Epidemiological, socio-demographic and clinical features of the early phase of the COVID-19 epidemic in Ecuador

  1. Esteban Ortiz-Prado
  2. Katherine Simbaña-Rivera
  3. Lenin Gómez Barreno
  4. Ana Maria Diaz
  5. Alejandra Barreto
  6. Carla Moyano
  7. Vannesa Arcos
  8. Eduardo Vásconez-González
  9. Clara Paz
  10. Fernanda Simbaña-Guaycha
  11. Martin Molestina-Luzuriaga
  12. Raúl Fernández-Naranjo
  13. Javier Feijoo
  14. Aquiles R. Henriquez-Trujillo
  15. Lila Adana
  16. Andrés López-Cortés
  17. Isabel Fletcher
  18. Rachel Lowe

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Abstract

The SARS-CoV-2 virus has spread rapidly around the globe. Nevertheless, there is limited information describing the characteristics and outcomes of COVID-19 patients in Latin America. We conducted a cross-sectional analysis of 9,468 confirmed COVID-19 cases reported in Ecuador. We calculated overall incidence, mortality, case fatality rates, disability adjusted life years, attack and crude mortality rates, as well as relative risk and relative odds of death, adjusted for age, sex and presence of comorbidities. A total of 9,468 positive COVID-19 cases and 474 deaths were included in the analysis. Men accounted for 55.4% (n = 5, 247) of cases and women for 44.6% (n = 4, 221). We found the presence of comorbidities, being male and older than 65 years were important determinants of mortality. Coastal regions were most affected by COVID-19, with higher mortality rates than the highlands. Fatigue was reported in 53.2% of the patients, followed by headache (43%), dry cough (41.7%), ageusia (37.1%) and anosmia (36.1%). We present an analysis of the burden of COVID-19 in Ecuador. Our findings show that men are at higher risk of dying from COVID-19 than women, and risk increases with age and the presence of comorbidities. We also found that blue-collar workers and the unemployed are at greater risk of dying. These early observations offer clinical insights for the medical community to help improve patient care and for public health officials to strengthen Ecuador’s response to the outbreak.

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  1. Version published to 10.1371/journal.pntd.0008958
  2. ScreenIT

    SciScore for 10.1101/2020.05.08.20095943: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableRelative risks (RR) and 95% confidence intervals were computed for all age groups using female cases as the reference level.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    One of the main limitations in understanding the development of COVID-19 in Ecuador is the lack of molecular testing capabilities 31. In January, alarms went off with the first suspected COVID-19 case in Ecuador, alarms that denoted the poor readiness of the public health system that took more than 15 days to rule-out a highly suspicious COVID-19 patient, who died with the diagnosis of hepatitis B and atypical pneumonia 32,33. At the beginning of the outbreak, the World Health Organization (WHO) emphasized the importance of testing capabilities in order to improve case tracing and diseases detection worldwide (Figure S8-Appendix 1). Nevertheless, Ecuador has not enough capabilities to perform molecular diagnosis (RT-PCR), limiting epidemiological surveillance strategies and case tracing 15,34 For this reason, the number of samples taken exceeds the local molecular diagnosis capabilities, causing that thousands of tests are not been reported in a daily basis 11,12 Despite the limitations, in some areas of the country, especially richer areas, such as Samborondon, testing rates are as high as those seen in Iceland or even close to those seen in the US (Supplementary Table 3 – Appendix 1) 35. This trend might be driven by those patients who were able to pay for their diagnosis and their medical treatment. Therefore, their high attack rate is interpreted as better access to health resources and that is why mortality is also low among these cantons. Although social status and mont...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  3. Version published to 10.1101/2020.05.08.20095943 on medRxiv