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From April 10 to May 10, a dozen Felician sisters at the Presentation of the Blessed Virgin Mary convent died of Covid-19. In June, a 13th sister died after contracting the coronavirus.

Climate policy director Rhiana Gunn-Wright, architect of the Green New Deal, explains the connections between the pandemic and the climate crisis.

Shortly after instituting coronavirus disease 2019 (COVID-19) mitigation measures, such as banning air travel and closing schools, the South African government implemented a national lockdown on 27 March 2020 when there were 402 cases and the number of cases was doubling every 2 days ([ 1 ][1]). This drastic step, which set out to curb viral transmission by restricting the movement of people and their interactions, has had several unintended consequences for the provision of health care services for other prevalent conditions, in particular the prevention and treatment of tuberculosis (TB) and HIV. Key resources that had been extensively built up over decades for the control of HIV and TB are now being redirected to control COVID-19 in various countries in Africa, particularly South Africa. These include diagnostic platforms, community outreach programs, medical care access, and research infrastructure. However, the COVID-19 response also provides potential opportunities to enhance HIV and TB control. In Africa, the COVID-19 epidemic is unfolding against a backdrop of the longstanding TB and HIV epidemics. South Africa ranks among the worst-affected countries in the world for both diseases. Despite having just 0.7% of the world’s population, South Africa is home to ∼20% (7.7 to 7.9 million people) of the global burden of HIV infection ([ 2 ][2]) and ranks among the worst affected countries in the world for TB, with the fourth highest rate of HIV-TB co-infection (59%) ([ 3 ][3]). South Africa has made steady progress since 2010 in controlling both diseases. Increased access to antiretroviral drugs for treatment and for prevention of mother-to-child transmission of HIV has resulted in a 33% reduction in AIDS-related deaths between 2010 and 2018 ([ 2 ][2]). Similarly, the death rate among TB cases has declined from 224 per 100,000 population in 2010 to 110 per 100,000 population in 2018 ([ 3 ][3]). Have the strategies implemented for COVID-19 mitigation, particularly the lockdown, inadvertently threatened these gains in HIV and TB? HIV and TB polymerase chain reaction (PCR) tests are key to treatment initiation and monitoring to achieve the United Nations goals for the control of HIV and TB. Disturbingly, these diagnostic tests declined during the lockdown. The 59% drop in the median number of daily GeneXpert TB tests—a cartridge-based PCR test capable of diagnosing TB within 2 hours while simultaneously testing for drug resistance—was accompanied by a 33% reduction in new TB diagnoses ([ 4 ][4]). The restriction of people’s movement and curtailment of public transport has led to substantial declines in patient attendance at health care facilities. A survey of 339 individuals in South Africa revealed that 57% were apprehensive about visiting a clinic or hospital during the lockdown, in part because of concerns that they may be exposed to infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from COVID-19 patients attending these facilities ([ 5 ][5]). Delayed HIV and TB testing impedes initiation of appropriate treatment, which increases the risk of new infections and drug resistance ([ 6 ][6]). Both TB and HIV diagnostic platforms are important contributors to COVID-19 testing. The GeneXpert point-of-care testing platform, which is widely used in South Africa to diagnose TB, with more than 2 million individuals tested annually ([ 7 ][7]), is also being used to diagnose COVID-19. Until now, the limited availability of the GeneXpert COVID-19 cartridges has meant that spare capacity is mostly being used with little, if any, displacement of TB testing. Because there was also a decline in CD4+ assays (to test for immune status in HIV patients), it indicates decreased demand rather than displacement because this assay is not used for COVID-19. This may change as the demand for COVID-19 