Pronouncement from Health Professionals in the face of the COVID-19 Pandemic in Nicaragua

The following pronouncement appeared as a paid advertisement in the Saturday, May 9, 2020 edition of La Prensa. The next day, six former Nicaraguan Ministers of Health sent a joint letter to the WHO and the PAHO warning about the lack of response on the part of the government to the pandemic; and COSEP issued a statement in support of this pronouncement of Health Care professionals. In addition, the Nicaraguan Medical Association reports 60 confirmed COVID-19 cases among health care professionals, and have denounced this past week that fact that several doctors were fired for reporting on infected cases in state hospitals. It has been five days since the government has released statistics on the incidence of coronavirus in the country.

[Spanish version]

This past March 11, 2020 the World Health Organization (WHO) declared that the outbreak of a new Coronavirus (SARS-CoV-2), started in Wuhan, China in November 2019, had become a global pandemic. As a consequence of this outbreak, the WHO advised the implementation of national contention and mitigation plans for the epidemic, for the purpose of attaining its control. The lessons learned in China, the European countries and America have taught us that the late implementation of these recommendations has given rise to the collapse of health systems in many countries, with the subsequent rise in the mortality rate and enormous social and economic impact.

We health care professionals, in the face of the expectation that the Nicaraguan government would follow the guidelines of the WHO – like the rest of the Latin American countries – placing priority on the common health and wellbeing of the people, at the expense of great economic sacrifices, still hoped that the health authorities would develop and implement a national plan with basic measures of preparation in the face of the imminent threat of SARS-CoV-2, such as:

Contention Measures, through:
Identifying location, follow up and isolation of cases and contacts of COVID-19
Appropriate sampling of the population for the identification of suspected cases.
Partial or complete closure of land and air borders.
Training, preparation and supply of appropriate means for all the health personnel for self- protection, and adequate treatment in private as well as public health unit.
Development of treatment and case management protocols for cases diagnosed with COVID-19.
Increase in the perception of risk and education of the most vulnerable populations in the country, like the elderly, people with multiple comorbidities, and immune-compromised patients.

Mitigation measures, like:

Physical distancing, restriction on mobility and mass concentrations, as well as quarantine and isolation of affected populations.
Hygienic-sanitary measures, like frequent hand washing.
Use of masks for the general population in places where people congregate with the risk of transmission of the infection.

Transparency of information and communications, with clear, brief and precise messages to the general population

Nevertheless, instead of complying with the recommended measures, the Nicaragua Government has promoted mass activities (like the March of Love in Times of COVID, Summer Plan, boxing tournaments, baseball games, Mayo ya welcome parties, etc.), its educational campaign has been extraordinarily timid, with the aggravating factor of exposing health professionals to the risk of infection, with the modalities which have not demonstrated any effectiveness, like the so called house to house visits. Nor have they adequately equipped health units, and health workers lack the basic protective measures to treat the sick population with minimal risk. On the contrary, the use of masks has been discouraged and restricted, and in some cases even prohibited, jeopardizing the health of health care workers.

Likewise, confusing information has been generated on people affected by the infection. This type of communication has created disinformation among the population, blocking the responsible management of the health crisis, becoming instead a factor facilitating the spread of the infection.

For its part, the sampling of suspected cases is extremely insufficient to detect the progression or development of the infection, it is found to be centralized and done under arbitrary and capricious criteria, which pursues the concealment of the status of the epidemic.

It is important to highlight that SICA in their report No. 16 on April 3, 2020, said the following:

“Nicaragua received today the donation of US$1 million on the part of the Republic of China (Taiwan) to face the COVID-19 pandemic, in the framework of the Regional Contingency Plan of SICA: Thanks to this solidarity support, medical inputs and equipment will be increased to treat patients affected by the virus in Nicaragua.”

In the table that summarizes the measures implemented in each one of the country members of SICA, Nicaragua, in contrast to the rest of the countries, did not suspend classes in public and private institutions, nor did it restrict the entry of foreigners into national territory, and did not confirm whether it implemented telecommuting as a measure for the prevention of contagion.

For its part, the Central American Bank for Economic Integration (CABEI) in the first week of April delivered to Nicaragua 26,000 rapid tests for the diagnosis of COVID-19, and in contrast to the rest of the country members of SICA, Nicaragua has not reported on the plan for distribution and testing in the country.

Also the Assistant Director of the Pan-american Health Organization (PAHO), Jarbas Barbosa da Silva, this past April 24, stated that they “cannot do an evaluation” of the situation of the pandemic in Nicaragua, and reiterated that “in Nicaragua the situation is still undetermined”, in other words, data does not exist on “what the situation of the pandemic is at this time.”

We think that as Nicaraguan citizens we have the right to receive quality holistic health care, without discrimination, and it is the inherent obligation of the state to ensure it. In addition to health care being a Constitutional Right, it is a Human Right, and it is the non-transferable responsibility of the State of Nicaragua to ensure this right.

Therefore, we health care professionals, demand and insist that the government of Nicaragua, in the face of the scenario of the natural evolution of this pandemic:

Free up massive testing at the public as well as private levels. Doing universal sampling is fundamental to be able to mitigate the epidemic, and reduce its impact on mortality and the health services of the state and the nation.
Make the pertinent data transparent on the evolution of the epidemic in accordance with international epidemiological standards, using technical and clear language.
Publicly establish their contingency plan in the face of this public health emergency, and immediately implement social distancing measures and the restriction of mass gatherings, as well as the isolation and quarantine of those who merit it.
Ensure adequate protective measures for all health care personnel of public treatment services.
Ensure sufficient existence of diagnostic means, medicines and life support systems (like ventilators) to all COVD-19 patients who need it.
Ensure – like the rest of the SICA countries – policies of reduction or cushioning of damage on the social-economic level (freezing rates for water, light, value added taxes and bank debts, support funds, etc.) that would allow for relief in the face of the health crisis for health care workers and the citizenry in general, as well as ensure the effectiveness of human rights for the most vulnerable part of the population.

In spite of the negligent management of the COVID-19 pandemic in our country, and that economic stability has taken primacy over health care and the common good of the Nicaraguan people, we think that – in the moment of the beginning of the rise in the curve of serious cases – it is still possible to carry out mitigation actions that might reduce the catastrophic impact on the rate of lethality and the health care system.

We acknowledge the health care personnel who – in this health crisis – continue offering treatment to the population without the needed protective resources.

TO THE GENERAL POPULATION, WE URGE YOU TO STAY AT HOME, FOLLOWING ALL THE PERSONAL PROTECTION MEASURES!

Sincerely,

[540 signatures from Health Care professionals, General Practitioners, Specialists, Sub-specialists, Odontologists, Bio-analysis Clinics, Psychologists and Nutritionists].