Jorge Capelán, Managua con Amor, April 6th 2020
250,000 volunteer health promoters have made 2.3 million house to house visits
to educate about COVID-19, just one of many activities undertaken
by the Sandinista government to address the pandemic. (Photo El 19 Digital)
One of the best hidden secrets amidst the cacophony of panic and media terrorism caused by the current COVID-2019 pandemic has been how successfully Nicaragua, a small, impoverished country in one of the most climate change-prone regions on the planet, has been tackling the arrival of the new coronavirus.
With 6.5 million inhabitants, Nicaragua had as of April 5th only 6 cases of COVID-19, all imported, of which 3 were active, 2 were recovered and one, ill with AIDS, had died. At the same time, the authorities kept under close surveillance some 10 people who, despite having tested negative, continue to be monitored as a precaution.
By comparison, in the Central American region, at that same date there were 4,598 confirmed cases of COVID-19 of which 4,360 were active, 167 dead and 71 recovered. In Central America, only Belize, with less than 400,000 inhabitants, has fewer confirmed cases than Nicaragua, with 5, all active.
In terms of cases per million inhabitants, Nicaragua has the lowest number of cases in the entire region, with 0.93 cases. It is followed by Guatemala, with 4.22 cases; El Salvador, with 9.56 cases; Belize, with 12.24 cases; Honduras, with 32.54 cases; Costa Rica, with 89.76 cases; and Panama, with 471.22 cases per million.
Note that the two countries with which Nicaragua has extensive and porous borders (Honduras to the north and Costa Rica to the south) have much higher levels of infection.
Likewise, in two countries characterized by draconian confinement and curfew measures to address the pandemic (El Salvador and Honduras), infection rates per million inhabitants are also much higher than in Nicaragua.
Sectors linked to the violent, failed 2018 opposition coup attempt in Nicaragua claim that the government figures are false and that it is not really doing anything to combat the pandemic. They say that there are so few confirmed cases because massive testing of COVID-19 has not been applied to the population.
These arguments are only viable for consumption abroad and for certain groups well out of touch with domestic opinion in the country, effectively living an illusion, since for any normal person living in Nicaragua the situation is obviously not like that.
Clearly, no health center in Nicaragua is overwhelmed with people with respiratory symptoms. According to statements by the Director General of the Ministry of Health, pneumonia cases this April, which generally increase nationally, show lower levels than last year. Last year, the population was given about one million vaccines against influenza (B, H1N1 and H3N2), while the pneumococcal vaccine was given to the elderly and to people suffering from chronic diseases.
On the other hand, where are thestreet protests against alleged lack of government action on the pandemic? Nowhere, only in cyberspace, in the fevered minds of people based in Miami and in some European Union countries.
The Sandinista Government's response to the COVID-19 emergency is based on a number of pillars:
Firstly, the development of a social state based on the rule of law that has prioritized as central the social and economic rights of the population, especially health, education and the right to food. In Nicaragua, contrary to the propaganda of the Western media, there is no antagonistic relationship between the State and the population, which in the vast majority (even among a great many of the opposition minority) is confident that the police and health authorities are seeking the public good.
The secondl pillar has been the broadest possible development of public health. It should be no secret that genuine public health policy in Nicaragua only began with the overthrow of the Somoza dictatorship in 1979 and the triumph of the Sandinista Revolution. Before July 19th 1979, the poorest popular sectors were forced to sell their blood to the Plasmapheresis company in order to survive while endemic diseases were widespread in a country where more than half the population could not read or write.
With the first stage of the Sandinista Revolution in the 1980s came massive vaccination, prevention and hygiene campaigns, as well as training of health personnel and development of health infrastructure, all in the midst of and despite a bloody terrorist war promoted by the United States. This was because this policy was a fundamental part of the historic programme of the Sandinista National Liberation Front, formulated many years before the 1979 triumph. All that human infrastructure formed during the 1980s, based on valuing health as a basic and inalienable right, resisted the neoliberal counter-reform of 1990-2007, which sought to totally privatize health. So when the Sandinista Front returned to government in January 2007 it was able to implement the successful community health model that today confronts the emergence of COVID-19.
During the last 13 years, the Sandinista Governent has built 18 hospitals: 15 primary, 1 departmental and 2 national, all of them operating free of charge. In the medium term, there are plans to build 15 more hospitals, six of which are already under construction, including two major ones in León and in Ocotal. In addition, countless health centers and heath posts have been built from scratch or else refurbished throughout the country, as well as Maternal Shelters in Nicaragua's prize winning system of maternity care for women from rural areas. Also, and as if this were not enough, there is a massive year round program that actively visits urban barrios and rural communities week-in week-out providing information and free medical attention to the population who, for different reasons, cannot go to a health center.
