In the past three months, at least six politicians have died, although details are vague on some of the causes. "Express burials" take place at night, witnesses told CNN, and doctors were reportedly fired for alarming the spread of the virus. Medical experts have also questioned government-released details of the country's coronavirus infection rate.
"There are always two versions," a doctor, who asked to have his name omitted for fear of losing his job, told CNN about the government's information. "The unofficial is more faithful to reality and the government [version] is confusing. "
The government of Nicaraguan President Daniel Ortega has called these allegations and information "express burials" "false news".
After six months of crisis that shook the world, the 74-year-old president refused to impose strict and preventive quarantine measures in neighboring countries. Public schools remain open, businesses continue to operate, festivals and cultural events take place almost every week.
Even Without Lockouts, Businesses Suffer, and Idea of Closing Any Labor Sector Could Lead to "Economic Pandemic," Ortega told the nation in May 18 speech - the last time he was seen live.
At the start of the pandemic, Ortega had also spent more than 40 days out of public view, and no explanation was given for his absence.
The country is in shock from an economic crisis following the socio-political unrest of 2018 and the American sanctions that paralyze the country. In his speech, Mr. Ortega said that the closure of the border to neighboring Costa Rica, effective until June 30, had created a "very difficult situation". About 1,000 truckers have been stranded at the border, paralyzing trade across the region, he added.
Ortega did not mention that Costa Rica had implemented preventive measures to control the spread of Covid-19 after 50 drivers tested positive for the virus. Eleven of them were Nicaraguans, said the Costa Rican authorities.
The Pan American Health Organization has also expressed concern about border areas. "We are witnessing a sharp increase in transmission in northern Costa Rica around the Nicaragua border," said Dr Carissa Etienne, director of PAHO, on Tuesday.
"Express burials"
The lack of transparency in the administration of Ortega has made it difficult for anyone to grasp the true scope of the problem. Here's what we know:
For many people who died from the virus, there were no mass, no revival and no funeral arrangements, residents and a priest told CNN. There is simply what has been called "express burials": a quick trip to the cemetery at night accompanied by police. Some relatives may be present, but no filming is allowed.
Domingo Rodríguez, 44, was an immigration officer at the Augusto Cesar Sandino International Airport in Managua. In early May, he started showing symptoms of Covid-19 and was diagnosed with the virus. Ten days later, he died, the family said.
The cause of death was mentioned as "atypical pneumonia" and his brother, Vladimir Rodríguez, wondered why Covid-19 was not specified on the certificate. When the family inquired, staff said they were just following orders, said the brother.
Although Rodríguez's death certificate did not mention the coronavirus as the cause, the family said the doctors asked them to bring nails to seal the coffin and had three hours to bury it 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 distance. "
Vladimir said a police patrol followed them to the cemetery to make sure no one was taking photos "so they don't make it public," he added.
Despite the presence of the police, a family member managed to shoot a video shared with CNN showing the darkness surrounding the cemetery and men dressed in yellow jerseys carrying the coffin, a disturbing farewell to a loved one.
The government has rejected such reports. First Lady and Vice President Rosario Murillo said the night burial scenes were "videos from other countries, pretending to make you think they were videos from Nicaragua". Addressing the nation in mid-May, she added, "there are those who specialize in what we have said, pandemics of fear, hate, fake news."
But Monseñor Carlos Aviles Cantón, a Catholic church leader, told CNN that the lack of government information was a problem in itself.
Although churches have never been officially closed by order of the government, many parishes in Nicaragua have committed to telling their congregants to stay home. Monseñor Aviles Cantón offers two masses a week via Facebook Live and the rest are inside the church, with only three or four people present.
Regarding express burials, he said that they happen so quickly that he cannot 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 walking past the church and they pray.
But his workload has almost tripled. Before the pandemic, there were usually 3-4 names of the deceased whom he read aloud and prayed during mass. Now there are 10-12 names of those who died and 5-6 requests to pray for those who are sick, he said.
What doctors and medical organizations say
What started out as daily government-sponsored coronavirus press events turned into a quick-fire weekly briefing a few weeks ago. This week, for example, the government update only took seven and a half minutes.