point-of-care testing rises and GeneXpert cartridges for COVID-19 become more readily available. South African clinical laboratories have substantial capacity to perform high-throughput PCR assays for HIV viral load (more than 50,000 tests per day). However, the lack of COVID-19 test kits in South Africa, stemming from the global shortage, has meant that the available spare capacity on these platforms has sufficed for COVID-19 testing. The full potential of this PCR capacity is likely to be called upon when the country needs to expand COVID-19 PCR testing for the expected surge in cases, estimated to exceed 1 million at peak ([ 8 ][8]). Laboratory capacity for PCR testing developed for HIV and TB is now an essential resource for COVID-19 testing. The use of this capacity for COVID-19 needs to be monitored to identify and address any potential displacement of HIV and TB testing. South Africa’s experience in dealing with substantial HIV and TB epidemics has laid the foundations for the country’s rapid, early community-based response. Both TB and COVID-19 are respiratory infections and can present with similar symptoms. They therefore present substantial infection control challenges, requiring timely and rapid diagnosis. Both diseases can spread more easily in conditions associated with poverty where social distancing is difficult to implement. Well-established community outreach capabilities for contact tracing, established for TB, were deployed to undertake contact tracing and quarantine monitoring for COVID-19. With the highest HIV burden in the world, South Africa has a highly developed network of health care providers that includes tens of thousands of community health care workers who are trained to interact safely with infectious individuals and have experience in undertaking door-to-door visits in South Africa’s most socially vulnerable communities. About 28,000 HIV community health care workers were deployed for COVID-19 symptom screening and testing referral (HIV outreach was put on hold) in 993 vulnerable, high-density communities, many lacking running water, to identify cases and thus reduce time to diagnosis and hence limit transmission. As clinical cases increased, there were insufficient tests for community-based screening, creating testing backlogs that delayed hospital patient results and led to curtailment of the community program with proposed adjustment to screening and quarantine without testing. The established community engagement and outreach for HIV, TB, and noncommunicable diseases (such as hypertension and diabetes) provide an opportunity for integrating screening and testing in the long-term COVID-19 response. This approach will play an important role in reaching at-risk populations who do not readily make use of health services to establish a broader program of health promotion, prevention, and early detection. Such integration can be facilitated by the expansion of mobile onsite rapid testing approaches, using newly developed COVID-19 tests ([ 9 ][9]) and existing tests for HIV and other conditions on readily accessible samples such as saliva and blood from finger pricks. Combining health promotion programs for these diseases will reduce duplication and provide synergistic messaging because social distancing affects not only COVID-19 transmission but also that of TB and other respiratory infections. After the COVID-19 surge, integrated services could potentially provide an important approach to balancing ongoing vigilance for COVID-19 with early community-based detection of individuals with HIV and/or TB. Access to medical care for non–COVID-19 conditions was limited during the lockdown, with health facilities experiencing declines in the number of TB and HIV patients collecting their medication on schedule. The World Health Organization estimates that a 6-month disruption of antiretroviral therapy could lead to more than 500,000 additional deaths from AIDS-related illness in 2021 and a reversal of gains made in the prevention of mother-to-child transmission ([ 10 ][10]). In South Africa, 1090 TB patients and 10,950 HIV patients in one province have not collected their medications on schedule since the start of the national lockdown ([ 11 ][11]). A