Excess deaths reveal the true spatial, temporal, and demographic impact of COVID-19 on mortality in Ecuador

Abstract

BackgroundIn early 2020, Ecuador reported one of the highest surges of per capita deaths across the globe.MethodsWe collected a comprehensive dataset containing individual death records between 2015 and 2020 from the Ecuadorian National Institute of Statistics and Census and the Ecuadorian Ministry of Government. We computed the number of excess deaths across time, geographical locations and demographic groups using Poisson regression methods.ResultsBetween January 1st and September 23rd, 2020, the number of excess deaths in Ecuador is 36,402 (95% CI: 35,762-36,827) or 208 per 105 population, which is 171% of the expected deaths in that period in a typical year. Only 20% of the excess deaths are attributable to confirmed COVID-19 deaths. Strikingly, in provinces that were most affected by COVID-19, such as Guayas and Santa Elena, the all-cause deaths are more than double the expected number of deaths that would have occurred in a normal year. The extent of excess deaths in men is higher than in women, and the number of excess deaths increases with age. Indigenous populations had the highest level of excess deaths among all ethnic groups.ConclusionsOverall, the exceptionally high level of excess deaths in Ecuador highlights the enormous burden and heterogeneous impact of COVID-19 on mortality especially in older age groups and indigenous populations in Ecuador that was not fully revealed by COVID-19 death counts. Together with the limited testing in Ecuador, our results suggest that the majority of the excess deaths were likely to be undocumented COVID-19 deaths.

COVID-19 outbreaks among isolated Amazonian indigenous people, Ecuador

“…By October 2020, Ecuador had more than 166 excess deaths per 100 000 population, becoming one of the countries with the highest number of coronavirus disease 2019 (COVID-19) related deaths. 1 – 3 Official data at the time of the study reported more than 170 000 confirmed COVID-19 cases and more than 8000 related deaths; however, these numbers are expected to be much higher. 3 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnosis has mainly targeted large urban areas such as Guayaquil, Quito or Cuenca, the only cities where free testing is available through the National Institute of Public Health Research.…”

“… 1 – 3 Official data at the time of the study reported more than 170 000 confirmed COVID-19 cases and more than 8000 related deaths; however, these numbers are expected to be much higher. 3 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnosis has mainly targeted large urban areas such as Guayaquil, Quito or Cuenca, the only cities where free testing is available through the National Institute of Public Health Research. Despite the institute’s efforts to improve testing capacity, 4 no more than 3000 polymerase chain reaction (PCR) tests have been performed per day in Ecuador, for a population of 17 million.…”

“…Amazonian indigenous communities are highly vulnerable to public health threats such as COVID-19 because of their extreme isolation and the poor health infrastructure in the areas they inhabit. 3 …”

“…While community leaders said that some deaths were potentially related to COVID-19, the number of COVID-19 deaths is uncertain. 3 COVID-19 outbreaks in the Amazonian indigenous communities are particularly worrying for the Tagaeri and Taromenane people, the last uncontacted groups of the Ecuadorian Amazonia at the Untouchable Zone of Yasuní National Park, where access is restricted due to the presence of uncontacted Amazonian tribes. These communities have some contact with the Waorani people.…”

“…Moreover, the effect of COVID-19 on the indigenous communities described in this study has been reported for other indigenous communities in Ecuador as well; they also have excess death rates due to COVID-19. 3 We call on the Government of Ecuador to act to improve the court-mandated measures to protect the Waorani people, as well as all the Amazonian, Andean and Coastal ethnic groups. We also call on all governments in the continent to protect the indigenous people of the Americas against COVID-19.…”