To all this we must add the recent inauguration of a WHO approved modern molecular biology laboratory capable of analysis and testing for various diseases, including COVID-19. This laboratory is the second most advanced in the region. In addition, since the end of 2018, Nicaragua has a drug plant with the capacity to produce 12 million influenza vaccines per year. The Cuban drug Interferon Alfa-2B, which has been successfully used to treat patients with COVID-19, is planned to be produced there.
Along with the development of this material base, the Sandinista Family and Community Health Model, conceptually formulated as early as 2008, has a broad social infrastructure in the form of sectoral, municipal, departmental and national networks that articulate public, community and private health resources that have been promoting all kinds of health campaigns for many years, especially to prevent diseases such as dengue, zika and chikungunya, in addition to all their other routine health tasks.
Several months before the alert about COVID-19, in July last year, the government had already declared an epidemiological alert to combat the above-mentioned diseases. In fact, for many years Nicaragua, due to its geographical location, has been in a permanent situation of epidemiological alert that the authorities have addressed together with local communities, giving the country better evels of health at grass roots along with wide experience in dealing with this type of threat.
Due to its physical characteristics, Nicaragua is obliged to have a warning system for all types of threats including epidemiological, climatic (e.g. hurricanes), tectonic (seismological and volcanic) in preparation for which for many years the Sandinista government has been carrying out gigantic civil defence exercises involving millions of citizens.
As can be seen on the website of the Ministry of Health, it is false that the Government does not report on the progress of the pandemic in the country, in addition to the daily press conferences offered by its representatives and the abundant information provided through the media. Just as, in Nicaragua, there is also unrestricted freedom of disinformation, since not a single one of the deceitful right-wing media outlets has been shut down, so too there is genuine information communicated via the country's Citizen Power media.
Since the end of February, the Nicaraguan Government has been announcing the policy to be followed in the face of the coronavirus:
- Nicaragua has not established, nor will it establish, any kind of quarantine.
- People who have symptoms of COVID-19 and also have some link to someone with the proven disease will be admitted to a health unit for study and follow-up.
- Those who also test positive for COVID-19 will be admitted to one of the centres for the treatment of patients with the disease.
- People who are admitted from countries at risk (as defined by WHO) will not be restricted from moving within the country, but will be alerted to the precautionary measures to be taken and asked for a contact number and address to follow up by phone and visits.
On January 21st, the day after Chinese authorities reported a third death from COVID-2019 and 200 infected people in Hubei province, as well as dozens of infected people in other Asian countries, the Nicaraguan Health Ministry, together with Pan American Health Organization, announced the epidemiological alert.
Ten days later, the Inter-Institutional Commission in charge of dealing with the emergency had drawn up a detailed protocol, based on its own experiences and those of the WHO, covering all aspects of the strategy for dealing with the pandemic, which is updated month by month as knowledge of the new coronavirus and COVID-19 advances.
The protocol contains detailed measures on epidemiological surveillance, laboratory and sampling procedures, organization of health services, inter-institutional organization, communication plans, etc.
During the first weeks, all health personnel were trained and all the medical infrastructure necessary to deal with the pandemic was prepared, including the inauguration on March 3rd of the molecular biology laboratory mentioned above, which allows testing for the new coronavirus.
Already on March 12th, the presidents of Central America (except Bukele of El Salvador) participated in a virtual conference to coordinate actions in the face of the pandemic. In addition, the Nicaraguan government held meetings with its border neighbours Costa Rica and Honduras to coordinate efforts against the pandemic. Certainly, Nicaragua has not adopted strident and conflictive attitudes, but rather total collaboration in the common effort to confront the pandemic.
A country like Nicaragua, dependent on foreign trade and labour income, without major natural sources of income in the form of hydrocarbons or other energy resources, cannot afford to "close" the economy lightly, much less in a situation when, at the time, there had not even been any imported cases of COVID-19.
In Nicaragua most families live from self-employment and depend on their daily income. This is similar to Honduras and El Salvador, where the draconian quarantine measures implemented have led to strong popular protests and breaches of the quarantine decreed by those governments. In El Salvador, the disruption of the delivery of $300 support payments led to protests and looting. In Honduras, the failure to deliver promised food to the population forced people to take to the streets.
With similarities to Sweden's successful strategy to tackle the pandemic, Nicaragua bases its strategy on confidence in the population's ability to take preventive measures while avoiding restrictions on economic activity to the greatest extent possible.
In addition, Nicaragua combines this work of public health education with a system of detection of possible cases of COVID-19, ranging from customs posts, ports and airports to work with border populations both to the north with Honduras and to the south with Costa Rica, and too with the activities of health centers and posts throughout the country as well as civil society structures in all neighborhoods and regions.
