With the spread of COVID-19 from east to west, Latin America has now become the epicentre of the global crisis. The effects of the pandemic will no doubt be worsened by the existing economic and social challenges and vulnerabilities faced by the region. Experts recognize that the immediate social impact and longer-term economic consequences of the global pandemic will be felt most strongly in developing and low-income economies (FT, 2020) . Within Latin America, Central American countries are therefore most at risk as they are consistently the poorest performing economies in the region.
Nicaragua is the poorest of these nations with high levels of poverty and an economy heavily reliant on informal employment, generating as much as 70% of the nation’s GDP (OECD, 2018). The economic position of Nicaragua endangers its capacity to combat the spread of COVID-19 effectively. The large number of informal workers greatly hinders the ability to limit the spread of the virus; many informal workers cannot afford to stop working and in Nicaragua more than 65% do not have any social security protection (OECD/ILO, 2019). As outlined by the IDAG there is a lack of medical infrastructure; Nicaragua averages 0.9 beds per 1000 people compared to the Latin American average of 2.2. The World Health Organization (WHO) reported in 2018 that the country had 6,320 doctors – that is, 9.7 per 10,000 people, well below the estimated regional average for the Americas of 23.3 per 10,000.
In the face of these challenges it perhaps would have been expected that Nicaragua would impose strict lockdown policies to prevent community spread and the risk of the pandemic growing out of control. However, Nicaragua is one of the few countries that has refused to implement a lockdown. The autocratic president Daniel Ortega has continually played down the importance of the virus. Comparisons can be drawn with the response of Bolsonaro and Trump who similarly sought to belittle the threat posed by COVID-19. However, in both the US and Brazil at the very least partial lockdown policies have been implemented. In Nicaragua, Schools have not been closed down, restaurants and businesses remain open, no extra measures were passed to prepare hospitals or fiscal policies introduced to help those affected by the virus (IDAG, 2020). The government has even gone as far as to hold its own large events, one march ironically named ‘Love in the time of COVID’. Despite the lack of measures Nicaragua has one of the lowest ‘official’ death rates in Latin America with only 91 deaths and 2846 cases being confirmed by the government (PAHO 2020).
The reality of this situation, however, is that Ortega seems more focused on hiding the disease than treating it. An independent organization formed by epidemiologists, medical professionals and students known as the Nicaragua Covid-19 Citizen Observatory was created with the aim of “filling the void of information” around the Coronavirus. While the Nicaraguan government still denies that community transmission is occurring, the Observatory claims that as of the 8th of July there were 2225 deaths and 7893 cases of COVID-19, nearly 23 times the number of official deaths calculated by the state. From the 25th of June to July 1 an 8% increase in the number of new cases was reported which suggests that Nicaragua is still to reach the ‘peak’. The autocratic nature of the state has allowed for the repression of information surrounding the outbreak. Ortega, who has held power since 2007, has control of all 4 branches of government and has banned opposition political parties, operating without a semblance of accountability or legitimacy (The Atlantic, 2018). The Nicaraguan government therefore has been able to retain tight control of all testing and has denied investigators from the WHO access to records of cases (NY Times, 2020). Due to the secrecy surrounding testing, doctors on the ground have stated that misdiagnoses are common. As outlined by Dr. Carlos Quant, the chief of the infectious diseases unit at Manolo Morales Hospital in Managua, “Sure, they are atypical pneumonias, because they are not tested.” According to the Citizens Observatory, at least 133 COVID deaths have been misdiagnosed as ‘atypical pneumonia’ with many other respiratory diseases replacing what should be COVID-19 on death certificates.
In attempts to hide the scale of the outbreak, the Nicaraguan state, which has become increasingly authoritarian in recent years, has fired medical staff who have challenged their handling of the pandemic. On May 18, more than 700 health workers from the public and private sectors signed a letter urging the government to acknowledge that the virus was spreading in Nicaragua. More than a dozen of the signatories were dismissed arbitrarily, receiving letters which did not identify the reason for their dismissal. On June 9, the Nicaraguan Centre for Human Rights (CENIDH) issued a statement of concern over the dismissals which did not follow the legal procedures set out in Nicaraguan law. This represents an overstepping of the Nicaraguan state; however, it is not the first time that democratic processes have been eroded in recent years. In 2018 anti-government protests were brutally repressed by the state leaving as many as 530 dead and causing 80,000 to flee the country (The Guardian, 2019). In the wake of these protests the Ortega administration fired at least 400 doctors, nurses, and other health workers in apparent retaliation for providing care to those injured in the protests (HRW, 2020). The firing of doctors is as concerning from a human rights perspective as it is from public health, as recognized by José Miguel Vivanco, Americas director at Human Rights Watch: “Arbitrarily removing health workers amid a health crisis further threatens a public health disaster.” Medical personnel themselves have been disproportionately affected by the crisis – the Citizens observatory has said 87 health personnel have died due to the virus. In March doctors were actively told not to wear masks by the government and one of the demands in the open letter in May was greater access to PPE for doctors.
The government has expanded efforts to hide the full scale of the outbreak through the use of so called “express burials” (NY Times, 2020). The families of those who have died have been forced to bury the dead as soon as possible with burials occurring all hours of the night. No filming is allowed and only a small number of family members can attend, even then, only from a distance. Men in hazmat suits accompanied by police officers hastily bury coffins which have been nailed shut. Families feel as if the mistakes made by the regime leading to the dire situation are literally being hidden by the cover of darkness. The nature of the burials has heightened the suspicion that surrounds suspected COVID-19 deaths and appears to confirm scepticism about the given causes of death; pneumonia cases in previous years have not led to express midnight burials. The government has condemned reports as false news and claimed that the few videos that have been filmed were “from other countries” even though distinctive landmarks can be seen (CNN, 2020).
While we may never know the true number of deaths and cases in Nicaragua, the likelihood is, as with the rest of Central America, that the burden of this virus will be placed on the poorest of society. The inevitable economic slump will be felt most by those with the least, already weak healthcare, education and welfare services which will no doubt struggle to function in the economic backlash of the pandemic (FT, 2020). In the absence of a strong response, as seen in Nicaragua, the pandemic could leave between 14 to 22 million more Latin Americans in extreme poverty by the end of 2020 (ECLAC, 2020). Ortega’s aim to prevent an ‘economic pandemic’, as he called it, by not imposing lockdown rules may well have meant that Nicaragua is even worse affected than it might have been (CNN, 2020). Only time will tell but with the authoritarian regime hanging on to control and a populace which has already displayed its distaste for the autocratic leader in the 2018 protests, the question remains whether the handling of the COVID crisis could be the catalyst for widespread political change or whether the Ortega regime will continue its path towards the formation of a totalitarian state.