national survey of 19,330 individuals in South Africa found that 13.2% indicated that their medication for chronic disease was inaccessible during the lockdown ([ 12 ][12]). Furthermore, hospital admissions for HIV and TB declined as a result of hospitals reducing nonurgent admissions in preparation for a surge of COVID-19 cases and owing to closures to reduce exposure to COVID-19 patients. The potential negative impact on the continuity of care for HIV and TB patients could have substantial repercussions for both treatment and control, including development of drug resistance ([ 6 ][6]). The biological and epidemiological interaction of COVID-19, HIV, and TB is not well understood. Patients immunocompromised by HIV or with TB lung disease could be more susceptible to severe COVID-19. However, preliminary results from a study of 12,987 COVID-19 patients in South Africa indicate that HIV and TB have a modest effect on COVID-19 mortality, with 12% and 2% of COVID-19 deaths attributable to HIV and TB, respectively, compared to 52% of COVID-19 deaths attributable to diabetes ([ 13 ][13]). The small contribution of HIV and TB to COVID-19 mortality is mainly due to these deaths occurring in older people, in whom HIV and active TB are not common. Integrated medical care for these three conditions is important as COVID-19 patients coinfected with HIV or TB start attending health care services in larger numbers. South Africa’s COVID-19 response, especially the lockdown, has led to substantial economic hardship, particularly among the poor and vulnerable. This has had a disproportionate impact on women, many of whom are self-employed or day laborers without a safety net ([ 14 ][14]). This may have a longer-term effect on increasing diseases associated with poverty (such as TB) and with gender, such as HIV, for which young women bear a disproportionate burden ([ 15 ][15]). The social determinants of HIV and TB will need to be carefully monitored to assess the impact of COVID-19. The effect of the lockdown on the economy, including declining taxes, is also likely to negatively affect funding for HIV and TB programs, among many others. New and ongoing research on HIV and TB prevention and treatment have been severely affected by the COVID-19 epidemic. At the initiation of the lockdown in South Africa, the National Health Research Ethics Committee suspended all medical research, including clinical trials. Research progress on these two conditions has also slowed because several of the country’s AIDS and TB researchers are redirecting their efforts to COVID-19. However, COVID-19 research efforts have increased collaboration and created new approaches to speed up therapeutic and vaccine development and testing, which will likely have long-term benefits for medical research beyond COVID-19. Several countries in Africa have well-developed HIV and TB clinical trial infrastructure that could contribute to COVID-19 vaccine trials. Past investments in infectious disease training and research have generated handsome returns to the COVID-19 response, highlighting the importance of maintaining these investments in the future. 1. [↵][16]1. S. S. Abdool Karim , N. Engl. J. Med. 382, e95 (2020). [OpenUrl][17] 2. [↵][18]UNAIDS, Global AIDS Update 2019: Communities at the Centre (2019); . 3. [↵][19]WHO, Global TB Database: 2000–2018 (2018); . 4. [↵][20]National Institute for Communicable Diseases, Impact of COVID-19 Intervention on TB Testing in South Africa (2020); . 5. [↵][21]1. A. Rademeyer , The Ask Afrika COVID-19 Tracker: Unpacking the Significant Social Change Brought On by the COVID-19 Pandemic (2020); . 6. [↵][22]1. J. B. Nachega et al ., Infect. Disord. Drug Targets 11, 167 (2011). [OpenUrl][23][CrossRef][24][PubMed][25] 7. [↵][26]National Health Laboratory Service, Annual Report 2018/2019 (2019); . 8. [↵][27]1. S. Silal et al ., Estimating Cases for COVID-19 in South Africa (2020); . 9. [↵][28]1. Z. Li et al ., J. Med. Virol. 10.1002/jmv.25727 (2020). 10. [↵][29]WHO, “The cost of inaction: COVID-19-related service disruptions could cause hundreds of thousands of extra deaths from HIV” (2020); . 11. [↵][30]Gauteng Province Department of Health, COVID-19 Impacts on Health Services in Gauteng (2020); . 