Coronavirus in Central AmericaCoronavirus in Central America

Reporters

Marcela Cantero, Beatriz Benítez, Evelyn Boche y Moisés Martínez
Conexión Centroamericana

Informe especial

* This project is part of the Historias Sin Fronteras Cross-Border Science Journalism Initiative and has been made possible thanks to the support of the nonprofit journalism organization InquireFirst and the Department of Science Education of the Howard Hughes Medical Institute.

Dozens of doctors, health workers, epidemiologists and scientists have put on — many times without fully intending to — the suit of dissent to protect themselves from governments in Central America that have ignored, censored or openly turned their backs on those who argue that responses to the Covid-19 pandemic should be based on proven scientific data and not on political interests or events.

As Covid-19 sweeps through the region, the team of journalists from Conexión Centroamericana in Guatemala, El Salvador, Nicaragua and Costa Rica sought answers to the question: "What role have scientists played during the pandemic?"

This special report is vital for a region that connects the Americas but seems unfocused in the fight again Covid-19, wedged between the huge numbers of infections and deaths in the United States and the overwhelming images of bodies on the streets in countries such as Brazil, Peru and Ecuador.

The Central American isthmus cannot escape these crude scenes in the face of a pandemic that seems far from the light at the end of the tunnel. It is a region where governments look askance at the researchers who have organized themselves to inform and propose in their role as dissenters.

Medición de temperatura Until the arrival of a vaccine, masks and temperature measurements will be part of the new normal. Photo: Óscar Navarrete.

During June and July, a team of journalists from Conexión Centroamericana conducted an exhaustive review of the management of the first five months of the Covid-19 health crisis in Guatemala, El Salvador, Nicaragua, and Costa Rica. Data and health strategies were analyzed from Honduras.

In March, these countries registered their first cases of the SARS-CoV-2 virus, which causes the respiratory infection Covid-19 -- two months after the World Health Organization (WHO) declared that a new type of coronavirus was the cause of the outbreak of "atypical pneumonia”, reported on December 31 by China.

R rate of Covid-19 in Central America

The reproduction rate R shows the growth potential of an epidemic by indicating how many individuals each patient infects; for example, an R rate equal to 1 means that one infected person infects another, on average. When R is less than 1, the pandemic is on its way to being eliminated.

grafica R Covid
grafica R Covid
grafica R Covid
grafica R Covid
grafica R Covid

* Although changes in measurements and the rate R coincide; a cause-effect relationship cannot be established.
• Note: Data for Nicaragua are not valid for this analysis.

SOURCE: DEMOGRAPHER, LUIS ROSERO, CCP-UCR / MEASURES, OWN PREPARATION.


The arrival of the virus triggered disagreements between the medical-scientific community and government authorities who, for the most part, ignored their recommendations.

In this comprehensive regional project, reporters in each Central American country delve into the rupture between science and politics.

The findings of Conexión Centroamericana are based on more than 40 interviews, the compilation and review of the decisions taken by the authorities—health strategies, political responses and economic reopening. Reporters combed through data on the impact of the pandemic, including official documents, websites, social networks, videos and audios.

At the end of close of edition on July 25, the health crisis in Central America totaled 115,591 accumulated cases with 3,393 deaths. According to official data for each nation, the number rises to 120,907 patients with 5,634 deaths when data is included from independent groups in Nicaragua. Official numbers from the Nicaraguan government have been questioned by the Pan American Health Organization (PAHO).

Mortality from Covid-19

Deaths from COVID-19 speak of the severity of the pandemic, such as deaths per 100,000 older adults, the most affected group - the numerator includes deaths of all ages because there is no disaggregated data.

Deaths per 100,000 older adults / Accumulated as of August 5

barras

• Note: Data from Nicaragua are not valid for this analysis.

SOURCE: DEMOGRAPHER, LUIS ROSERO, CCP-UCR.

Vaccines Under Crucial Testing Stage

None of the Central American countries participates in any of the studies that seek a vaccine against the SARS-CoV-2 virus, the great battle against time to stop deaths from Covid-19.

Despite this, there are mechanisms through which immunization is expected to reach the isthmus, according to a top PAHO representative.

"Everyone, absolutely everyone, will have access to the vaccine under the PAHO model … Of course, there is an issue of the production capacity of the laboratories, but we can tell the region that it will have the vaccine when the time comes,” Dr. Marcos Espinal, director of PAHO’s Department of Communicable Diseases and Health Analysis, said in an interview with Conexión Centroamericana from his Washignton D.C. office.

Dr. Espinal said the countries of the Americas will have access to immunizations through PAHO’s purchasing system, which allows better prices and a "fair and equitable" distribution.

To date, there are 165 proposals for a vaccine, mostly in the early stages with only 23 studies in humans, according to the WHO online report, as of press time, July 25.

At the moment, the focus is on the vaccine being developed by the University of Oxford and the Swedish laboratory Astrazeneca, which demonstrated both safety and generation of an immune response to the SARS-CoV-2 virus in Phase II of the study with 1,077 participants.

Researchers have now launched Phase III with 47,000 volunteers to measure the vaccine’s effectiveness against the virus.

If proven safe and effective in Phase III trials, Astrazeneca has said it will give the first production of its vaccine at cost.

“They offer a production of 2 billion doses with 400 million doses available by the end of this year. This is a very aggressive bet — if they get the vaccine," said Dr. Jessie Orlich, director of the Costa Rican Institute for Clinical Research, in a virtual conference of the National Academy of Science of Costa Rica in which she provided an overview of immunizations under study.

