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The mystery of sudden deaths on the streets of Nicaragua

The alarm started on April 7, when a 55-year-old man died of a heart attack while sleeping in a section of the Roberto Huembes market. That afternoon, Forensics workers arrived by Don Pepe’s body wearing white protective suits that covered them from head to toe, a precaution that seemed suspicious to many, considering that the world is experiencing a Covid-19 pandemic.

On May 6, Don Irineo Delgadillo Méndez, 67, died on the road while riding his motorcycle. His case is one of the most recent in the wave of sudden deaths recorded in recent weeks. La Prensa

Others, on the other hand, called for calm and asked not to jump to conclusions.

But just a day later, security guard Benito Uriarte, 54, died of a heart attack while working security at a gas station in the city of León. A man who happened to be passing by saw him put a hand to his chest before falling struck on the floor of the premises.

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After four days without an incident, on April 13, three people joined the list of deaths from a heart attack. University student Elton Vílchez, 21, died in a Matagalpa hospital to which he had been transferred the previous day after suffering a drop in blood pressure. The other two victims were Mercedes Ramos, 73, and Margarita Reyes, 98. Both residents of León.

Ramos died in the morning and a few hours later, in the late afternoon, Reyes began to feel sick. The old woman was reportedly on her way to the laundry room when she first fainted. Then she put her hands to her chest, said she felt pain in her heart, and passed out again.

In the following 23 days, the media has reported at least 14 other similar cases: sudden deaths from a heart attack or stroke.

Forensics workers in full gear to remove a body from the streets of Managua on April 7. La Prensa

Under normal circumstances, the explanation that the high temperatures are responsible for this wave of deaths could suffice. After all, if the statistics of the Ministry of Health (Minsa) are taken as a reference, during 2019 in Nicaragua 3,097 people died from acute myocardial infarction: an average of 8 people per day. But that explanation does not seem to suffice in the current circumstances.

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Expert opinion is divided. All affirm that definitely the heat of the season have something to do; But some argue that a possible link to Covid-19 should not be ruled out, an infection from which something new is discovered every day. These are the explanations behind the mystery of the sudden deaths on the streets of Nicaragua.

New evidence

Until a couple of weeks ago, cardiologist Daniel Meneses considered that there was still no scientific evidence to associate sudden deaths with Covid-19. However, recently the prestigious The New England Journal of Medicine published an article that made him change his mind.

According to the study “Out-of-hospital cardiac arrest during the Covid-19 outbreak in Italy”, between February 21 and March 31, 2020, there was an increase of 58 percent of cases in Lombardy, the region most affected by the pandemic in that country, in relation to the same period of 2019. These are 133 additional cases, of which 103 (74.4 percent) were diagnosed with Covid-19.

For Meneses, this is new evidence that suggests a relationship between the disease and sudden deaths, although it is “impossible to state conclusively.”

“What you do notice is a disproportionate increase in the reports of people on the streets who have these reactions,” he says. “At this point, the regular epidemiological estimate is out of the question.”

Coffins bound for a funeral home. Sudden deaths from heart attacks have been the order of the day in recent weeks. La Prensa

“We always had, close to Easter, an increase in heart attacks and sudden deaths, but not in these proportions. Now it is massive. Every now and then they are reporting it everywhere,” he warns.  “I think it is a little above what we regularly have from statistics. Instinctively one knows that this is new. It is a matter of perception because there is no clear statistic, but epidemiologically, so many cases are already significant.”

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Another phenomenon that must be taken into account, points out the doctor, is the reduction of “acute coronary symptoms that reach hospitals”.

Currently, he participates in a regional study of the Latin American Society of Interventional Cardiology and in the case of Nicaragua, he says, “the rates are eighty percent less than patients.”

But “it is not that there are fewer cases, but that these cases are staying at home” for fear of catching the new coronavirus. And that, too, likely “explains a little bit of these sudden street collapses.”

On the other hand, cardiologist Pablo Hurtado considers that the phenomenon may be related to Covid-19, but for different reasons. In addition to the high temperatures, which have been unusually prolonged this year, the stress and fear caused by the pandemic are added.