12. [↵][31]Human Sciences Research Council, “HSRC responds to the COVID-19 outbreak” (2020); . 13. [↵][32]1. M.-A. Davies , Western Cape: Covid-19 and HIV/Tuberculosis (2020); . 14. [↵][33]1. C. de Paz et al ., Gender Dimensions of the COVID-19 Pandemic (World Bank, 2020); . 15. [↵][34]UNAIDS, Global AIDS Update 2018: Miles to Go (2018); . Acknowledgments: We thank C. Baxter, W. Stevens, and A. Rademeyer for their assistance as well as the South African Department of Science and Innovation and Medical Research Council. Both authors are members of the South African Ministerial Advisory Committee for COVID-19. [1]: #ref-1 [2]: #ref-2 [3]: #ref-3 [4]: #ref-4 [5]: #ref-5 [6]: #ref-6 [7]: #ref-7 [8]: #ref-8 [9]: #ref-9 [10]: #ref-10 [11]: #ref-11 [12]: #ref-12 [13]: #ref-13 [14]: #ref-14 [15]: #ref-15 [16]: #xref-ref-1-1 “View reference 1 in text” [17]: {openurl}?query=rft.jtitle%253DN.%2BEngl.%2BJ.%2BMed.%26rft.volume%253D382%26rft.spage%253De95%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [18]: #xref-ref-2-1 “View reference 2 in text” [19]: #xref-ref-3-1 “View reference 3 in text” [20]: #xref-ref-4-1 “View reference 4 in text” [21]: #xref-ref-5-1 “View reference 5 in text” [22]: #xref-ref-6-1 “View reference 6 in text” [23]: {openurl}?query=rft.stitle%253DInfect%2BDisord%2BDrug%2BTargets%26rft.aulast%253DNachega%26rft.auinit1%253DJ.%2BB.%26rft.volume%253D11%26rft.issue%253D2%26rft.spage%253D167%26rft.epage%253D174%26rft.atitle%253DHIV%2Btreatment%2Badherence%252C%2Bdrug%2Bresistance%252C%2Bvirologic%2Bfailure%253A%2Bevolving%2Bconcepts.%26rft_id%253Dinfo%253Adoi%252F10.2174%252F187152611795589663%26rft_id%253Dinfo%253Apmid%252F21406048%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [24]: /lookup/external-ref?access_num=10.2174/187152611795589663&link_type=DOI [25]: /lookup/external-ref?access_num=21406048&link_type=MED&atom=%2Fsci%2F369%2F6502%2F366.atom [26]: #xref-ref-7-1 “View reference 7 in text” [27]: #xref-ref-8-1 “View reference 8 in text” [28]: #xref-ref-9-1 “View reference 9 in text” [29]: #xref-ref-10-1 “View reference 10 in text” [30]: #xref-ref-11-1 “View reference 11 in text” [31]: #xref-ref-12-1 “View reference 12 in text” [32]: #xref-ref-13-1 “View reference 13 in text” [33]: #xref-ref-14-1 “View reference 14 in text” [34]: #xref-ref-15-1 “View reference 15 in text”

The coronavirus disease 2019 (COVID-19) pandemic will have consequences for human populations. Worldwide, mortality levels are certainly affected. The worst-hit northern Italian provinces recorded losses of period life expectancy of 2 to 3.5 years for men and 1.1. to 2.5 years for women, the largest decline in life expectancy since the 1918–1919 influenza pandemic and World War II ([ 1 ][1]). Similar patterns follow in other countries ([ 2 ][2]). With the focus firmly on deaths, the scientific debate risks overlooking that population dynamics are also shaped by fertility trajectories. Throughout history, spikes in mortality owing to events such as wars, famines, and pandemics were followed by changes in fertility, resulting in fewer births in the short term and by recuperation in subsequent years ([ 3 ][3]). Economic and social change triggered by a pandemic is also likely to influence childbearing intentions and completed fertility. How the COVID-19 pandemic will affect fertility has implications for the rate of population aging, shaping future health challenges and economic growth potential across the globe. There are frequent claims that the ongoing pandemic will result in a “baby boom.” Couples, it is argued, spend more time with each other and, as such, they are more likely to procreate. The empirical evidence for this is sparse. Instead, recent studies focusing on the short-term fertility consequences of natural disasters, such as earthquakes and hurricanes, find that peaks in mortality are generally followed by birth troughs within a year; whereas studies focusing on a longer time frame, from 1 to 5 years following the event, have unveiled patterns of increasing fertility ([ 4 ][4]). Drivers of these medium-term rebounds are the desire of parents to replace lost children, as well as structural shifts in expectations on the survival probability of offspring. In