Nicaragua: COVID-19 Exposes Another Rift. This time, the Battleground in Public Health

After the announcement of the first case of COVID-19 in Nicaragua, the rift between the Ortega-Murillo government and the leading opposition groups, Unidad Nacional Azul y Blanco (UNAB) and Alianza Cívica por la Justicia y la Democracia (ACJD), has now infected public health discourse.

The government argues that Nicaragua is prepared for the pandemic, but UNAB and ACJD believe that to be false. To them, Ortega’s administration is not doing enough to curb the spread of COVID-19.

The sticking point is the administration’s unwillingness to stop promoting large gatherings, marches, political rallies, tourism, and other activities that can spark the community spread of COVID-19.

UNAB and ACJD have criticized the Ortega-Murillo government for it, and today they took their case to OAS Secretary General Luis Almagro. The gesture was more symbolic than anything else, as Ortega’s government stopped listening to the OAS when the organization began documenting and criticizing his government’s human rights record, almost two years ago.

Still, UNAB and ACJD wrote to Almagro to convey their “profound preoccupation”. According to them, the government’s carelessness exposes Nicaraguans to a health crisis.

In spite of the WHO’s requests for the adoption of measures to contain or curb the transmission of the virus […], the government of Daniel Ortega carelessly promotes the opposite. […]

The government promotes marches, supposedly to show support for its policies. Such events are contrary to WHO recommendations.

Vice President Rosario Murillo, who also acts as her government’s top spokesperson, called Nicaraguans to march in solidarity with countries facing the COVID-19 pandemic. The nation-wide event, held on March 14th, brought together hundreds of people, shoulder to shoulder.

But UNAB and ACJD’s concerns go beyond the march. The organizations criticize Ortega’s administration for the continued promotion of trade fairs and public festivals, “in order to maintain the image of normalcy.” Vice President Murillo actively publicizes these events in her daily address to the nation.

In fact, hours before revealing that the first COVID-19 patient had been diagnosed, Murillo promoted the “Flavors of Lent” food festival, scheduled for March 20-29, with events throughout the country.

Government preparedness plans

Nicaragua’s public health system is divided into 19 geographic regions, or SILAIS. The system includes 73 hospitals, 143 health centers, 1,333 health posts, 5 specialized centers, 178 birthing centers, and 91 centers for people with special needs. As for system capacity, there are 12 hospital beds, 10 doctors, 8 nurses, and 9 nurses’ aids per 10,000 people. In addition, the country has a WHO-certified testing lab, that can handle diagnostic tests for COVID-19. The system also consists of a community network of health brigades that can be activated to carry out any number of health promotion and communication activities.

According to the government, the existing system is ready to handle the pandemic, but additional measures have been taken as well.

In January, the Ortega-Murillo administration created a National Commission to coordinate and oversee the response, under the guidance of the Ministry of Health (MINSA). The commission includes MINSA, the Ministry of the Interior, Customs Enforcement, the Ministry for the Environment and Natural Resources, among other entities, working together to detect, treat, and prevent the spread of COVID-19.

The government has designated and outfitted 19 hospitals — one per SILAIS — to service COVID-19 patients, but it has yet to disclose the list. A partial list, obtained by La Prensa mentions 10 hospitals, selected to diagnose and treat travelers displaying symptoms, when they come into the country through any legal point of entry.

COVID-19 Designated Hospitals in Nicaragua

Location	Hospital Name	Number of beds (2004)
Managua	Hospital Alemán Nicaragüense	282
Rivas	Hospital Departamental Gaspar García Laviana	223
Chinandega	Hospital Departamental España	149
Madriz & Somoto	Hospital Departamental Juan Brenes	145
Nueva Segovia	Hospital Departamental Alfonso Moncada	115
Río San Juan	Hospital Departamental Luis Felipe Moncada	45
Chontales	Hospital Asunción	183
León	Hospital Oscar Danilo Rosales	414
RAAN	Hospital Nuevo Amanecer	114
RAAS	Hospital Ernesto Sequeira	138

Source: La Prensa

According to the government, they have also performed the following activities:

Establish preparation and response protocols, which have been updated to include WHO recommendations
Create patient treatment guides, that outline procedures for treating patients depending on the severity of their illness.
Set up isolation wards in all nineteen COVID-19-designated hospitals. These wards are equipped with ventilators, suction, monitors, and personal protection equipment for workers.
Ensure availability of medicines, medical supplies, personal protection equipment, ventilators, and other equipment.
Initiate purchase to increase existing inventories of needed materials
Organize health centers and health posts to perform early detection and transport patients to the designated hospitals.
Perform simulations at hospitals and entry points, to verify response capacity.
Set up the national lab, to diagnose COVID-19, through the use of two testing protocols.
Exchange information with specialist from Taiwan, the WHO, and the Henry Reeve Medical Brigade (Cuba), about prevention and management of COVID-19
Conduct public health education campaigns in public markets and house-to-house, with support of the community health network.
Prepare a regional contingency plan, in collaboration with SICA member states.
Train over 30,000 healthcare workers in both the public and private health systems, on prevention, case identification, protection measures, medical attention, and patient transport.
Train over 250,000 members of the community network, workers, and young people on preventative measure, early detection, and procedures to refer patients to health clinics.
Meet with city governments, religious groups, universities, and teachers, to inform them about the situation, and to explain preparedness and prevention activities.
Conduct regular briefings, to inform the population.
Create and disseminate health communication campaigns, addressing families, schools, and work centers, to educate them on protection and prevention.
Conduct demonstrations in schools, parks, markets, bus terminals, to teach people how to properly wash their hands, as this is the primary means of prevention.

However, UNAB and ACJD believe these measures will not suffice, as long as the government continues promoting large gatherings and is not enforcing quarantines for individuals coming into the country. Violeta Granera, a member of UNAB’s political council, said today that Ortega was failing the Nicaraguan people

Ortega is failing the people, but that is not surprising. This dictatorship turned its back on the Nicaraguan people a long time ago, and when it faces us, it is to kill us. Therefore, we shouldn’t expect anything. We hope they wake up in time, because there are [public health] measures that must be taken, and only the state can do that. The government, the dictatorship, must act in accordance to the Constitution and the Public Health Law, and if they don’t do it, we won’t just sit around waiting. We’ll sit around and not leave our homes if it isn’t necessary.

"Hay medidas que deben de salir del Estado, y la dictadura tiene la obligación de cumplir de acuerdo a la Constitución Política y a la Ley de Salud, pero si no lo hace, no vamos a quedarnos esperando."

Granera, integrante del CP, intervención posterior al Foro Virtual Conjunto. pic.twitter.com/ytAWXqkvoz

— Unidad Nacional Azul y Blanco (@UnidadNic) March 19, 2020

And the government isn’t prepared to step back. On the contrary, Ortega’s administration feels it is following the recommended protocols and has the situation under control.

In fact, Murillo hinted that another gathering was being planned for Saturday. “We will deploy with the strength of the Spirit, with the Grace of God, and with the Fortitude of Faith and Hope, in these times of COVID-19, when Love must prevail,” she stated.

President Daniel Ortega has yet to address the Nicaraguan people about COVID19. His last public appearance was on March 12, when he participated in a virtual meeting to discuss COVID19.