Nicaraguan epidemiologists Leonel Argüello and Álvaro Ramírez agreed that there is enough evidence and declarations to bring suits in international courts of justice against President Daniel Ortega, Vice President Rosario Murillo and the highest authorities of the Ministry of Health for the mismanagement of the Covid-19 pandemic.
"There was major irresponsibility [in the management of the pandemic] and there is a chain of responsibility, going from the president, the vice-president, downwards," said Argüello, during a panel shared with Ramírez in the program Esta Semana, in which they evaluated the management of Covid-19 in Nicaragua in the context of the announcement by the World Health Organization of the end of the international public health emergency.
"The Ministry of Health [Minsa]," Argüello continued, "is who should take action because it has a team of medical auditors." These auditors are obliged to investigate what happened and "apply the different kinds of sanctions, be they administrative sanctions or referrals to the criminal side."
Argüello explained that a "verbal autopsy" can be done on the pandemic in Nicaragua. This would consist of talking to the relatives of the deceased and the doctors who treated the cases in order to "reconstruct" cases that could be used in a suit for "mismanagement".
Ramírez, who was director of epidemiology at Minsa in the 1990s, recalled that there are precedents of similar investigation processes, but that a "forensic reconstruction" will be needed to measure the impact of the pandemic on Nicaraguans, as well as to attribute judicial responsibilities "to the people in charge of what should have been an international health response."
"The president of South Africa [Thabo Mbeki] is being taken to international courts for mishandling the AIDS epidemic, and the same is happening in Brazil [with Covid]. This is going to need a structure, an international framework, in which to reconstruct what happened in Nicaragua," Ramírez said.
Nicaragua subscribes to the International Health Regulations of the Pan American Health Organization (PAHO), which advises governments on how to proceed when a health problem such as the pandemic occurs. However, PAHO cannot oblige countries to comply nor sanction them if they don't.
"PAHO [did not] have to say that Nicaragua was super prepared. They practically repeated [the regime's discourse] until reality overtook the country and they had to make a 180-degree turn. PAHO also has responsibility in this matter," stressed Ramírez.
Argüello, who was the Ministry of Health's general director of Hygiene and Epidemiology in the 1980s, agrees that PAHO has some degree of responsibility, as do those who are giving millionaire loans to the regime for work on a pandemic it claimed it had controlled.
Ortega only acknowledges 245 deaths in three years
Daniel Ortega's dictatorship minimized the Covid-19 pandemic. Despite the high number of hospitalizations and deaths that were independently reported, Minsa claims there were only 245 deaths. The last death they recognize occurred at the beginning of July 2022. However, excess mortality analyses, based on official data, disprove this version.
"The latest study conducted by [the medical journal] The Lancet on excess mortality suggests that some 32,000 people died in Nicaragua. And I believe that is quite close to reality. That is a barbaric number. It is as if we had had a war in Nicaragua. Indeed, that is what it was, a unilateral war," said Argüello.
Ramírez, who has made estimates of excess mortality, affirmed that in the whole world, there are only three countries where there was an "evident mismanagement of Covid-19": Nicaragua, Belarus and Tanzania.
"In these three countries, there was no follow-up, impact was made to seem less than it was, and international obligations to inform the community about the number of official cases were not fulfilled. Because of all this, the data is not officially known and there is a lot of doubt," Ramírez said.
Ramírez added that in the case of Nicaragua, with the national excess mortality studies, an estimated excess of 16,700 deaths due to diabetes, pneumonia, hypertension and heart attacks occurred between 2020 and 2023. The excess mortality for these four causes is attributable to Covid-19, and when other causes are considered, the calculation goes up even more.
In Nicaragua, Minsa used these four causes of death to hide deaths caused by Covid-19. According to doctors and relatives of the deceased, the patients were infected with the coronavirus, which aggravated their pre-existing medical conditions. However, Covid-19 was the main cause of their deaths.
Excess mortality studies identify Nicaragua as the Central American country with the highest excess number of deaths attributable to the pandemic. "All countries had excess mortality, but the number of deaths in Nicaragua was absolutely avoidable, because we knew what they were dying from," lamented Argüello.
Civil society was key in the management of Covid-19
Both doctors agreed that the Ministry of Health failed to take advantage of the willingness of the population to respond to the international emergency, so Nicaraguans had to organize and protect themselves on their own.
"Despite having health volunteers with Health Ministry structures in different places, and despite having a population that was really willing to work on the epidemic, none of this was taken advantage of, it was all thrown away," said Argüello, who is in exile because of his work on the pandemic.
Argüello, who led the Multidisciplinary Scientific Committee that provided preventive information during the pandemic and was dissolved due to pressure from the regime, explained that the support of the population for the medical community was overwhelming. "Everyone was willing to support and we even had the problem of not having the capacity to involve so many people who wanted to help. That's a great problem to have."
"We delivered protective equipment all over the country, except for one hospital in Matagalpa that said no, so we wanted to send it somewhere else. We told them we were going to denounce them in the media if they didn't return the equipment we'd delivered, but we managed to get it back. All this was done with funds that people donated, things like oxygen tanks that we took to people's homes so that they wouldn't die," Argüello said.
This article was originally published in Spanish in Confidencial and translated by our staff.