the wake of unexpected mortality shocks, fertility may also take on a symbolic meaning, as new births become a positive reframing mechanism, signaling a return to normality. A relationship between excess influenza deaths and a 9-month lagged depression in births was observed by Jacques Bertillon in seminal studies on the impact of the 1889 influenza outbreak on the population of France ([ 5 ][5]). This relationship was further explored in the context of the largest pandemic of the last century, the 1918–1919 H1N1 influenza A pandemic (the so-called “Spanish flu”). In the United States, it caused a 13% drop in birth rates from 1918 to 1919 ([ 6 ][6]). Channels for adverse fertility effects include the increased mortality and morbidity of adults in reproductive age; higher frequency of maternal mortality and stillbirths; and slowdowns in conceptions, owing to fear of infections and decreased social mixing. As for subsequent positive fertility effects, the literature disagrees on whether the baby boom that followed in 1920 should be attributed to the direct effects of the pandemic or to the end of World War I, or to a mix of both. Peace led to a recuperation of postponed marriages and childbearing after couples reunited, as well as remarriage of war widows ([ 7 ][7], [ 8 ][8]). ![Figure][9] Possible post-pandemic fertility trajectories according to regional income level The social measures aimed at reducing coronavirus disease 2019 (COVID-19) infection may be expected to have different effects on fertility, depending on societies’ development and stage of the demographic transition, and ultimately, on population density and age distribution. ART, assisted reproductive technology. GRAPHIC: H. BISHOP/ SCIENCE Although heuristically useful, historical comparisons suffer several limitations. In particular, unlike the 1918–1919 influenza, COVID-19 affects older people more than other age groups. Therefore, the mortality and morbidity of potential parents is not a viable mechanism for negative short-run fertility changes today. In addition, during the COVID-19 pandemic, child mortality has been negligible, removing one of the main drivers of the fertility rebounds observed in the combined mortality-fertility crises of the Malthusian era. Moreover, the unfolding effect of the COVID-19 pandemic on fertility will depend on the ways in which societies have developed and at what stage they are in the demographic transition, from regimes characterized by high birth rates and lack of contraception, to controlled and low fertility (see the figure). Over the past century, world fertility has undergone major change. Although high birth rates remain the norm in the poorest rural areas of the world, high-income countries, several transition economies, and most urban regions within low- and middle-income countries reached approximately replacement fertility levels of 2.1 children per woman. Some countries even plunged to extremely low fertility rates of

This spring, the Haíɫzaqv (Heiltsuk) First Nation on the West Coast of Canada cancelled their 2020 commercial spawn-on-kelp herring fishery season in response to the coronavirus disease 2019 (COVID-19) pandemic ([ 1 ][1]). This fishery constitutes a central economic and cultural activity ([ 2 ][2]), the rights to which the Nation fought to have recognized through precedent-setting efforts, including a successful Supreme Court ruling ([ 3 ][3]) and the occupation of a federal fisheries office, which led the Canadian government to engage in more meaningful co-management ([ 4 ][4]). The Haíɫzaqv fishery closure demonstrates the effectiveness of informed, responsible decision-making by community members themselves. Community- and Indigenous-led governance and decision-making authority, as exemplified by the Haíɫzaqv Nation, should be recognized and upheld across the world. The Haíɫzaqv closure decision was made locally, by the fishers in the community. The closure bore substantial costs, both directly (such as lost income) and indirectly (such as lost eligibility for government income benefits). However, opening would have brought out-of-town members to the Nation’s village of Wágḷísḷa (Bella Bella) to participate. With fishers working in