Nicaragua is a small country, it is very difficult to hide a situation of the seriousness of a COVID-19 infection. The health authorities have so far been able to track down any suspicious cases, not so as to restrict the freedom of the affected person, but to follow up and help them.
One event heavily manipulated by the Western press, and by the coup media within Nicaragua, was the "Love in the Time of COVID-19" walk held on Saturday, March 15th. This national event was interpreted in a tendentious way as a show of contempt for public health and for the protection measures against the coronavirus, when in fact the Citizen Power media supportive of the government had been covering COVID-19 promoting preventive measures against it for a couple of months.
The message conveyed by thousands of Sandinistas and people who support the Sandinista government who marched to all Nicaraguans that Saturday was that we should not lose our heads and "shut down" the country, that we should continue working but take the precautionary measures recommended in the media for weeks.
It was not until March 18th, with the report of the first case of coronavirus from a citizen who had been in Panama, that Nicaragua left the initial phase of preparation to enter the phase of imported cases, in which it currently still is. Since then, five more cases have been reported, of which two have recovered, one has died and three are under treatment.
On March 19th, now that Nicaragua has entered phase two of the pandemic, Vice President Rosario Murillo reported on the training of 250,000 volunteer health brigadistas who will visit more than one million homes throughout the country. By now, most Nicaraguan households have been visited more than once to follow up on the situation of the COVID-19 in the country.
It should be noted that all this work is by no means limited to informing the population and preparing the health system for COVID-19. The regular programs of the health system are still in place, as well as the days of free operations for the people who need them, etc. At the same time, the COVID-19 prevention campaign is also carried out alongside prevention of influenza, dengue, zika, chikungunya and other diseases that threaten the population.
At present, the Nicaraguan people are enjoying the Easter holidays in peace and with great responsibility. Many people have stayed in their neighborhoods with their families, which can be seen when they go out to the streets, which in many cases have become a space for socialization for the neighbors. However, many others have preferred to go to the different bathing spas in the country, or even in religious activities, also avoiding large crowds and observing the rules of hygiene.
For Easter Week, state employees have been given a break from April 4th to April 15th or April 17th (depending on the activity), and students until April 20th, in a kind of soft quarantine for the entire sector, which also serves to care for people in groups at risk from COVID-19 without burdening family members who are self-employed.
The future development of the pandemic in Nicaragua is not yet known. It could be, as indicated by some U.S. researchers, that the higher levels of vaccination of the population with BCG against tuberculosis compared to those of the Euro-American countries as well as Latin and Central American countries, will translate into a lower impact of COVID-19 in Nicaragua. If so, this would become a tribute to the massive vaccination campaigns that Sandinismo has promoted over the past 40 years.
Another element to be taken into account to explain the lower incidence of this pandemic in Nicaragua so far is the decline of Euro-American tourism following the defeated violent coup attempt in April 2018. In any case, there are a number of factors at play in this regard, especially the attentive operational activity, devoid of hysteria that the Sandinista government has shown in facing this emergency.
One thing is certain, however: If the Sandinista Government had acted before the COVID-19 as its neighbors in Honduras and El Salvador, the economic losses would have been enormous even before entering the peak of the pandemic in our region. Let us remember that the levels of contagion per million inhabitants in Central America are still much lower than those in Europe or North America. By the end of Holy Week, both Honduras and El Salvador will have suffered enormous losses, incurring unpayable debts and irretrievable damage to their relationship with the population.
Meanwhile, Nicaragua is still waiting for the pandemic to develop, so far without local community contagion, with all the resources of its health system intact, with valuable experience accumulated in treating the few cases that have occurred and with a strengthened relationship with the civilian population.
The Sandinista Front, and especially under the leadership of President Comandante Daniel Ortega together with Vice President Compañera Rosario Murillo, is expert in the art of mass political manoeuvring, or in other words, in rapid, operational political manoeuvring involving organised, disciplined and broad masses of people.
There are many historical examples of this, for example: the organization in a few months of the award-winning National Literacy Crusade in 1979-80; the organization of the Patriotic Military Service in the 1980s; the exchange of the entire national currency in less than 24 hours in 1988 (which deprived the Contra of billions of córdobas that had fled to Honduras); the years of disciplined restraint when faced with unremitting right wing government provocations, right up to the defeat of the failed "soft coup" of 2018, when many people outside Nicaragua believed that the Sandinista Front was defeated.
To the changing scenarios of COVID-19 the Sandinista Government will respond in a flexible but decisive manner, prioritizing the most vulnerable sectors so as to affect the popular economy as little as possible, aware that, more than a disease to be defeated, COVID-19 is a challenge to the ability of society as a whole to function, more a virus of society than a virus of the individual.