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Nicaragua uses "comorbidity" to lower covid-19 case fatality

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  • Nicaragua uses "comorbidity" to lower covid-19 case fatality


    Regimen uses "comorbidity" to lower covid-19 case fatality
    coronavirus comorbidity
    "They want to justify a lot of deaths, with another name," asks the doctor; there are "other conditions" caused by viruses that can affect seven organs
    Keyling T. Romero
    June 2, 2020

    The Nicaraguan Ministry of Health (MINSA) has implicitly admitted the death of patients with the new coronavirus who were excluded from official statistics, due to death due to "other complications", as stated in the last two weekly reports and in the " White Paper: Report on the covid-19 and a singular strategy ”. However, these "other complications" or "conditions", which the government has also called comorbidity, would be triggered by the virus, according to doctors and specialists.

    "They are wanting to justify that pile of deaths, giving them another name and everyone knows that. What happens is that there is no way to prove it because here who has the data is the Government. And this is not a political position, it is an obviously professional position ”, says the expert doctor in diabetes, Hugo Villareal.

    According to the Minsa data, between March 18 and May 26, only 35 people have died from the new coronavirus, placing the country with a lethality of 5%, after having the highest percentage on the continent, with a 32%. However, they acknowledge that there are other patients, who were under surveillance, who died from pulmonary thromboembolism, acute myocardial infarction, hypertensive crisis, bacterial pneumonia and diabetes mellitus.

    Even when they report these deaths, the Minsa does not include them in the list of covid-19 deaths, nor does it give details of how many there are. As if the Government of Guatemala, which reported and included in the statistics two people who died due to "causes unrelated to COVID-19" that had tested positive.

    "They are trying to hide the existence of the disease in its real dimension. They try to make people think that they were going to die anyway because they had this disease and in this way they take away the responsibility that they have ”, says the epidemiologist, Rafael Amador.

    Comorbidity is not a direct cause of death

    Medical research indicates that only 5% of covid-19 patients will develop the disease in a serious way, and those who are at higher risk are people with chronic diseases and comorbidities such as diabetes, hypertension, heart disease, cancer, HIV, among others.

    This occurs because when the virus comes into contact with the body what it does is duplicate itself and travel through the bloodstream. Then, the immune system fights against it so that it does not continue increasing in number.

    In this process, specialists have explained, there are people who develop what in medicine is known as an “immunological storm”. That is, the cells that should protect us attack us; and if the patient already had a chronic disease, the virus attacks that condition, causing its death in the worst case scenario.

    "If you have a heart condition and you get the coronavirus, it may happen that the organ that is going to affect you in the whole process is going to be the heart because it is the weakest link. (…) And there are people who are dying of the heart, but it is as a consequence of the virus ”, explains Dr. Amador.

    However, he adds, this does not mean that all people with comorbidities will die. If they receive good care and have their chronic condition under control, the chances of successfully overcoming the disease increase.

    "What the covid is doing is accelerating the death of the people who are contagious, who had some chronic abused base disease, and who arrived late to the hospital to be treated," explains the epidemiologist.

    The harm of covid-19 to diabetics

    According to the Minsa data, some of the deaths of people with covid-19 were due to diabetes mellitus. And although they are patients belonging to the most vulnerable group, their death cannot be attributed only to this condition.

    "The diabetic patient who gives him covid-19 does not die from diabetes, he dies from covid. What happens is that diabetes is a chronic disease that conditions a decrease in the immune system. So the system is depressed and predisposes him to get sick, ”explains the diabetologist Hugo Villareal.

    In Nicaragua, for the past three years, diabetes is second on the list of chronic diseases. According to the National Health Map, in 2019 84,846 cases were registered and there were 2,253 deaths throughout the country.

    "When people with diabetes develop a viral infection it may be more difficult to treat due to fluctuations in blood glucose levels and possibly the presence of complications from diabetes," says the International Diabetes Federation of Spain .

    The biggest complication that occurs in the body of diabetics is that since they cannot process blood sugar, it crystallizes and causes the obstruction of veins and arteries, preventing the person from receiving oxygen. This condition is worsened because several studies indicate that covid-19 causes an inflammatory process, which in simple words, causes the blood to thicken, leading to the formation of clots.

    Covid-19 predisposes pulmonary thromboembolism

    When the formation of clots and micro clots — known as thrombi — begins, especially in the lower extremities, they travel inside the body and obstruct the pulmonary alveoli, which is where the exchange of oxygen and carbon dioxide occurs. But with an obstruction, oxygen cannot enter the bloodstream.

    "When there are enough thrombi, they alter the ventilation-perfusion, that is, the blood that reaches the lung, will reach the socket and will exchange the bait with oxygen. So, if it is "plugged," oxygen no longer reaches the tissues, this is another cause of fatigue and deaths that covid-19 will cause, "explains pulmonologist Mario Espinoza.

    Given this background, it has been discovered that if the patient with the new coronavirus keeps a record of the levels of oxygen in the body, anticoagulant treatment can be started promptly when it begins to decrease, reducing the chances of dying.

    "If you start to have symptoms and your body's oxygen is measured, if you have it above 93% you are in a safe zone, but if it falls below 93%, the alert should be triggered because it means that you are four days or five days from develop the severe form of the disease, which is when they practically arrive at the hospital to die, "says Dr. Amador.

    However, although it is true that there are deaths caused by this lack of oxygen, classified as pulmonary thromboembolism or pulmonary embolism, the main cause of death remains covid-19. Therefore, the Minsa should include these deaths in the official statistics of the evolution of the pandemic.

    "If the patient with covid presents a rapid deterioration of his oxygenation with a circulatory collapse, the direct cause of death is probably pulmonary thromboembolism, but the basic cause will continue to be covid-19," says the pulmonologist, Pablo Cuadra.

    "All atypical pneumonia is covid-19"

    Of all these diseases that are related to covid-19, the only known data on their incidence is pneumonia. According to official information until May 15 of this year, 309 deaths have occurred, 87 more than last year. And many of the deaths, although they are from patients with the new coronavirus, are being classified as atypical pneumonia.

    "All excess deaths since March 18 here is attributed to coronavirus pneumonia, because, in addition, we are not in the pneumonia season. Therefore, almost all, if not all, the deaths at this time should be attributed to the coronavirus, "says Dr. Jorge Iván Miranda.

    With the increase in the fatality of pneumonia, the Ministry of Health stopped sharing the weekly epidemiological bulletin. And according to the Ortega Government, in the white paper on covid-19: "Two months after the first case, the situation of the pandemic is under control in the country." But the truth is that the country lacks transparency in data and reliable information on managing the global health crisis. Even the Pan American Health Organization (PAHO) has been concerned about the situation in Nicaragua.

    The health worker, Carlos Hernández, who predicted the start of the contagion curve during the month of May, assured that in the best of scenarios these will continue to increase in the next four or six weeks. However, this will depend on the decisions made by the State to reduce infections. In addition, he revealed that projections can no longer be made using information from the region because Nicaragua moved away from the reality of the Central American countries.