report, without detailing the origin or any other data from the new confirmed case. [It did not make a report on May 6 or 7.]

Despite the increasingly scarce official information on the progress of the pandemic in Nicaragua, MINSA maintains that there is no “local community transmission,” while reports of suspected or “undetermined” cases continue to increase.

Since April 26, MINSA had maintained that there were only three active cases of Covid-19 in the entire country. On May 2, it added that one was “frail and cared for” and two were “delicate, but stable.” On May 5 added another “frail and cared for,” but did not provide any details about it. In total, the Government has only recognized 16 positive cases, among which there are 14 men and one woman, between 33 and 76 years of age.

In addition, more than 170 people have been hospitalized as suspected Covid-19, although according to MINSA only 16 remain under observation as of this Tuesday.

On Monday, May 4, it was also noted that while the number of reports of suspected cases of Covid-19 cases in different parts of Nicaragua increases, MINSA did not provide any information related to the disease, nor did the government spokesperson and Vice President Rosario Murillo, in her daily monologue, mention the pandemic.

In parallel, the Government of El Salvador, which reported its first positive Covid-19 case just a few minutes later than Nicaragua, exceeds 500 Covid-19 infections and, since April 27, President Nayib Bukele, announced to its citizens that El Salvador was already in the “phase of total local community transmission.”

Ortega Government tries to hold on to the “imported phase”

Public Health specialists and epidemiologists believe Nicaragua is in the 4th stage of transmission of Covid-19, according to WHO guidelines. Photo: Carlos Herrera | Confidencial

“In complete diagnostic blindness and without interest in identifying new cases of Covid-19, the Ortega-Murillo government seems to be anchored to the initial phase of the pandemic, that is, the phase of imported coronavirus,” warns the molecular biology and biochemistry doctor, Jorge Huete, in an academic essay published by the Nicaraguan Academy of Science.

“In reality—assesses doctor Huete—the situation of the disease in Nicaragua surely resembles that of the other Central American nations.”

Of the officially registered positive cases, the first seven were “imported” from Panama, Colombia and the United States, while the Government refused to close the borders or suspend commercial flights. In two of these imported cases, the origin of the infection was not specified.

The government confirmed the first positive case “non-imported” on April 10, when it reported the eighth infection: a 64-year-old man, who died eight days later.

From that date until May 5, the MINSA reported: two more cases “non-imported” and three in “contact with other nationalities” not specified.

Furthermore, in the last four cases admitted since April 27, the Government has not clarified the origin of the contagion.

The government also has recognized five deaths from Covid-19, but medical and family sources have confirmed three other deaths that the authorities have chosen to ignore.

The phases of Covid-19: What is community transmission?

According to the WHO, the Covid-19 pandemic has four phases of transmission. The first is the “absence of cases” which is when the country is waiting for possible infections; the second is the “sporadic cases,” which occurs when the first citizens who became infected in some country with Covid-19 begins to be identified.

Then follows the phase of “conglomerate of cases,” which is confirmed when imported and “non-imported” cases have been detected in the country, also known as secondary, local or autochthonous. This last definition can change, but it means that there are people who became infected by having direct contact with the confirmed cases and later spread the virus to other people nearby. Nicaragua is officially in this phase, although the government does not specify it in its communiques.

The last phase of community transmission of Covid-19 and, unlike the previous phase, infection chains cannot be detected, in other words, how the person was infected is unknown. And, in addition, broader outbreaks of Covid-19 are reported, and countries are beginning to register an increase in cases that lead to the dreaded curve that has collapsed the health systems of various countries, including some of the most developed ones.

“That is what we are seeing now,” says the infectious disease doctor, Carlos Quant.

“Many patients come from a neighborhood X, they bring a well-defined symptomatology and when one looks for the chain of contagion, there is no link. So, when there are already several cases of those that do not have a link, it is called community transmission,” he explains.

What happens when community transmission is detected?

Experts agree that the important thing to know what phase of the pandemic the country is in, is to be able to make the decisions that would help contain or slow down the spread of Covid-19, because failure to do so would cause a rapid collapse of the health system.

“The final objective is to reduce the rate of infections, to slow down the curve so that the health system does not saturate because we are not going to have the capacity to care for all the population of patients. And then you are going to find a great mortality rate, because if three seriously ill patients arrive and we only have two ventilators, one of them will be left out,” warns Quant.

In Nicaragua, it is estimated that there is a total capacity of less than 6,000 hospital beds and, although the government has only said that there are enough ventilators—a report by Confidencial reveals that the country has only about 160 ventilators, of which 80% are occupied by patients with other pathologies.

Massive testing and preventive measures are urgent

To prevent the growth of the pandemic, the government must take extreme measures at the nationwide level, starting with the massive application of Covid-19 tests to identify the sources of transmission, promoting isolation, the use of masks and decree a quarantine, as has happened in other countries after confirming community transmission of Covid-19. Such is the case of Mexico, where the Government of Andres Manuel Lopez Obrador first tried to minimize the pandemic, or that of Panama, the country in the Central American region hardest hit by the pandemic.

“It is true,” says doctor Huete, “that due to negligence and wrong decisions they neglected the exceptional opportunity that they had to test before. However, the government must notably increase sampling and the numbers of tests in Nicaragua. With ten thousand tests per week, in a matter of two or three weeks, the true dimension of Covid-19 in the country could be known with rigor,” he estimates.

However, he warns that this measure would force the government to decentralize the diagnosis of Covid-19, training personnel from other hospitals and centers on the detection of the virus; applying the tests to other sectors of the population, for example, patients with acute respiratory syndrome; or calling private hospitals, medical laboratories and clinics to purchase rapid diagnostic kits and inviting molecular biology laboratories at universities to do screening work.

Observatory: more than 600 suspected cases of Covid-19

The latest report from the Covid-19 Citizen Observatory, which independently monitors the progress of the pandemic based on citizen complaints, reports that by May 4, in Nicaragua there are 632 cases suspected of having the new coronavirus, including in that list those confirmed by the MINSA.

In addition, they mention that they have received information on deceased people allegedly from this virus in Managua, Matagalpa, Leon and Chinandega.

“We at the Observatory have more than 400 cases at the national level, and the epidemiological link has not been established for them either. So, we don’t know who is infecting whom. For this reason, contingency actions must be taken, which in the end is what the definition of phase one, two, three or four is for,” points out epidemiologist Rafael Amador.

To the scarce state information on the pandemic, another official contradiction was recently added: since last week, the government, which insists on minimizing the pandemic, has ordered some preventive measures such as the sanitation of public transport vehicles (including buses and taxis), markets, schools and churches. However, President Daniel Ortega himself has ruled out establishing a quarantine in Nicaragua as a preventive measure against Covid-19.