Before the covid-19 pandemic in Nicaragua, which registered its first case on March 18, 2020, some 19 people died a day from pneumonia, heart attacks, diabetes, and hypertension, according to the Ministry of Health (Minsa). However, when SAR-CoV-2 spread throughout the country, daily deaths from these causes rose to 37 in 2020 and 41 in 2021. This excess mortality, which in two years totaled 14,815 deaths, is attributable to the covid-19 according to public health experts, although during the same period the Minsa only admits 218 deaths.
In its sustained attempt to hide the true impact of the pandemic in Nicaragua, the Minsa has used these causes of “comorbidity” to classify the deaths of patients who fell ill with covid-19, as confirmed before. CONFIDENTIAL through the review of death certificates.
In its reports, the Minsa every week records the death “of people who have been under follow-up (for covid-19), due to pulmonary thromboembolism, diabetes mellitus, acute myocardial infarction, hypertensive crisis and bacterial pneumonia”, although it never reveals the deaths. These figures do not include them among those who died from covid-19, which for more than a year remained at only one every seven days.
However, the excess mortality is undeniable, according to the same data published by the Minsa in the Health Map of 2020 and 2021, published in mid-February 2022 and analyzed by CONFIDENTIAL.
The analysis reveals an excess of mortality when comparing the figures with the year before the pandemic, resulting in these deaths, attributable to covid-19, during 2020 and 2021, being 68 times higher than the total number of deaths admitted by the Minsa, which only reports 218 deaths nationwide, in those two years. In addition, this excess mortality – with 14,815 deaths from these four diseases – rises to 20,264 if eleven other “comorbidities” are included, which also multiplied in both years of the pandemic.
The analysis was performed using the “excess mortality” methodology, a retrospective assessment that was first used in 1918, to approximate the number of deaths caused by the Spanish Flu, and has also been used in tracking waves of heat and other events with an impact on the health of the population, according to the World Health Organization (WHO).
With the covid-19 pandemic, this methodology is used internationally to calculate the impact of SAR-CoV-2, and the Pan American Health Organization (PAHO) has developed a guide to use it, arguing that “surveillance of excess all-cause mortality is a reliable and comprehensive way of measuring the overall impact of mortality by covid-19”.
6,756 excess deaths in 2020 and 8,058 in 2021
To perform this analysis, CONFIDENTIAL built a database with the historical record of deaths from all causes between 2017 and 2021, and the daily average of deaths that occurred in 2017, 2018 and 2019 was calculated.
Then, the daily average of deaths reported in the years of the pandemic: 2020 and 2021, was calculated and subtracted with the average of the previous three years. The difference between the expected deaths and those that occurred revealed the excess mortality that, according to national and international health specialists, is attributable to covid-19.
This is the second analysis of excess mortality carried out by CONFIDENTIAL. The first was published in October 2020 and revealed that during the first six months of the pandemic, when the first wave occurred, there were an excess of 6,042 deaths attributed to diabetes, pneumonia, hypertension, and heart attacks, but which would have been triggered by covid-19. 19.
Independent doctors then explained that the Minsa used the pre-existing diseases of the “covid patients” to affirm that the deaths occurred due to an aggravation of these comorbidities, without considering that these would not have occurred if the person had not been infected and sickened by the coronavirus.
The new analysis of CONFIDENTIAL reveals that in all of 2020 the excess deaths from these four causes was 6,756 and during the following year, when Nicaragua suffered a second wave of covid-19 stronger than the first, excess mortality from heart attacks, pneumonia, diabetes, and hypertension was of 8,058, for a total of 14,815 attributable deaths in less than two years.
The calculations of Dr. Álvaro Ramírez and Ariel Karlinsky
The epidemiologist doctor Álvaro Ramírez, who was the national director of the Department of Epidemiological Surveillance of the Minsa, made an estimate that is close to the analysis of CONFIDENTIAL. The specialist calculates that the deaths from these four causes were 14,853. His methodology consisted of adding the deaths that occurred in 2018 and 2019 and subtracting them with those reported in 2020 and 2021, and he agrees that the excess mortality is attributable to covid- 19.
Likewise, a calculation by the Israeli researcher Ariel Karlinsky, a pioneer in the study of excess mortality worldwide, and whose data is taken up by the Our World in Data platform and the British newspaper Financial Times, estimates that the excess mortality attributable to covid -19 in Nicaragua is 15,839.
According to Karlinsky’s analysis, Nicaragua is the second country in the world with the highest underreporting. The first is Tajikistan. Its calculation is based on the data from the Health Map and also with the report of deceased by death certificate collected in the statistical yearbooks of the National Institute of Development Information (INIDE).
Increase in deaths from “pneumonia” and “heart attacks”
The figures published in the Minsa Health Map indicate that during the first year of the pandemic, in 2020, the cause of death that increased the most was pneumonia.
