Source: Council on Hemispheric Affairs – Analysis-Reportage
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By John Perry
From Masaya, Nicaragua
Every country in the world is trying to balance its fight against the virus with the need to have a functioning economy, and there is plenty of debate about what the balance should be. The world’s poorer countries face the toughest challenge, because a high proportion of their populations engage in a daily struggle to earn enough to eat, whether in small businesses or the informal economy. In Nicaragua, around 80% of people make their living in this way.[1]
But there are two more problems uniquely affecting Nicaragua in tackling the pandemic. One is that its economy and social life had already been attacked only two years ago when a right-wing coup attempt closed much of the country down for nearly three months. Although the economy is recovering, it is inevitably weaker than it was prior to April 2018. Moreover, continuing US sanctions deprive Nicaragua of help towards its anti-poverty programs and also block much of the assistance other Central American countries are able to access, including medical supplies.
The second problem is that the opposition, thwarted in their coup attempt, have seized the COVID-19 epidemic as a new weapon with which to attack the government. Whereas in the US and Europe opposition political parties have generally combined criticism of their political rivals with overall support for their country’s efforts to defeat the epidemic, the Nicaraguan opposition has been not simply negative but contemptuous. Opposition spokespeople have poured scorn on the government’s efforts and encouraged the international media to accuse it of negligence or even that it is in denial about the epidemic.[2] Worse still, they have deliberately sown fear and suspicion among the Nicaraguan population, so that many people are not only scared of the virus but even of using the public health services that are there to help protect them from its effects.
This is the background to an unusual step taken by Nicaragua’s Sandinista government on May 25: it published a 75-page “white paper” describing its strategy to tackle COVID-19. Much of the strategy was already in place as early as January this year, but in the paper the different elements are set down clearly and the reasons for taking them are explained in detail.
The strategy to tackle COVID-19
Government recognition of the importance of confronting the virus was made clear at a press conference in mid-January, two months before Nicaragua even detected its first virus case, which was a passenger arriving at the international airport. Then on January 31, a day after the World Health Organization (WHO) declared a “public health emergency”, Nicaragua created a special commission to deal with the virus threat. By February 9 it had issued a joint protocol with the Pan-American Health Organization (the Americas branch of the WHO), setting out its strategy. At this early stage of the crisis, few countries outside Asia had done anything similar.
Nicaragua: progresive social policies and outcomes
Importantly, the White Paper makes clear that the real work had started a decade earlier. Since 2007 when the current Sandinista government took office, it has been making significant investments in the public health service, increasing the number of doctors from 2,715 to 6,045, building 18 new hospitals, opening dozens of new health centers and creating new vaccination programs. By 2018, Nicaragua was spending 21% of its government budget on health, one of the highest proportions among less-developed countries.[3] Compared with 2006, infant mortality in 2019 had fallen by more than half; deaths in childbirth had fallen from 92.8 for every 1,000 live births to 29.9 over the same time period.[4]
Given this base, the government’s strategy to fight COVID-19 enabled it to designate 19 hospitals as specialist centers to receive patients; one, the Hospital Alemán Nicaragüense in Managua, has been dedicated entirely to dealing with respiratory infections during the outbreak. Among other resources, at the start of the crisis these hospitals counted with 562 intensive care beds and 449 ventilators (this last was similar to Costa Rica’s 450 ventilators, whereas neighboring Honduras and El Salvador had fewer than 200 each, for bigger populations).[5]
Strong public measures against the virus
The government also set about strengthening the defenses against the epidemic within the community. It intensified its vaccination program, so as to reduce the level of other respiratory diseases such as influenza and pneumonia that would make the fight against COVID-19 more difficult by using similar health resources. It trained 158,000 health brigadistas who have now carried out more than 4.6 million house-to-house visits, dispensing advice about the virus. It set up a free telephone helpline, which in its first month’s operation had 110,000 callers.[6] Schools, buses and markets are being regularly disinfected. Public buildings have safeguards to limit transmission of the virus and there has been general public education both through the brigadista visits and through the media.
A key part of the strategy has been to train the 9,000 people operating at the 19 points of entry to the country in dealing with visitors during the crisis. This has enabled some 42,000 travellers arriving in Nicaragua to be asked to self-isolate for 21 days, during which they receive follow-up visits and phone calls from officials to monitor their state of health and detect possible new cases of transmission.[7] Internationally, many countries set up such systems much later than Nicaragua and, in the UK for example, so-called “track and trace” arrangements will not be in place until later in June. The Nicaraguan government deliberately did not close its borders as it wanted returning travellers to use official crossing points, and it deployed the army to track down the many people who have made unofficial crossings, evading health controls.