José Noel Amador, 47, died of a stroke while caring for an Enacal wastewater treatment plant in Boaco. Photo from TN8

According to Hurtado, at least fifty percent of patients with hypertension do not control their disease. “It is very frequent that an uncontrolled hypertensive person can collapse from heat, if he does not hydrate well and does not take the entire treatment,” he said in an interview with LA PRENSA days ago. However, worry, anxiety and depression multiply the risk of having a heart attack.

“People are worrying more about the virus than about current health. Everyone’s current alert is the (prevention) measure, so people are very afraid, “said Hurtado, and recommended hydration and little stress. In other words, no person at risk should submit to the bombardment of the news or participate in pessimistic conversations about what has happened in places like Guayaquil.

“It should not be ruled out”

On April 17 the issue of sudden deaths returned to give something to talk about. The chinandegano Alberto Martínez died at home, after suffering a cardiorespiratory arrest caused by a heart attack. A Forensic Medicine unit came to examine the body and the coroner ruled that the man died at night while sleeping. It counted six victims of heart failure in ten days.

Three days later, on April 21, caretaker José Noel Amador, 47, died while caring for an Enacal wastewater treatment plant in Boaco. His body was found at 6:40 in the morning by a co-worker at the start of his shift. According to official media, the man died at about 4:00 a.m. when “a rise in blood pressure” triggered a stroke.

The following morning, the case of Bismarck Ruiz, 64, a former ambulance driver, became known, who suffered a heart attack when he withdrew a payment in the city of Jinotepe. And at night Mr. William Castillo, 82, was found dead in the bathroom of his home in Granada. The cause of his death was a sudden heart attack, according to the coroner.

It was not three days before another heart attack death was reported. At noon on Saturday, April 25, the veterinarian and breeder of roosters Orlando Acevedo, 73, died in Jinotepe. And on April 28, exactly a week after Boaco’s security guard died, another Enacal security guard fell to the ground while working. Domingo Antonio Laguna, 51, was found dead at dawn in a company well located on the Carretera a Masaya. A relative said that Laguna had heart problems.

On April 17, Alberto Chinandegano, 58, woke up dead in his home. His partner called the police to investigate the case. La Prensa

“They are warning signs,” he says. Deaths that “raise the red flag that the virus is already circulating, because it has the capacity to affect the heart and paralyze the system suddenly,” says epidemiologist Álvaro Ramírez.

In his opinion, the secrecy of the Government in the handling of information has been a fundamental problem.

“Trying to minimize the impact of a pandemic is what has increased doubt, uncertainty, and the number of rumors and insecurity of the population,” he says. “Also, here in Nicaragua no autopsy is performed, so all we have left is conjecture. To say that this is not associated with heatstroke is very difficult, but it cannot be ruled out that these are cases of coronavirus either”.

We will be seeing it more frequently during this process,” he says. “Although temperatures will drop, sudden deaths will continue to occur in the streets,” added Dr. Ramírez.

Covid-19 clots

As the number of sick and dead increases, doctors discover that Covid-19, the infection caused by the new coronavirus, is much more complex than initially thought.

“It can affect not only the respiratory system of patients but organs such as the liver, kidneys, intestines, heart and brain,” said the BBC World on May 5 in the article Coronavirus: blood clots, (in Spanish) the worrying pathology that many severe patients present with Covid-19.

In the CNN article of May 12, says Covid-19 isn’t just a respiratory disease, it hits the whole body and that doctors treating coronavirus patients are seeing a range of odd and frightening syndromes, including blood clots of all sizes throughout the body, kidney failure, heart inflammation and immune complications.

Currently one of the most worrisome complications is the unusual formation of blood clots in many patients with Covid-19, even in those who were receiving anticoagulants. These clots can reach organs such as the lung, heart, or brain, causing heart attacks or strokes, with fatal consequences.

In the United States, the main epicenter of the pandemic, where almost 1.5 million cases and more than 80,000 deaths had already been confirmed last week, many doctors already place clots among the main causes of death in patients with Covid- 19, only behind severe acute respiratory syndrome (SARS).

Article translated from La Presna El misterio de las muertes súbitas en las calles de Nicaragua published May 9, 2020.

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