Before the arrival of covid-19, the average number of deaths from pneumonia was two per day. However, after the epidemic, daily deaths rose to eight. In 2020, the total number of deaths from pneumonia was 2,214.
In Nicaragua, pneumonia was the main indicator that warned of the impact of covid-19, despite the fact that the Minsa authorities did not recognize it. In April 2020, when the coronavirus circulated in the country for a month and the Minsa only admitted four deaths, epidemiologists and public health doctors alerted the population about an increase in lethality of this disease, according to the reports of the epidemiological bulletins.
After these alerts, the Minsa authorities suspended the online publication of the bulletins and it remained so until December 2021, when they published the bulletins for that year, but without including the death data.
In 2021, the average number of deaths from pneumonia decreased by six per day, for a total of 1,700 deaths attributable to covid-19 in that year. The cause of death that increased the most last year was heart attacks.
Before the pandemic, there were eight daily deaths from heart attacks. However, in 2020 these rose to 14, indicating that there were an excess of deaths of six per day, totaling 2,075 for the year. But in 2021, the daily deaths were 18, giving a surplus of nine deaths that totaled 3,382 deaths during that year.
The excess of deaths from diabetes was higher in 2020. According to the analysis, before the pandemic there was a daily average of six deaths, but in the first year of covid-19 deaths per day rose to 11, indicating an excess of five. With this daily average, they accumulated 1,791 deaths attributable to covid-19 in that year. However, in 2021 the total excess mortality due to this cause was 1,585.
Excess deaths from hypertension in 2020 are minor. The data indicates that that year there were 677 deaths attributable to the pandemic, but in 2021 these rose to 1,392, for a total of 2,068 in two years.
Minsa: 17 months reporting a weekly death
Until December 31, 2021, Central America added a total of 45,965 deaths from covid-19, according to official figures reported by each country. Nicaragua admitted 218 deceased, representing 0.47% of the regional total.
This is the lowest figure in the region and the American continent, excluding the Caribbean islands: Grenada, Dominica, Saint Vincent and the Grenadines, Antigua and Barbuda and Saint Kitts and Nevis, which do not have even a tenth of the population of Nicaragua. and they have accumulated between 45 and 216 deaths from covid-19.
The death toll from covid-19 in Nicaragua is statistically improbable, as the report from CONFIDENTIAL Minsa celebrates one year reporting a single weekly death from covid-19. The authorities assure that since October 13, 2020, only one person has died from covid-19, every week, throughout the country. Although independent doctors report more.
The death toll did not change even when the country faced the second wave, between August and October 2021. This outbreak caused the main hospitals, including the German Nicaraguan, located in Managua, and the San Juan de Dios, in Estelí, exceed their hospital bed capacity.
in these hospitals deaths averaged 30 per day in the most critical weekaccording to hospital sources reported to CONFIDENTIALthe only media outlet that did weekly monitoring of hospitalizations during the second wave.
In those months, the Minsa exceeded the record of 480 infections reported in the first wave, reaching a total of 718 in the last week of September 2021, but deaths remained frozen.
“Statistically it is unlikely, it is almost impossible. Infections and deaths go together. If infections increase, deaths also. But I think that the number of cases and deaths reported in Nicaragua is false and it is a bad falsification,” said Karlinsky, an expert in studies on mortality. The Citizen Observatory, which monitors suspicious cases and deaths, identified 10,948 infections and 2,229 deaths in 90 days. While the Minsa only admitted 7,169 infections and 13 deaths in the same period.
A few days after the second anniversary of the identification of the first case of covid-19 in Nicaragua -on March 18, 2020- the Minsa assures that 18,503 infections have occurred, of these 13,708 have recovered and 226 died. And that death toll, which excludes excess mortality data, does not include people who died from the aftermath of covid.
The sum of cases and suspicious deaths of the Citizen Observatory amounts, instead, to 32,032 infections and 5,984 suspicious deaths. However, they could be more because this independent effort lost the capacity to collect information since November 2021 “for fear of reprisals by the Government of Nicaragua.”
Other studies on excess mortality from covid-19
The first study of excess mortality in Nicaragua was presented by the Multidisciplinary Scientific Committee, which dissolved itself in 2021. The specialists indicated that as of June 2020 there were an excess of 4,429 deaths attributable to covid-19.
In October of that same year, they expanded the study and the number of deaths rose to 7569. In 2021, there was a third analysis by the Scientific Committee in which they estimated up to 9,000 deaths that occurred in the first year of the pandemic.
The Citizen Observatory and the Nicaraguan Foundation for Economic and Social Development (Funides) later carried out two other analyses. The first concluded that the deaths attributable to covid-19 were between 6,273, until August 2020, and the second estimated 9,360 in that entire year.
These calculations coincide with the case study “Covid-19 and opacity: The death formula in Nicaragua”, carried out by the Observatory for Transparency and Anticorruption, which calculated between 6,000 and 9,000 deaths from covid-19 are not recognized by the authorities.