Conservative NGO’s financed by the US make up data about COVID-19
As the White Paper concedes, there have been many criticisms of Nicaragua’s approach. These have far exceeded what the country should reasonably expect, given that it intensified its preparations as soon as the global emergency was officially recognised in January and kept the numbers of cases to double figures until early May. The reason for the heavy criticism is, of course, political.
One example is the way the official reports of numbers of cases and numbers of deaths are challenged on a daily basis. This is not simply a matter of questioning the accuracy of official figures, but an attempt to completely deny their legitimacy. A so-called “Citizens’ Observatory” has been set up, consisting of anonymous “experts,” who create their own figures which come from “civil society, networks, digital activists and affected families” and are “verified by the citizenry.” These are carried in official-looking twice-weekly reports, which say in small print that they are not government publications but which are treated by much of the media, including the international press, as if they have more credibility than official sources.[8] France 24 describes the body as “a prominent Nicaraguan NGO” even though it has no registered status and has only existed for a few weeks.[9]
Since it started in March it has produced vastly inflated 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.” Right-wing NGOs and media channels have produced even worse forecasts. A report by the notorious media channel 100% Noticias on April 2 predicted that 23,000 Nicaraguans would have died from the virus by early May.[10] The BBC carried a report which included a forecast by local NGO Funides that by June there would be at least 120,000 virus cases and 650 deaths. While the BBC cast doubt on the Nicaraguan government figures, it reproduced the Funides figures without questioning them.[11] 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.[12]
Other unfounded criticisms regarding Nicaragua’s pandemic situation
Another criticism has been to challenge Nicaragua’s approach of keeping the economy and daily life moving and not requiring the kinds of “lockdown” that have taken place in neighbouring countries and to varying degrees in the US and Europe. Ignoring the obvious need for a balanced judgment to be made that aims to avoid what the White Paper calls an economic “catastrophe,” critics have implied the need for more drastic measures without explaining how the majority of ordinary Nicaraguans will make a living if these are put into practice. The experience of adjoining countries’ lockdown strategies has been extremely mixed, as COHA has already shown.[13]
In recent weeks, criticisms of the lockdown measures in adjoining El Salvador[14] and Honduras have intensified.[15] While Costa Rica’s lockdown policy appears to have been more successful, it has come at the cost of severely affecting relations with every other Central American country, when it shut down its borders to commercial traffic giving no notice and causing both enormous queues and considerable economic hardship.[16] From nearby Colombia, The Guardian reports that “that strict quarantine measures have done little to flatten the curve [of numbers of virus cases],” even while the same newspaper repeatedly criticizes Nicaragua’s failure to adopt a lockdown policy.[17]
Proponents of lockdown for poor countries such as Nicaragua have also ignored the many criticisms of such policies. For example, the eminent epidemiologist Professor Sunetra Gupta, of Oxford University, describes lockdown as a “luxury” only available to the middle classes in developed economies.[18] Many other experts agree with this view, as do international NGOs such as Oxfam.[19]
But the worst attacks have been to accuse the government either of gross negligence, of having no strategy to confront the epidemic or even of deliberately wanting people to die. These have been detailed and sophisticated. For example, the government is alleged to be opposed to using facemasks, though in fact, it has been promoting their use. “Reliable sources” assert that hospitals are full, and incapable of helping prospective patients. False allegations have been made that victims of the virus are being secretly buried in communal graves (illustrated with photographs shown to have been taken in Ecuador).[20]
Inevitably, as COHA reported on April 17,[21] these criticisms have been picked up and amplified by the international media. If anything, their coverage is even worse now than it was in early April. According to the BBC on April 20, for example, the Nicaraguan government “ignored messages from public health experts.”[22] In the UK, The Guardian has three times compared President Ortega with the right-wing President Bolsonaro in Brazil (who has cynically dismissed the seriousness of the virus), most recently on May 10.[23]
Propaganda that puts people in danger
The propaganda of course does have an important effect on international opinion about Nicaragua and – perhaps to a lesser extent – on opinion in Nicaragua itself. More importantly, however, it is clear that the aim of producing fear and even panic about the epidemic has partly succeeded, as it is confirmed by the experience of the Jubilee House Community in Ciudad Sandino.
Jubilee House’s Coordinator, Becca Mohally Renk, says that their staff have direct experience of the impact of the opposition propaganda on patients who come to the community run clinic. They have spoken with people whose family members have COVID-19 symptoms, and many are not only afraid to take them to an official MINSA (Health Ministry) clinic, they even fear calling the government’s special hotline number to report the case. They have been told that MINSA doesn’t have tests and isn’t really attending patients, so they don’t see a lot of point in bothering to report their case. But they’ve also heard that MINSA will come and take away their family member and they won’t see them again. With so many fake stories of secret burials and false accounts of MINSA hiding bodies and losing bodies, people don’t want to go to the hospital.