close proximity, the fishery would have risked bringing and spreading COVID-19 to this remote community with limited medical capacity. An outbreak would pose heightened risks to Elders ([ 5 ][5])—cultural leaders and knowledge holders who comprise most of the remaining fluent speakers of Haíɫzaqvḷa, the Haíɫzaqv language. These potential consequences were prioritized by the fishers, who considered the trade-offs and decided that opening was not worth the risk. The Haíɫzaqv fishery closure contrasts with decisions by other governments and industries in Canada to continue resource extraction despite COVID-19 risks ([ 6 ][6]). It also demonstrates an alternative to centralized management approaches. State-led fisheries have faced criticism for making decisions that are isolated from the nuances of individual communities ([ 7 ][7]), for viewing resources through a narrow lens of stock productivity and extraction ([ 8 ][8]), and for paying too little attention to complex social outcomes ([ 9 ][9]). COVID-19 requires a coordinated worldwide response, but empowering at-risk communities and those most directly affected by resource extraction [and movement of people ([ 10 ][10])] provides a powerful and just means for supporting well-being and resilience ([ 5 ][5], [ 11 ][11], [ 12 ][12]). 1. [↵][13]1. S. Wood , “Adapting to coronavirus: How B.C. First Nations balance food security and conservation,” The Narwhal (2020). 2. [↵][14]1. A. Gauvreau et al ., Ecol. Society 22, 10 (2017). [OpenUrl][15] 3. [↵][16] R. v. Gladstone , 2 S.C.R 723 (1996). 4. [↵][17]1. S. Harper et al ., Maritime Stud. 17, 1 (2018). [OpenUrl][18] 5. [↵][19]1. K. Gunn , “Indigenous peoples and COVID-19: Protecting people, protecting rights” (Centre for Constitutional Studies, 2020). 6. [↵][20]1. W. Bernauer, 2. G. Slowey , Extract. Indust. Society 10.1016/j.exis.2020.05.012 (2020). 7. [↵][21]1. R. Hilborn et al ., Phil. Trans. R. Soc. Ser. B 360, 47 (2005). [OpenUrl][22] 8. [↵][23]1. R. L. Stephenson et al ., Can. J. Fish. Aquat. Sci. 76, 480 (2019). [OpenUrl][24] 9. [↵][25]1. M. R. Poe et al ., Ecol. Econ. 116, 241 (2015). [OpenUrl][26] 10. [↵][27]1. D. Selkirk , “Why First Nations communities are uninviting visitors,” BBC (2020). 11. [↵][28]1. R. Robinson, 2. D. Shaw, 3. M. Slett, 4. W. Webber , “Opinion: How B.C. health authorities are undermining Indigenous governments,” Globe and Mail (2020). 12. [↵][29]1. N. J. Bennett et al ., Coast. Manag. 10.1080/08920753.2020.1766937 (2020). [1]: #ref-1 [2]: #ref-2 [3]: #ref-3 [4]: #ref-4 [5]: #ref-5 [6]: #ref-6 [7]: #ref-7 [8]: #ref-8 [9]: #ref-9 [10]: #ref-10 [11]: #ref-11 [12]: #ref-12 [13]: #xref-ref-1-1 “View reference 1 in text” [14]: #xref-ref-2-1 “View reference 2 in text” [15]: {openurl}?query=rft.jtitle%253DEcol.%2BSociety%26rft.volume%253D22%26rft.spage%253D10%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [16]: #xref-ref-3-1 “View reference 3 in text” [17]: #xref-ref-4-1 “View reference 4 in text” [18]: {openurl}?query=rft.jtitle%253DMaritime%2BStud.%26rft.volume%253D17%26rft.spage%253D1%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [19]: #xref-ref-5-1 “View reference 5 in text” [20]: #xref-ref-6-1 “View reference 6 in text” [21]: #xref-ref-7-1 “View reference 7 in text” [22]: {openurl}?query=rft.jtitle%253DPhil.%2BTrans.%2BR.%2BSoc.%2BSer.%2BB%26rft.volume%253D76%26rft.spage%253D480%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [23]: #xref-ref-8-1 “View reference 8 in text” [24]: {openurl}?query=rft.jtitle%253DCan.%2BJ.%2BFish.%2BAquat.%2BSci.%26rft.volume%253D116%26rft.spage%253D241%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [25]: #xref-ref-9-1 “View reference 9 in text” [26]: {openurl}?query=rft.jtitle%253DEcol.%2BEcon.%26rft.volume%253D116%26rft.spage%253D241%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [27]: #xref-ref-10-1 “View reference 10 in text” [28]: #xref-ref-11-1 “View reference 11 in text” [29]: #xref-ref-12-1 “View reference 12 in text”

