In the last three weeks I have bathed at least six times a day. The curve of the coronavirus epidemic in Nicaragua is in the rapid ascent phase. Patients with acute respiratory insufficiencies and atypical pneumonia have full rooms for covid-19 care in the two hospitals where I work. Every time I attend to one, I must remove my protective suit, disinfect it, and bathe. There is a clear exponential increase in cases, although the Government does not publicly recognize it. As a pulmonologist it worries me, because we are going towards the gorge.
The first time I heard of the coronavirus was on January 1, 2020. I saw on the news that the Chinese authorities reported 46 cases of pneumonia in Wuhan, but I didn’t think it was serious. At the time, I thought it would be like SARS-CoV, a virus that was limited in countries and barely reached the United States and Canada. But in mid-January, when I saw alarms in Japan and South Korea, I was worried… although I always thought it was remote that it would reach our country. It was confident that countries would control the virus like South Korea did, but it was the only nation that got it right. The rest of the countries did not isolate the people who landed at their airports, and that was when everything got out of control. That’s when I said to myself: “This changed.”
I started reading, researching and documenting myself about the new coronavirus. I prepared a series of educational presentations to share with my colleagues at Hospital Monte España (a Social Security center), in Managua, and with doctors from the associations of pulmonologists, critical care and emergency physicians. Seeing what was happening in the world, we had to prepare. It was a feeling of imminence: at any moment the covid-19 would reach Nicaragua.
The feeling of imminence was reinforced by the government’s statements. The health authorities decreed that they would not close borders or that there would be preventive quarantine. They did not restrict entry to foreigners or isolate those who entered Nicaragua. At any moment it would explode … And the public health system, flat, was not prepared. The only hospital that was prepared, even before the first positive cases in Central America, was the Vivian Pellas private hospital, the other center where I work. We began to make a plan, to allocate the area to serve covid-19 patients and to buy protection materials. Because we said one thing clear: the one who has the highest risk of contagion is the health personnel. The public system never did anything like it.
On the night of March 18, I was in the hospital when Vice President Rosario Murillo announced the first positive case. I was affraid. Although I was in the most prepared hospital in Nicaragua, in the other hospital, Monte España, there was no preparation. After the first case was known, the Minsa (Ministry of Health) began to publicize the virus, and PAHO (Pan American Health Organization) trained personnel to take covid-19 tests. It is the most relevant thing that Minsa has done so far. The doctors were on alert.
During that first stage of the epidemic, we had a very high threshold of suspicion. We knew that contagions related to the first positive cases recognized by the Government could circulate. But the explosion of respiratory failure and pneumonia occurred in the fourth week of the epidemic. Pneumonia associated with covid-19 everywhere, but the Government insists that there is no local-community transmission.
I had to attend to two of the first positive cases recognized by the authorities because they were wealthy people who arrived from the United States and entered the Vivian Pellas. Currently, I have handled a lot of cases. That gives fear and stress. As I said before: even if you are in the most prepared hospital, no country in the world is ready for the level of contagion of this virus. Your family worries and that causes nervousness and tension headaches. I have three children and the little boy would throw himself into my arms every time I came home from work. Now, his mom has told him not to go near his dad until he takes a bath. It is tremendous to see how that impulse is cut off in the child. I can see it in their eyes.
At the beginning of the epidemic, Minsa used a very narrow case definition to test for covid-19. They rejected a high number of patients with clear symptoms of having the virus, because they did not meet, they said, the epidemiological link of not coming from another country. I sent more than 50 tests and they rejected them in that first moment. Then they relaxed the criteria further. Now the condition to do the test is that you have atypical pneumonia. In other words, a moderate or severe case is not rejected as before, but now there is an excess of “indeterminate” cases.
The “indeterminate” cases are those tests that give neither positive nor negative; when little virus percentage is detected. Then, the Minsa declares them indeterminate, although in the context of a pandemic they should be considered positive until the opposite is definitively ruled out. That’s a huge source of underreporting. For the Minsa, the “indeterminate” is not valid as positive, but for the doctor it does, because clinically and radiologically they are covid-19. I began to see positive cases that are not reported to the official statistics. I wondered, what is it?
I began to notice that, selectively, they do not report to those who do not suit them. For example, the second airport worker infected. It is not convenient for them to admit a source of contagion at the international airport. The other group that they do not admit is the more than 40 positive cases of doctors that exist. They do not say it because it gives a bad image to admit that there are infected doctors, when the Ministry itself ordered them not to use protective equipment because it was unnecessary and alarmist. That is why some doctors are seriously intubated. It hurts to see patients cramming the emergencies and waiting for a bed, but it hurts more when I see my colleagues with pneumonia in serious condition, because they did not give them adequate protection. The government is more concerned with hiding the epidemic than with protecting health workers. It is scrubbed.
The term “indeterminate” exists, it is valid, but they are abusing it. And the worst thing is that we are not certain that they really are “indeterminate”, because the test results are transmitted verbally in a call. But we do not have written reports, proofs … because if they give me a technical report I can see it and say: it is not indeterminate, it is positive. Our suspicions are that they want to put positive cases in that bag of indeterminate.
I no longer follow what the Government or the Minsa say, because they lie when they say the official statistics. Apart from the “indeterminate”, they exclude from the list patients who have recovered or died from coronavirus. That is why in Nicaragua there are never more than three cases. That is to confuse the unwary and the naive. To the poor people. But it’s amazing how this message penetrates. People believe it and minimize: “If there are only three cases.” It is perverse. Then the measurements are not taken.
The Minsa hides many cases, but there are more than 2,000 positives in the country. We have three months of epidemic and the Government had to admit a sudden rise of 254 cases in a single week. Each week the figures will increase until they reach the real one, this to give the false impression that they have controlled the pandemic. But the hospitals are overwhelmed. The burials carried out at night and with the covid-19 protocol say something different from the official discourse … as well as what we see in hospitals.
For saying these things I suffered retaliation: at the Monte España hospital they excluded me from the covid-19 team. They did not give me information about the patients, as I was the only pulmonologist at the hospital. But the weight of the problem is such now that when they see that the management of covid-19 gets out of hand, they have consulted me by force, and they introduce me to patients even if they do not trust me. I prefer to be a “deformed brain”, as Vice President Rosario Murillo called the specialists who alert us about the epidemic to being a sheep.
The last four weeks I have spent full with pure cases. I take my temperature in the morning and in the afternoon. I write it down on a sheet, as well as my symptoms. At the first suspicion I have, I will submit my test for a covid-19 test. Meanwhile, I keep working. And bathing. It is tiring.
Information about the coronavirus
– Here you can follow the last hour on the evolution of the pandemic
– This is how the coronavirus curve evolves in Spain and in each autonomy
– Search engine: The de-escalation by municipalities
– Questions and answers about the coronavirus
– Guide to action against the disease
– Click here to subscribe to the daily newsletter on the pandemic