'There are two realities.' What is really happening in Nicaragua during the pandemic?

Gravediggers carry a coffin during a funeral at the Jardines del Recuerdo Cemetery in Managua on June 5, 2020.

(CNN)Nicaragua has seen its fair share of unrest, fear and struggles throughout its troubled history. Now, faced with the deadly coronavirus, the government is coming under fire for its casual approach to containing the pandemic.

In the past three months, at least six politicians have died, although the details are vague on some of the causes. "Express burials" are happening at night, witnesses told CNN, and doctors have been allegedly fired for raising alarm about the virus' spread. Medical experts have also questioned government-released details about the country's coronavirus infection rate.
"There are always two versions," a doctor who asked that his name be omitted for fear of losing his job told CNN, regarding information offered from the government. "The non-official is truer to reality and the government [version] is cause for confusion."
The government of Nicaraguan President Daniel Ortega has described these allegations and reports of "express burials" as "false news."
    Six months into a crisis that has shaken the world, the 74-year-old president has refused to impose strict, preventive quarantine measures seen in neighboring countries. Public schools remain open, businesses continue to operate, festivals and cultural events are happening on an almost-weekly basis.
    Even without a lockdown, businesses are suffering and the idea of closing down any work sector could lead to "an economic pandemic," Ortega told the nation during an address on May 18 -- the last time he was seen live.
    At the start of the pandemic, Ortega had also spent more than 40 days out of the public eye, and no explanation was given for his absence.
    The country has been reeling from an economic downspin following socio-political unrest in 2018 and US sanctions that are crippling the country. During his address, Ortega said neighboring Costa Rica's border closure, effective through June 30, had created a "very tough situation." Around 1,000 truck drivers were left stranded at the border, paralyzing commerce throughout the region, he added.
    What Ortega failed to mention was that Costa Rica had placed preventative measures to control the spread of Covid-19 after 50 drivers tested positive for the virus. Eleven of them were Nicaraguan, Costa Rican authorities said.
    The Pan American Health Organization has also expressed alarm about border areas. "We are witnessing a sharp spike in transmission in the north of Costa Rica around the border of Nicaragua," Dr. Carissa Etienne, the PAHO director said at a briefing on Tuesday.

    'Express burials'

    A lack of transparency from Ortega's administration has made it hard for anyone to grasp the true scope of the problem. Here's what we know:
    For many who died of the virus, there has been no Mass, no wake and no funeral arrangements, residents and a priest told CNN. There are simply what have become known as "express burials": a swift trip to the cemetery at night accompanied by police officers. A few relatives can be present, but no filming is allowed.
    Domingo Rodríguez, 44, was an immigration agent at Managua's Augusto Cesar Sandino International Airport. In early May he started showing symptoms of Covid-19 and was diagnosed with the virus. Ten days later, he passed away, according to the family.
    The cause of death was given as "atypical pneumonia" and his brother, Vladimir Rodríguez, wondered why it didn't specify Covid-19 on the certificate. When the family inquired, the staff said they were simply following orders, the brother said.
    Even though Rodríguez's death certificate did not list coronavirus as a cause, the family said they were asked by doctors to bring nails to seal the coffin and given three hours to bury him that night.
    "You couldn't see his face, he was already wrapped in a black bag," Vladimir told CNN en Español. "All they tell you is that three [or] four family members can go at a distance."
    Vladimir said a police patrol followed them to the cemetery to ensure nobody was taking pictures "so they don't make it public," he added.
    Despite the police presence, a family member managed to shoot a video shared with CNN showing the darkness surrounding the cemetery and men in yellow hazmat suits carrying the casket, an unsettling farewell to a loved one.
    The government has rejected such reports. First Lady and Vice President Rosario Murillo said the scenes of night burials were "videos from other countries, pretending to make you believe they are videos from Nicaragua." Addressing the nation in mid-May, she added, "there are those who specialize in what we have said, pandemics of fear, of hate, from false news."
    But Monseñor Carlos Aviles Cantón, a Catholic church leader, told CNN the absence of information from the government was a problem in its own right.
    While churches were never officially closed by order of the government, many parishes in Nicaragua have taken it upon themselves to tell their followers to stay home. Monseñor Aviles Cantón offers two Masses a week via Facebook Live and the rest is inside the church, with just three or four people attending.
    As for the express burials, he said they happen so quickly he can't get to the cemeteries in time to officiate. Sometimes, he does a video chat with the family and they pray. Sometimes, it's just the hearse passing by the church and they pray.
    But his workload has nearly tripled. Before the pandemic, there were usually 3-4 names of the deceased he would read out loud and pray for during Mass. Now, there are 10-12 names of those that have died and 5-6 requests to pray for those who are sick, he said.

