(TODAY NICARAGUA) Here is a simple math exercise: how do you get 199 recovered patients of the Covid-19 when you had only 25 confirmed cases to begin with?
In its official report on Tuesday, May 19, Nicaragua’s Ministry of Health assured that 199 Nicaraguans that were infected with the Covid-19 have recovered. A week earlier, in its report of May 12, the Minsa said it had only 25 cases in the entire country.
The incongruity of the Minsa is betrayed by the behavior of the virus in the human body. The World Health Organization (WHO) explains that the time between a person’s exposure to Covid-19 and the onset of symptoms takes around five to six days, but the total incubation period is fourteen days.
It does not work like the common flu, that on the third day the symptoms disappear and in a week the recovery can be complete.
That is, there is no way that 199 patients could have recovered in a week and if they are cases from the start of the pandemic, that means the Minsa did not report them and has been lying all this time.
The head of the Minsa, Martha Reyes, said in a report that covers the week of May 12 to 19, that “to date we have the recovery of 199 Nicaraguans”, and assured that “from the start of the pandemic until today from today-May 19-, we have attended and given responsible and careful follow-up to 470 people”.
She did not give further details.
But the previous week, in her report, the Minsa said that there were only 25 cases in the country.
Experts agree that the recovery time of patients can vary due to the severity level of the case, starting with those who are asymptomatic, but in 80% of infections, according to studies carried out in other countries, the cases are mild. They are people who develop a catarrhal stage, there is no fatigue, there may be a fever or not, a sore throat, among others. The average recovery is about two weeks.
Serious cases are those that show some of the symptoms after the first week of becoming infected, those that move to the pulmonary or inflammatory phase, feel fatigue, their oxygen saturation decreases, and require hospitalization and even ventilatory support; on average, taking three to six weeks for the body to stabilize again.
In very serious cases, which are patients moved to the Intensive Care Unit (ICU) and require a connection to a ventilator, can remain n the hospital for some time, even up to two months from the start of symptoms, until they die or recover.
Every patient, even in the mildest form, takes time to recover from the Covid-19.
Cases since April?
As of April 20, the Minsa reported only ten cases of Covid-19 in the entire country. The number was increased to 15 two weeks later and on May 12, there were 25 cases.
However, reports from NGO’s like Observatorio Cuidadano put the numbers much, much higher, estimating (since officials numbers not available) that the infected could be as high as 800, increased to double that this week. Which is closer to the reality in the country.
Let’s say for a moment the 199 recovered are for real, and they were mild cases, which implies about two weeks of recovery, these cases had to have been confirmed in late April or early May.
If within this statistic there are the most serious cases, of those that take from three to six weeks to show improvement, that indicates that they are patients infected in mid-April. Remember that is when the Minsa said only 10 cases in the entire country.
Contrary to previous occasions, this Tuesday the Minsa provided more data than in other press conferences, but kept its pattern of statistics confusing, without clarifying the real impact of the pandemic.
Doctors consulted all agree that it is not possible that the 199 people had recovered suddenly, thus the logical explanation is that they had been previously diagnosed and had not been reported by the Minsa.
“It is literally impossible for them to get sick and recover in a week. That is not possible from a medical point of view,” infectologist Carlos Quant told La Prensa.
The Minsa not only surprised everyone with the numbers of recovered, but it also assured that they had confirmed 254 new cases of Covid-19, a statistical jump in a week that breaks the behavior of contagion in other countries in the same period of a rise in the curve, which It is where Nicaragua is located.
Epidemiologist Rafael Amador explains that the Minsa already had these cases, but had not reported them, this reinforces the fact that the 25 infections they had referred to were “absolute underreporting,” he said.
He added that severe cases develop other complexities, but this happens not directly due to the virus, but as a consequence of the body’s response to the virus, which is the inflammatory phase and generalized coagulopathy, which involves hospital management of a patient, whose period Recovery is greater, which will also depend on the chronic diseases you suffer from.
The World Health Organization (WHO) points out that the majority (81%) of people with Covid-19 present mild symptoms without complications, in some severe symptoms that require oxygen therapy appear (14%), and approximately 5% should be treated in intensive care unties. Of the critically ill, most require mechanical ventilation.
In March, WHO Director-General Tedros Adhanom said that people recovered from Covid-19 could infect others, so they should continue 15 days after medical discharge in isolation, even if they stop having symptoms.
Quant explains that the recommendation is still valid because some patients, after recovering, can still infect someone or reinfect themselves because it is not yet known if they have sufficient immunity.
More inconsistencies
Despite the Minsa offering more data this week, there are inconsistencies which does not allow to arrive at a real total number of Covid-19 cases, how many of have recovered, are in hospital, or have died.
Dr. Miguel Ángel Orozco, health officer, explains that there is an inconsistency with the Minsa data on the number of patients recovered against the number of confirmed positive cases, either by tests or by clinical criteria, which is another category introduced by the Minsa this Tuesday.
“This is a question that must be cleared by the governing body of health. The Minsa must follow what the International Classification of Diseases X Edition (CIES-X) determines for these cases,” said the doctor.
“It is illogical to report from one report to another a total of 199 recovered, without before they had not been reported for diagnosed cases, which is how Minsa reported this new situation,” he added.
Orozco also explained that the most convenient way to manage the pandemic is to organize the information in a technical way, so that it makes epidemiological sense, that serves to make decisions, to know how the epidemic behaves in Nicaragua. The most appropriate would be to calculate the rates, or any way that allows comparing; however, these have published total data on pandemic cases, keeping accumulated, since the first contagion.
“In the country, the story is another. It is as if a game starts every week and the indicators start again, and that cannot be so, (…) this is not accounting, these are statistics that must follow the technical norms of the case,” he told La Prensa.
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