Portal de Periódicos da CAPES

Ecuador and Covid-19: A pandemic we won't be able to run away from

2021; Elsevier BV; Volume: 109; Linguagem: Inglês

10.1016/j.ijid.2021.05.077

1878-3511

Gabriel A Molina, Andrés Ayala, Santiago A. Endara, William G. Aguayo, Christian L. Rojas, Galo E. Jiménez, Miguel A Moyón, Fernando X Moyon,

COVID-19 epidemiological studies

Ecuador's response to the Covid-19 pandemic started on 26 February 2020 (Se registra el primer caso de coronavirus en Ecuador, 2021Se registra el primer caso de coronavirus en Ecuador – Secretaría General de Comunicación de la Presidencia Comunicacion.gob.ec..2021https://www.comunicacion.gob.ec/se-registra-el-primer-caso-de-coronavirus-en-ecuador/#:∼;:text=Ese%20fue%20el%20anuncio%20que,el%20pasado%2014%20de%20febreroGoogle Scholar). Several policies were implemented to reduce the number of infections, which partially worked. However, as the virus moved through the country, the hospitals became overwhelmed (Se registra el primer caso de coronavirus en Ecuador, 2021Se registra el primer caso de coronavirus en Ecuador – Secretaría General de Comunicación de la Presidencia Comunicacion.gob.ec..2021https://www.comunicacion.gob.ec/se-registra-el-primer-caso-de-coronavirus-en-ecuador/#:∼;:text=Ese%20fue%20el%20anuncio%20que,el%20pasado%2014%20de%20febreroGoogle Scholar; Deutsche Welle, 2020Deutsche Welle (www.dw.com. (2020). Ecuador concluirá el domingo estado de excepción por pandemia | DW | 13.09.2020. DW.COM.2020https://www.dw.com/es/ecuador-concluir%C3%A1-el-domingo-estado-de-excepci%C3%B3n-por-pandemia/a-54909273Google Scholar). Most of the medical staff was transferred to Covid-19 care to cope with the high number of cases. Medical personnel struggled around the lack of protective personnel equipment (PPE), multiple failed treatments (including hydroxychloroquine, antibiotic and antiviral therapies, and various ventilation regimes), and the lack of hospital beds (Mehta et al., 2021Mehta S. Machado F. Kwizera A. Papazian L. Moss M. Azoulay É et al.COVID-19: a heavy toll on health-care workers.Lancet Respir Med. 2021; https://doi.org/10.1016/s2213-2600(21)00068-0Abstract Full Text Full Text PDF Google Scholar). Ecuador and Latin America already had severe healthcare limitations, even in the absence of a pandemic (Thompson et al., 2020Thompson C.N. Baumgartner J. Pichardo C. Toro B. Li L. Arciuolo R. et al.COVID-19 outbreak — New York City, February 29–June 1, 2020.MMWR Morb Mortal Wkly Rep. 2020; 69: 1725-1729https://doi.org/10.15585/mmwr.mm6946a2Crossref PubMed Google Scholar). The country was not prepared for this disease, and it came with great cost. The world witnessed the human toll that Covid-19 caused in places like Italy, Spain, and New York (Adibe, 2021Adibe B. COVID-19 and clinician wellbeing: challenges and opportunities.Lancet Public Health. 2021; 6: e141-e142https://doi.org/10.1016/s2468-2667(21)00028-1Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar). It was only a matter of time before places like Brazil, Colombia, Guayaquil, and Quito had their turn (Se registra el primer caso de coronavirus en Ecuador, 2021Se registra el primer caso de coronavirus en Ecuador – Secretaría General de Comunicación de la Presidencia Comunicacion.gob.ec..2021https://www.comunicacion.gob.ec/se-registra-el-primer-caso-de-coronavirus-en-ecuador/#:∼;:text=Ese%20fue%20el%20anuncio%20que,el%20pasado%2014%20de%20febreroGoogle Scholar). As the unprepared healthcare workforce tried to face this deadly and unknown disease, the remainder of the population fought against one another (How COVID-19, 2020How COVID-19 How COVID-19 will increase inequality in emerging markets and developing economies.IMF Blog. 2020; ([Accessed 20 February 2021]. October 29)https://blogs.imf.org/2020/10/29/how-covid-19-will-increase-inequality-in-emerging-markets-and-developing-economiesGoogle Scholar, The Great Lockdown, 2021The