    What doctors and medical organizations say

    What started as daily government-sponsored press events about the coronavirus turned a few weeks ago into a rapid-fire weekly briefing. This week, for example, the government's update took only seven and a half minutes.
    As of Tuesday, Nicaragua's health ministry has reported 1,823 confirmed coronavirus cases and 64 deaths. But medical experts told CNN the number is significantly higher.
    "There are two realities, what the government tells you and what we are seeing," epidemiologist Dr. Leonel Argüello Yrigoyen told CNN on the phone. "What the government reports is at least four times less than what the Observatory is reporting."
    Dr. Argüello Yrigoyen was referring to the Nicaragua Covid-19 Citizen Observatory, an interdisciplinary monitoring group of epidemiologists, medical professionals and students working to "fill the void of information about Covid-19 in Nicaragua," according to its website.
    The Observatory reported that as of June 10 there were 4,971 suspicious cases and 1,398 suspicious deaths from the virus. Coronavirus test data are solely controlled by the government.
    On Monday, a group of at least 33 independent medical organizations in Nicaragua released a joint statement saying that community transmission was a serious threat.
    "The first thing the government needs to do is admit there is a health problem and not make this a political issue," Dr. Argüello Yrigoyen said. "They need to make space to address the problem and recognize that an epidemic exists. So many deaths could be avoided."
    The medical organizations also highlighted the firings of health workers who raised the alarm or demanded better personal protective equipment.
    "In the last days the Health Ministry of Nicaragua decided to dismiss medical colleagues of diverse specialties without justification, the Nicaraguan people losing generations of teachers, professional experience and with great humanism that in the midst of the global health crisis are vital importance in the care of patients," the group statement said.
    At least 15 medical personnel have recently been forced to quit or were fired, Dr. José Antonio Vásquez, president of Nicaragua's Medical Unit, told CNN en Español in an interview. Many of them have been in their professions for over 20 years, according to doctors who were interviewed or who posted their dismissal letters on social media.
    The Nicaraguan Center for Human Rights also condemned the government's actions, describing the dismissals as "unusual and outrageous."
    Not only are health workers losing their jobs, some are dying and getting sick at an alarming rate. According to the Observatory, at least 536 health personnel have shown Covid-19 symptoms and 61 are suspected to have died from the virus as of June 10. The government has yet to recognize any of these deaths or infections in the health sector.
    CNN reached out to the health ministry and government's office for comment on the firing and deaths of medical personnel and received no response.

    Unexplained deaths and painful decisions

    Six politicians in Nicaragua have passed away since mid-May, according to an unusual government announcement by Vice President Murillo, though the cause of death for some is unclear.
    Murillo reported the deaths of two mayors, one of whom died after a blood sugar spike, she said. National Assembly deputy Maria Manuela Sacasa passed away from cancer, Murillo noted, though the other politicians' causes of death were not clarified.
    The lack of official guidance has created fear in the country, according to medical experts.
    Many Nicaraguans are now wary of being hospitalized, according to three doctors who spoke to CNN. Hospital numbers have decreased because people would rather stay home and be treated by family.
    Oxygen tank sales have increased, said a doctor who asked to remain anonymous for fear of losing his job.
    "People staying home is dangerous — the calm before the storm," the doctor told CNN.
    "At home they create an infection bomb because everyone in that household can be infected and you might put on a mask, but that won't help," he added.
    "I have never seen so many people self-medicating. People are desperate," Dr. Argüello Yrigoyen said.
    And with the country open for business, many have no choice but to work.
    Javier, who asked that his first name be changed for his safety, told CNN via a WhatsApp text message that he looks for credible information from the Observatory website because the government is not trustworthy.
    But he still needs to work as he's the sole breadwinner for his family. He said eight people have fallen ill at his workplace, a distribution company dealing with farm products. One of those workers had to be intubated Javier said, but he has no choice and must work.
      "There is this feeling of anguish and fear thinking about when I will get sick and if I would survive the disease. I think of my wife and daughter and how I would spend my last days," Javier said.
      "And I feel hatred toward the government, a sentiment growing in the population since the only ones guaranteed life are the rulers, who have lived in quarantine for many years."