The Nicaraguan government’s disastrous coronavirus disease 2019 (COVID-19) strategy has precipitated uncontrolled contagion and deaths and threatens regional security. The crisis in Nicaragua deserves the attention of the international scientific community. Early in the pandemic, Central American countries adopted measures to fight COVID-19. Nicaragua, however, instituted only “epidemiological control at borders through surveillance,” relying on travelers to declare symptoms ([ 1 ][1]). In contrast to recommended policies, the government has kept schools and businesses open and convenes massive public gatherings ([ 1 ][1]). Nicaragua’s 347 COVID-19 deaths per million people is the highest in Central America ([ 1 ][1], [ 2 ][2]). The independent Citizen Observatory reports that COVID-19–related deaths in Nicaragua are greater than those in Panama ([ 2 ][2]), the country with the highest incidence of infections in the region ([ 3 ][3]). Scientists have called for an emergency plan and advised the Nicaraguan government to scale up testing and contact tracing of COVID-19 patients ([ 4 ][4]). A declaration signed by 34 medical associations urged citizens to implement voluntary self-quarantine ([ 5 ][5]) to curb the spread of the virus. The Pan American Health Organization (PAHO) has warned that Nicaragua refuses to report COVID-19 cases even though an appropriate response to the pandemic requires knowledge of its true magnitude ([ 6 ][6]). Nicaraguan authorities deny that the pandemic has been in the community contagion phase since May ([ 6 ][6]), and insufficient testing has led to COVID-19 deaths going uncounted. The number of deaths among health care professionals is rising ([ 7 ][7]), and at least 10 doctors have been fired for demanding protective equipment and voicing concern about the Nicaraguan government’s slow response to the pandemic ([ 8 ][8]). Because Nicaragua has given free rein to the coronavirus contagion, neighboring Costa Rica considers transmissions from Nicaragua to be the main health threat during the country’s de-confinement phase. Costa Rica has demanded that PAHO take forceful and urgent action ([ 9 ][9]). Nicaragua’s reckless handling of the COVID-19 crisis merits an exhaustive, independent audit. Supporting the efforts of local scientists and medical personnel to combat the spread of COVID-19 is a fundamental duty of PAHO and the global scientific community. 1. [↵][10]1. F. Castellani et al ., “The impact of COVID-19 on the economies of the region (Central America).” (Inter-American Development Bank, Washington, DC, 2020); [in Spanish]. 2. [↵][11]Nicaraguan Citizens Observatory on COVID-19 (2020); [in Spanish]. 3. [↵][12]1. J. R. Loaiza et al ., Rev. Panam. Salud Publica 44, e86 (2020). [OpenUrl][13] 4. [↵][14]1. M. Medrano , “More than 500 doctors in Nicaragua ask the government for a strategy against COVID-19 and protection of health personnel,” CNN (2020); [in Spanish]. 5. [↵][15]1. Y. Luna , “Medical associations in Nicaragua call for a 4-week ‘voluntary quarantine,’” Confidencial (2020). 6. [↵][16]1. I. Munguía , “PAHO: ‘In Nicaragua COVID-19 spread is already at community level,’” Confidencial (2020). 7. [↵][17]1. I. Munguía , “More than 40 health workers have died from COVID-19,” Confidencial (2020); [In Spanish]. 8. [↵][18]“Nicaragua doctors ‘fired’ for criticizing government over COVID-19,” AFP (2020). 9. [↵][19]“Costa Rican lawmakers request intervention in Nicaragua due to pandemic,” The Tico Times (2020). [1]: #ref-1 [2]: #ref-2 [3]: #ref-3 [4]: #ref-4 [5]: #ref-5 [6]: #ref-6 [7]: #ref-7 [8]: #ref-8 [9]: #ref-9 [10]: #xref-ref-1-1 “View reference 1 in text” [11]: #xref-ref-2-1 “View reference 2 in text” [12]: #xref-ref-3-1 “View reference 3 in text” [13]: {openurl}?query=rft.jtitle%253DRev.%2BPanam.%2BSalud%2BPublica%26rft.volume%253D44%26rft.spage%253De86%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [14]: #xref-ref-4-1 “View reference 4 in text” [15]: #xref-ref-5-1 “View reference 5 in text” [16]: #xref-ref-6-1 “View reference 6 in text” [17]: #xref-ref-7-1 “View reference 7 in text” [18]: #xref-ref-8-1 “View reference 8 in text” [19]: #xref-ref-9-1 “View reference 9 in text”

Coronavirus shutdowns led to “the longest and most coherent global seismic noise reduction in recorded history,” scientists report.

Join us on 26-31 July 2020 for a series of online events celebrating the art and artists who have taken the call to respond to the COVID-19 crises through the production of artwork.