So, as a direct result of the propaganda, some people are effectively hiding cases from MINSA and making contact tracing impossible, possibly putting themselves and family members who are infected with COVID-19 in danger if they worsen suddenly and don’t go to the hospital in time out of fear. In Masaya, this author knows personally of a death which might have been avoided if the victim had gone to MINSA. Interviews with satisfied patients leaving the Masaya hospital after recovering from the virus, posted on social media locally, may to some extent help to counteract these false rumors.
The opposition’s response to the White Paper
Will the opposition give up its negative campaign now that it is even clearer than before what the government’s strategy is about? Of course not. It has already dismissed the white paper as “a confession of the enormous error which the government committed” in its approach to the epidemic.[24] It accuses the government of putting Nicaraguans at risk by promoting the theory of “herd immunity,” when this term (inmunidad del rebaño in Spanish) does not appear in the document. It criticizes the White Paper’s citing of experience in Sweden, yet the available data show that Sweden’s avoidance of a lockdown has in most respects resulted in a better response to the epidemic than those in the US, UK, Spain or Italy.[25]
What does the opposition advocate instead? Spokespeople such as Carlos Tünnermann, coordinator of the opposition Civic Alliance (described by news agency EFE as “one of Nicaragua’s most prestigious intellectuals”),[26] stop short of actually calling for a lockdown yet imply strongly that one is needed. Why do they want one? It may be because it would recommence the destruction of Nicaragua’s economy that they attempted in 2018, and also erode popular support for Daniel Ortega’s government. Why do they not actively call for a lockdown themselves? It may be because they can see the reality of its disastrous effects in El Salvador and Honduras, and they know full well that some of their key political allies in the United States want lockdowns to be rescinded as soon as possible.
The authorities’ efforts are being complemented by the behaviour of the great majority of people and businesses in Nicaragua who are following the Health Ministry recommendations. In general, people are actually doing more to protect themselves, as well as workers and customers, by wearing masks, ensuring they keep physical distance and applying systematic hygiene measures. As a result of this combined national effort against the virus, the white paper is able to show that, so far, mortality in Nicaragua is very clearly remaining at levels below those of the previous five years.
Overall mortality in Nicaragua for January 1st to May 15th each year, 2015-2020 [27]
The outlook
For the moment it seems clear that Nicaragua is now well into the phase of community transmission of the virus. At this point trying to estimate the number of cases precisely is impossible because, as a WHO report indicates, data through March 2020 suggests “80% of infections are mild or asymptomatic.” [28]Nicaragua’s health authorities are focused on identifying patients with symptoms and ensuring they get the treatment they need while also monitoring those patients’ contacts and ensuring they isolate appropriately, a task made vastly more difficult by the opposition’s propaganda.
Nevertheless, the authorities’ efforts are being complemented by the great majority of people and businesses in Nicaragua following the Health Ministry recommendations. In general, Nicaraguans are actually doing more to protect themselves, as well as workers and customers, by wearing masks and ensuring they keep physical distance and applying systematic hygiene measures. As a result of this combined national effort against the virus, overall mortality in Nicaragua has – so far – very clearly remained at levels below those of the previous five years (see chart). Of course, the system now begins to face a huge test and the next 2-3 months are expected to be crucial.
[Credit Photo: “Members of the 300-strong sanitation squad who work for the Managua city council”, from https://www.el19digital.com/]
End notes
[1] “AL PUEBLO DE NICARAGUA Y AL MUNDO INFORME SOBRE EL COVID-19 Y UNA ESTRATEGIA SINGULAR – LIBRO BLANCO” p 3. https://www.el19digital.com/app/webroot/tinymce/source/2020/00-Mayo/25%20MAYO/AL%20PUEBLO%20DE%20NICARAGUA%20Y%20AL%20MUNDO-%20INFORME%20SOBRE%20EL%20COVID-19.pdf. An English translation, “To the People of Nicaragua and to the World: COVID-19, A Singular Strategy, White Book” is available at http://www.tortillaconsal.com/tortilla/node/9402. All references to the White Paper refer to the original Spanish edition page numbers, hereafter cited as “White Paper”.
[2] See “Nicaraguan Opposition Misrepresents Government Response to COVID-19,” http://www.coha.org/nicaraguan-right-wing-opposition-misrepresents-government-response-to-the-covid-19-pandemic/
[3] Data from https://datosmacro.expansion.com/estado/gasto/salud
[4] See http://www.tortillaconsal.com/tortilla/node/9402
[5] Costa Rica and other Central American countries have since been able to acquire more, given their stronger economies and freedom from US sanctions. See “Costa Rica tendrá 700 ventiladores para atender pacientes críticos por Covid-19,” https://www.teletica.com/252364_costa-rica-tendra-700-ventiladores-para-atender-pacientes-criticos-por-covid-19
[6] See White Paper, pp 27-29.