On Tuesday, the Nicaraguan health ministry reported 1,823 confirmed cases of coronavirus and 64 deaths. But medical experts told CNN that the number was considerably higher.
"There are two realities, what the government is telling you and what we are seeing," CNN epidemiologist, Dr. Leonel Argüello Yrigoyen, said on the phone. "What the government reports is at least four times less than what the Observatory reports."
Dr. Argüello Yrigoyen was referring to the Citizens' Observatory of Nicaragua Covid-19, an interdisciplinary monitoring group made up of epidemiologists, health professionals and students working to "fill the information vacuum on Covid-19 in Nicaragua, "according to its website.
The Observatory reported that as of June 10, there were 4,971 suspected cases and 1,398 suspected deaths from the virus. Coronavirus test data is only controlled by the government.
On Monday, a group of at least 33 independent medical organizations in Nicaragua released a joint statement claiming that community transmission was a serious threat.
"The first thing the government needs to do is admit that there is a health problem and not make it a political problem," said Dr. Argüello Yrigoyen. "They have to make room to tackle the problem and recognize that an epidemic exists. So many deaths could be avoided."
Medical organizations also highlighted the dismissals of health workers who sounded the alarm or demanded better personal protective equipment.
"In the past few days, the Nicaraguan Ministry of Health has decided to fire medical colleagues from various specialties without justification, the Nicaraguan people losing generations of teachers, professional experience and great humanism which, in the midst of the global health crisis, are vitally important in patient care, "said the group's press release.
At least 15 medical personnel have recently been forced to resign or have been dismissed, said Dr. José Antonio Vásquez, president of the Nicaragua medical unit at CNN en Español in an interview. Many of them have practiced their profession for more than 20 years, according to doctors interviewed or who published their dismissal letters on social networks.
The Nicaraguan Center for Human Rights also condemned the government's actions, calling the dismissals "unusual and outrageous".
Not only do health workers lose their jobs, some die and fall ill at an alarming rate. According to the Observatory, at least 536 health workers have shown symptoms of Covid-19 and 61 are suspected of having 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 contacted the Ministry of Health and the government office for comments on the layoffs and deaths of medical personnel, and received no response.
Unexplained deaths and painful decisions
Six Nicaraguan politicians have died since mid-May, according to an unusual government announcement by Vice President Murillo, although the cause of death for some is unclear.
Murillo reported the deaths of two mayors, one of whom died after an increase in blood sugar, she said. National Assembly member Maria Manuela Sacasa died of cancer, noted Murillo, although the causes of death of other politicians have not been elucidated.
The lack of official guidance has created fear in the country, according to medical experts.
Many Nicaraguans now fear hospitalization, according to three doctors who spoke to CNN. The number of hospitals has decreased because people prefer to stay at home and be treated by their families.
Sales of oxygen tanks have increased, said a doctor who asked to remain anonymous for fear of losing his job.
"People who stay at home are dangerous - calm before the storm," the doctor told CNN.
"At home, they create an infectious bomb because everyone in this household can be infected and you could put on a mask, but that won't help," he added.
"I have never seen so many people taking care of themselves. People are desperate," said Dr. Argüello Yrigoyen.
And with the country open to business, many have no choice but to work.
Javier, who requested that his first name be changed for his safety, told CNN via a WhatsApp text message that he was looking for credible information on the Observatory's website because the government was not trustworthy.
But he still has to work because he is the only breadwinner in his family. He said eight people fell ill at his workplace, a distribution company specializing in agricultural products. One of these workers must have been intubated, said Javier, but he has no choice but to work.
"There is this feeling of anxiety and fear when I think about when I will get sick and if I will survive the illness. I think about my wife and daughter and how I will spend my last days," said said Javier.
"And I feel hatred towards the government, a growing feeling in the population since the only guaranteed for life are the leaders, who have been living in quarantine for many years."
CNN's Natalie Gallón reported and wrote from Mexico City. Mario Medrano of CNNE in Managua, Nicaragua, contributed to this report.