Great Lockdown The Great Lockdown: Worst Economic Downturn Since the Great Depression.IMF Blog; IMF Blog. 2021; ([Accessed 20 February 2021])https://blogs.imf.org/2020/04/14/the-great-lockdown-worst-economic-downturn-since-the-great-depressionGoogle Scholar, Ontiveros, 2020Ontiveros E. Coronavirus "second wave": What lessons can we learn from Asia?.BBC News; BBC News. 2020; ([Accessed 20 February 2021]. June)https://www.bbc.com/news/world-asia-52807255Google Scholar). The lack of economic resources, job opportunities, and interruptions on schooling plunged the economy into one of the worst recessions the region has ever faced and will likely impact behavior for decades (Yo Me Cuido, 2020Yo Me Cuido "Yo Me Cuido", la campaña del Gobierno Nacional para incentivar el compromiso ciudadano – Secretaría General de Comunicación de la Presidencia.2020Google Scholar, Giusti et al., 2020Giusti E.M. Pedroli E. D'Aniello G.E. Stramba Badiale C. Pietrabissa G. Manna C. et al.The psychological impact of the COVID-19 outbreak on health professionals: a cross-sectional study.Front Psychol. 2020; 11https://doi.org/10.3389/fpsyg.2020.01684Crossref Scopus (316) Google Scholar). In Ecuador, even though it was known that lifting restrictions could cause a rise in cases (as happened in places like Spain, Italy, and Germany), the government completely lifted travel restrictions and curfew restrictions on 12 September 2020 and implemented a new health policy, which was far from ideal (Waters, 2020Waters M. This Pandemic Is Perilously Boring.Wired; WIRED. 2020; ([Accessed 27 February 2021]. March)https://www.wired.com/story/this-pandemic-is-perilously-boringGoogle Scholar). Social distancing, alcohol, and hygiene measures were implemented; nonetheless, the virus was and is still here. It spread again very quickly, causing a new spike in cases and more workload on the already exhausted medical personnel (Noonan, 2020Noonan P. A Look Back at the Pandemic Year.WSJ; Wall Street J. 2020; ([Accessed 27 February 2021]. December)https://www.wsj.com/articles/a-look-back-at-the-pandemic-year-11608847540Google Scholar, Hospitales enfrentan subida de casos con las UCI a tope, 2021Hospitales enfrentan subida de casos con las UCI a tope El Comercio.2021https://www.elcomercio.com/actualidad/quito-covid-hospitales-pacientes-contagiados.htmlGoogle Scholar). Surgeons, especially young ones, worked alongside gynecologists, traumatologists, anesthesiologists, and other surgical specialists, and assumed the roles of clinicians and continued to treat Covid-19 patients (Thompson et al., 2020Thompson C.N. Baumgartner J. Pichardo C. Toro B. Li L. Arciuolo R. et al.COVID-19 outbreak — New York City, February 29–June 1, 2020.MMWR Morb Mortal Wkly Rep. 2020; 69: 1725-1729https://doi.org/10.15585/mmwr.mm6946a2Crossref PubMed Google Scholar). They have relearned medical skills and put aside their surgical knowledge to help patients in their time of need (Adibe, 2021Adibe B. COVID-19 and clinician wellbeing: challenges and opportunities.Lancet Public Health. 2021; 6: e141-e142https://doi.org/10.1016/s2468-2667(21)00028-1Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar, How COVID-19, 2020How COVID-19 How COVID-19 will increase inequality in emerging markets and developing economies.IMF Blog. 2020; ([Accessed 20 February 2021]. October 29)https://blogs.imf.org/2020/10/29/how-covid-19-will-increase-inequality-in-emerging-markets-and-developing-economiesGoogle Scholar). Due to the need for more hospital beds, temporary tents were erected; when they became insufficient, many non-traditional areas were transformed into clinics, including endoscopy units and even cafeterias. As a result, staff became increasingly exhausted. The long list of patients and the overwhelming days and nights during which many patients died due to the lack of ICU beds and ventilators have forever made us question our role in this critical scenario (Thompson et al., 2020Thompson C.N. Baumgartner J. Pichardo C. Toro B. Li L. Arciuolo R. et al.COVID-19 outbreak — New York City, February 29–June 1, 2020.MMWR Morb Mortal Wkly Rep. 2020; 69: 1725-1729https://doi.org/10.15585/mmwr.mm6946a2Crossref PubMed Google Scholar, Adibe, 2021Adibe B. COVID-19 and clinician wellbeing: challenges and opportunities.Lancet Public Health. 