"Still, it is not certain that the vaccines give prolonged immunity. A recent publication showed that patients who have already recovered present the disease again in weeks or months... It is not well known how many doses will be taken, there is no certainty of this," warned Dr. Orlich, who added that no dates can be given when it comes to research.

In addition to Astrazeneca's study, the U.S. National Institutes of Health's candidate vaccine is being tested with the biotechnology company Moderna, which, at press time, was on schedule to move to phase III on July 27 with 30,000 volunteers from that northern country.

Finally, the American laboratory Pfizer and the German company BioNTech announced that their immunization candidate has also moved on to the third phase: they will recruit 30,000 volunteers in countries such as the United States, Argentina, Brazil and Germany.

Searching for a Solution

Dr. Rolando Herrero, an epidemiologist and director of the Costa Rican Agency for Biomedical Research, stressed that scientific teams "are dedicated to research on SARS-CoV-2 in order to find solutions as quickly as possible."

Dr. Herrero is recognized for his participation in the global study of the human papillomavirus vaccine.

In August, Dr. Herrero will join the group of scientists searing for solutions with the launch of RESPIRA: a study with 5,000 volunteers -- infected and healthy -- which will measure the level of antibodies in the body and how long this immunity remains after an infection by Covid-19 in order to clear up doubts about possible reinfections with the virus.

It will recruit 5,000 volunteers among the sick and the control group -- patients cared for by the Costa Rican Social Security Fund, an ally of this work.

In addition, as part of RESPIRA, the form of transmission of the virus in the families of the patients will be studied, with the research conducted in coordination with the National Institute of Allergies and Infectious Diseases of the United States.

Dr. Herrero's work is an example of the initiatives of Central American scientists whose brains are focused on the demands of a crisis where uncertainty is the only certainty.

Dr. Marcos Espinal
Director of PAHO’s Department of Communicable Diseases and Health Analysis

"Everyone, absolutely everyone, will have access to the vaccine under the PAHO model … Of course, there is an issue of the production capacity of the laboratories, but we can tell the region that it will have the vaccine when the time comes”

Dr. Jessie Orlich
director of the Costa Rican Institute for Clinical Research

“They offer a production of 2 billion doses with 400 million doses available by the end of this year. This is a very aggressive bet — if they get the vaccine,"

34 Countries Will Share Innovations

A looming question is democratic access to this knowledge, as well as treatment and immunization options.

In response to a proposal by the Costa Rican government, the World Health Organization (WHO) created the COVID-19 Rights Repository.

Launched on May 29, the goal is for member countries to place diagnostic tests, devices, drugs, and also vaccines they have developed with free access or licensing on reasonable terms for WHO countries. As of July, 34 nations were part of the repository.

"In the case of treatments that are developed privately there are two ways to access them: to voluntarily place them in the repository, or to access funds that are being worked on to purchase patents that are part of that repository," explained Costa Rican President Carlos Alvarado to Conexión Centroamericana.

Carlos Alvarado Quesada

President of Costa Rica

To the Table To Talk About Health

Far from the laboratories, there is the Central American Integration System (SICA), which brings together the governments of Central America and the Dominican Republic to discuss the health crisis from a regional perspective.


Within SICA, the Council of Ministers of Health of Central America and the Dominican Republic operates a website that offers data, online training, pronouncements and bulletins on the meetings of its members.

Ironically, since June 25, Nicaraguan Health Minister Martha Reyes, has been presiding over the council. At home, the senior Nicaraguan official rushes through her report on Covid-19 cases in less than two minutes before the official press of her country.



PAHO maintains its role as a specialized organization that provides recommendations with scientific evidence, logistical support for donations from other nations and the purchase of inputs at more accessible prices.

In Guatemala and Costa Rica, PAHO has advised the governments at key moments. PAHO assisted the Guatemalan government with the development of a data board for its economic reopening.

In Costa Rica, the government presented the "Health Cooperation Plan for the Northern Zone" bordering Nicaragua in June, with the participation of the United Nations -- including PAHO. In the northern border zone, the increase in cases of Covid-19 required strong border surveillance and labor and health inspections in agricultural enterprises.

PAHO Challenges Ortega

In Nicaragua, the government of Daniel Ortega claimed to have the support of PAHO in its actions against the pandemic.

In fact, during the first weeks PAHO maintained a cautious position in relation to the actions of the Nicaraguan authorities. But on April 7, PAHO took a turn when its director, Carissa F. Etienne, referred to the situation in Nicaragua in response to a question from a journalist in her press conference for the Americas.

"PAHO has been concerned about the response to Covid-19 seen in Nicaragua. We are concerned about the lack of social distancing and the convening of mass meetings. We are concerned about the examinations, the traceability of contacts and the notification of cases. We are also concerned about what we see as inadequate prevention and control of infections," said Etienne.

For his part, the PAHO representative in El Salvador, Carlos Garzón, appeared seated in the first row, listening in silence, when President Nayib Bukele has given press conferences with controversial topics that are political in nature and not health-related.


Bukele Nayib Bukele gives his reports surrounded by his cabinet, in addition, the PAHO delegate in El Salvador usually joins it. Photo: Facebook NB.

Technician, doctor, scientist. In times of COVID-19, everything goes through the filter of politics in Central America. The countries that achieve the best match of science and politics will find their way out of the cycle of infection and death. Those that don’t, scientists worry, will be battling Covid-19 and a rising death toll for months, if not years, to come.


Coronavirus
Credits

This project is part of the Historias Sin Fronteras Cross-Border Science Journalism Initiative and has been made possible thanks to the support of the nonprofit journalism organization InquireFirst and the Department of Science Education of the Howard Hughes Medical Institute.