[7] White Paper, p 5.
[8] The reports from the “Observatory” are published on Twitter, Facebook and at its sophisticated website https://observatorioni.org/
[9] “Under-fire Nicaragua reports significant rise in COVID-19 cases,” https://www.france24.com/en/20200526-under-fire-nicaragua-reports-significant-rise-in-covid-19-cases
[10] These and other rumours and predictions have been collated in a video by Juventud Presidente, “Falsas matemáticas sobre el Covid-19 en Nicaragua,” https://www.youtube.com/watch?v=bMJZK5U9VUo
[11] “5 insólitas cosas que ocurren en Nicaragua mientras los expertos advierten de la “grave” falta de medidas ante la pandemia,” https://www.bbc.com/mundo/52530594
[12] See https://www.ned.org/region/latin-america-and-caribbean/nicaragua-2018/
[13] “COVID-19 as Pretext for Repression in the Northern Triangle,” http://www.coha.org/covid-19-as-pretext-for-repression-in-the-northern-triangle/
[14] On El Salvador, see for example, CNN News (May 21) “¿Salvador o autoritario? El presidente ‘millennial’ de El Salvador desafía a las cortes y al Congreso en la respuesta al coronavirus,” https://cnnespanol.cnn.com/2020/05/21/salvador-o-autoritario-el-presidente-millennial-de-el-salvador-desafia-a-las-cortes-y-al-congreso-en-la-respuesta-al-coronavirus/; and earlier in COHA “ Bukele y uso político de pandemia en El Salvador: entre la ilegalidad y la violación de DDHH,” http://www.coha.org/bukele-y-uso-politico-de-pandemia-en-el-salvador-entre-la-ilegalidad-y-la-violacion-de-ddhh/
[15] On Honduras, see for example, “Del Mitch al golpe y de la pandemia al autoritarismo contra los derechos humanos,” https://defensoresenlinea.com/informe-2-del-mitch-al-golpe-y-de-la-pandemia-al-autoritarismo-contra-los-derechos-humanos/
[16] “Nicaragua-Costa Rica Coronavirus Dispute Stalls Hundreds of Trucks at Border,” https://www.usnews.com/news/world/articles/2020-05-22/nicaragua-costa-rica-coronavirus-dispute-stalls-hundreds-of-trucks-at-border
[17] “Colombian designers prepare cardboard hospital beds that double as coffins,” https://www.theguardian.com/world/2020/may/27/colombia-coronavirus-cardboard-hospital-beds-coffins
[18] See the interview on May 21 by Unherd: https://www.youtube.com/watch?v=DKh6kJ-RSMI&feature=youtu.be
[19] “Half a billion people could be pushed into poverty by coronavirus, warns Oxfam,” https://www.oxfam.org/en/press-releases/half-billion-people-could-be-pushed-poverty-coronavirus-warns-oxfam
[20] Examples are given in videos by Juventud Presidente, see https://www.juventudpresidente.com.ni/coronavirus-y-noticias-falsas-en-nicaragua/; and https://www.juventudpresidente.com.ni/las-falsas-noticias-sobre-el-covid-19-en-nicaragua/
[21] “Nicaraguan Opposition Misrepresents Government Response to COVID-19,” http://www.coha.org/nicaraguan-right-wing-opposition-misrepresents-government-response-to-the-covid-19-pandemic/
[22] “Coronavirus in Latin America: How bad could it get?” https://www.bbc.com/news/av/world-latin-america-52349439/coronavirus-in-latin-america-how-bad-could-it-get
[23] “Bolsonaro attends floating barbecue as Brazil’s Covid-19 toll tops 10,000,” https://www.theguardian.com/world/2020/may/10/bolsonaro-attends-floating-barbeque-as-brazils-covid-19-toll-tops-10000
[24] “Libro Blanco sobre COVID-19 aviva señalamientos contra Ortega en Nicaragua,” https://www.lavanguardia.com/vida/20200527/481430490140/libro-blanco-sobre-covid-19-aviva-senalamientos-contra-ortega-en-nicaragua.html
[25] See comparisons between Sweden and other countries at https://ourworldindata.org/coronavirus/country/sweden?country=~SWE
[26] See above (https://www.lavanguardia.com/vida/20200527/481430490140/libro-blanco-sobre-covid-19-aviva-senalamientos-contra-ortega-en-nicaragua.html)
[27] White Paper, p 18.
[28] “Coronavirus disease 2019 (COVID-19) Situation Report – 46” March 6, 2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200306-sitrep-46-covid-19.pdf?sfvrsn=96b04adf_2