2021; 6: e141-e142https://doi.org/10.1016/s2468-2667(21)00028-1Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar, Chughtai et al., 2020Chughtai M. Minkara A.A. Kuivila T.E. Patterson B.M. Implications of the COVID-19 pandemic on orthopaedic surgical residency and fellowship training: lost opportunity or novel experience?.Ann Transl Med. 2020; 8 (1121–1121)https://doi.org/10.21037/atm-20-3777Crossref PubMed Google Scholar, Ministro de Salud habla de la ocupación de las UCI en Ecuador y dice que 86 000 dosis de vacunas se aplicarán en 43 000 personas de grupos prioritarios, 2021Ministro de Salud habla de la ocupación de las UCI en Ecuador y dice que 86 000 dosis de vacunas se aplicarán en 43 000 personas de grupos prioritarios El Comercio.2021https://www.elcomercio.com/actualidad/ministro-salud-vacunacion-ecuador-coronavirus.htmlGoogle Scholar). A year passed since the pandemic began, and the general population had to forget the fear of the virus, especially when there were many more immediate and deadly threats at hand (Balhareth et al., 2020Balhareth A. AlDuhileb M.A. Aldulaijan F.A. Aldossary M.Y. Impact of COVID-19 pandemic on residency and fellowship training programs in Saudi Arabia: a nationwide cross-sectional study.Ann Med Surg. 2020; 57: 127-132https://doi.org/10.1016/j.amsu.2020.07.025Crossref PubMed Scopus (46) Google Scholar, Coronavirus en Ecuador, 2021Coronavirus en Ecuador No se pueden esconder los cadáveres. Antes en Guayaquil había alrededor de 35 muertes por día, hoy 150.BBC News Mundo; BBC News Mundo. 2021; ([Accessed 2 February 2021])https://www.bbc.com/mundo/noticias-america-latina-52219012Google Scholar). We had to turn our sight on political and social issues, especially when the news about Covid-19 became dangerously tedious (Balhareth et al., 2020Balhareth A. AlDuhileb M.A. Aldulaijan F.A. Aldossary M.Y. Impact of COVID-19 pandemic on residency and fellowship training programs in Saudi Arabia: a nationwide cross-sectional study.Ann Med Surg. 2020; 57: 127-132https://doi.org/10.1016/j.amsu.2020.07.025Crossref PubMed Scopus (46) Google Scholar). Thus, more cases appeared and the number of patients requiring intensive care became greater than ever. (Ministro de Salud habla de la ocupación de las UCI en Ecuador y dice que 86 000 dosis de vacunas se aplicarán en 43 000 personas de grupos prioritarios, 2021Ministro de Salud habla de la ocupación de las UCI en Ecuador y dice que 86 000 dosis de vacunas se aplicarán en 43 000 personas de grupos prioritarios El Comercio.2021https://www.elcomercio.com/actualidad/ministro-salud-vacunacion-ecuador-coronavirus.htmlGoogle Scholar) Hospitals were pushed to total ICU capacity, and ICU staff worked tirelessly with this high patient load, leading to a rise in the Covid-19 mortality rate (Funerarias registran un 50% más de servicios exequiales and Gremio dice que aparecieron negocios de "garaje", 2021Funerarias registran un 50% más de servicios exequiales Gremio dice que aparecieron negocios de "garaje" El Comercio.2021https://www.elcomercio.com/actualidad/funerarias-levantamiento-cadaveres-covid-guayaquil.htmlGoogle Scholar, El Telégrafo, 2020El Telégrafo 12 mil profesionales de la salud tendrán nombramientos definitivos. El Telégrafo, 2020https://www.eltelegrafo.com.ec/noticias/actualidad/44/medicos-contratos-definitvosGoogle Scholar). What could have been done when there were no tools to help patients? Many professionals resigned due to this complex scenario. However, many continue to show resilience