Nicaragua's COVID-19 crisis demands a response.

Abstract

The Nicaraguan government's disastrous coronavirus disease 2019 (COVID-19) strategy has precipitated uncontrolled contagion and deaths and threatens regional security. The crisis in Nicaragua deserves the attention of the international scientific community. Early in the pandemic, Central American countries adopted measures to fight COVID-19. Nicaragua, however, instituted only “epidemiological control at borders through surveillance,” relying on travelers to declare symptoms ([ 1 ][1]). In contrast to recommended policies, the government has kept schools and businesses open and convenes massive public gatherings ([ 1 ][1]). Nicaragua's 347 COVID-19 deaths per million people is the highest in Central America ([ 1 ][1], [ 2 ][2]). The independent Citizen Observatory reports that COVID-19–related deaths in Nicaragua are greater than those in Panama ([ 2 ][2]), the country with the highest incidence of infections in the region ([ 3 ][3]). Scientists have called for an emergency plan and advised the Nicaraguan government to scale up testing and contact tracing of COVID-19 patients ([ 4 ][4]). A declaration signed by 34 medical associations urged citizens to implement voluntary self-quarantine ([ 5 ][5]) to curb the spread of the virus. The Pan American Health Organization (PAHO) has warned that Nicaragua refuses to report COVID-19 cases even though an appropriate response to the pandemic requires knowledge of its true magnitude ([ 6 ][6]). Nicaraguan authorities deny that the pandemic has been in the community contagion phase since May ([ 6 ][6]), and insufficient testing has led to COVID-19 deaths going uncounted. The number of deaths among health care professionals is rising ([ 7 ][7]), and at least 10 doctors have been fired for demanding protective equipment and voicing concern about the Nicaraguan government's slow response to the pandemic ([ 8 ][8]). Because Nicaragua has given free rein to the coronavirus contagion, neighboring Costa Rica considers transmissions from Nicaragua to be the main health threat during the country's de-confinement phase. Costa Rica has demanded that PAHO take forceful and urgent action ([ 9 ][9]). Nicaragua's reckless handling of the COVID-19 crisis merits an exhaustive, independent audit. Supporting the efforts of local scientists and medical personnel to combat the spread of COVID-19 is a fundamental duty of PAHO and the global scientific community. 1. [↵][10]1. F. Castellani et al ., “The impact of COVID-19 on the economies of the region (Central America).” (Inter-American Development Bank, Washington, DC, 2020); [in Spanish]. 2. [↵][11]Nicaraguan Citizens Observatory on COVID-19 (2020); [in Spanish]. 3. [↵][12]1. J. R. Loaiza et al ., Rev. Panam. Salud Publica 44, e86 (2020). [OpenUrl][13] 4. [↵][14]1. M. Medrano , “More than 500 doctors in Nicaragua ask the government for a strategy against COVID-19 and protection of health personnel,” CNN (2020); [in Spanish]. 5. [↵][15]1. Y. Luna , “Medical associations in Nicaragua call for a 4-week ‘voluntary quarantine,’” Confidencial (2020). 6. [↵][16]1. I. Munguia , “PAHO: ‘In Nicaragua COVID-19 spread is already at community level,’” Confidencial (2020). 7. [↵][17]1. I. Munguia , “More than 40 health workers have died from COVID-19,” Confidencial (2020); [In Spanish]. 8. [↵][18]“Nicaragua doctors ‘fired’ for criticizing government over COVID-19,” AFP (2020). 9. [↵][19]“Costa Rican lawmakers request intervention in Nicaragua due to pandemic,” The Tico Times (2020). [1]: #ref-1 [2]: #ref-2 [3]: #ref-3 [4]: #ref-4 [5]: #ref-5 [6]: #ref-6 [7]: #ref-7 [8]: #ref-8 [9]: #ref-9 [10]: #xref-ref-1-1 View reference 1 in text [11]: #xref-ref-2-1 View reference 2 in text [12]: #xref-ref-3-1 View reference 3 in text [13]: {openurl}?query=rft.jtitle%253DRev.%2BPanam.%2BSalud%2BPublica%26rft.volume%253D44%26rft.spage%253De86%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [14]: #xref-ref-4-1 View reference 4 in text [15]: #xref-ref-5-1 View reference 5 in text [16]: #xref-ref-6-1 View reference 6 in text [17]: #xref-ref-7-1 View reference 7 in text [18]: #xref-ref-8-1 View reference 8 in text [19]: #xref-ref-9-1 View reference 9 in text