and keep working even in these extreme situations. Holidays and days off were and continue to be restricted; there are simply not enough personnel to handle this pandemic. This feeling of self-reproach, emotional and moral distress, risk of infection, fear of transmission to family members, death of friends and colleagues, and the loss of many patients, combined with long shifts and personal isolation have affected doctors' ability to cope with an already stressful profession (Ontiveros, 2020Ontiveros E. Coronavirus "second wave": What lessons can we learn from Asia?.BBC News; BBC News. 2020; ([Accessed 20 February 2021]. June)https://www.bbc.com/news/world-asia-52807255Google Scholar). Not only this, many professionals, especially the young, who were seeking additional training or looking for a fellowship program, the residents who were looking for more suitable job positions, and the interns and students who were expecting to learn more surgical skills before the pandemic have been affected (Renuncia el ministro, 2021Renuncia el ministro de Salud de Ecuador tras el escándalo de vacunación - BBC News Mundo BBC News Mundo.BBC News Mundo. 2021; ([Accessed 28 February 2021])https://www.bbc.com/mundo/noticias-america-latina-56210659Google Scholar). We were all denied these opportunities. Covid-19 demanded our full attention, and despite this, we failed. The number of deaths is so overwhelming that the official numbers have fallen short. Many patients have died undiagnosed, without being able to access any testing or treatment. The Ecuadorian government acknowledges that the coronavirus crisis is more severe than reported, a fact that was recognized when the funeral system collapsed (Funerarias registran un 50% más de servicios exequiales and Gremio dice que aparecieron negocios de "garaje", 2021Funerarias registran un 50% más de servicios exequiales Gremio dice que aparecieron negocios de "garaje" El Comercio.2021https://www.elcomercio.com/actualidad/funerarias-levantamiento-cadaveres-covid-guayaquil.htmlGoogle Scholar; Renuncia el ministro de Salud de Ecuador tras el escándalo de vacunación - BBC News Mundo, 2021). The discovery of vaccines and the promise of job stability to the personnel who serve in this pandemic gave some hope. Yet, inadequate administration and delays have disturbed an already weakened medical staff; this feeling grew even worse when the wealthy and well-connected were given access to the vaccine even before the first responders, and long-term contracts were handed to personnel who had never seen or worked beside a Covid-19 patient (El Telégrafo, 2020El Telégrafo 12 mil profesionales de la salud tendrán nombramientos definitivos. El Telégrafo, 2020https://www.eltelegrafo.com.ec/noticias/actualidad/44/medicos-contratos-definitvosGoogle Scholar; Renuncia el ministro de Salud de Ecuador tras el escándalo de vacunación - BBC News Mundo, 2021). We want to say that things are going to improve. We want to feel that there is a light at the end of the tunnel and that everything will be better when we are all vaccinated; however, the Ecuadorian reality is worrying. Many of us have lost faith in our leaders and authorities. We fear the day when this feeling of helplessness will make us lose faith in our patients. We can only wait and show the same resilience we have shown since the beginning of this pandemic, not forgetting our calling. And above all remembering that we have a critical mission to serve our patients – not the system. GAM, concept, and drafting the manuscript; AVA, insight on the manuscript and help during writing; SAE, conceptualization of ideas; WGA, writing the manuscript and ideas around vaccines; CLR, writing the manuscript and ideas around Covid-19 task force; GEJ, conceptualization of ideas, in the hospital; MAM, insight on the manuscript and help during writing; FXM, insight on the manuscript and help during writing. None.