Abstract:Latin America has struggled to control the transmission of COVID-19. Comparison of excess death (ED) rates during the pandemic reveals that Ecuador is among the highest impacted countries. In this analysis, we update our previous findings with the most complete all-cause mortality records available for 2020, disaggregated by sex, age, ethnicity and geography. Our study shows that in 2020, Ecuador had a 64% ED rate (95% CI 63% to 65%) or 64% more deaths than expected. Men had a higher ED rate, 75% (95% CI 73% t… Show more
“… 22 A large excess death rate of 64% more deaths in 2020 than 2019 were also reported in Ecuador, where it was found that indigenous populations had four times the excess death rate of the majority mestizo group, indicating unequal impact of COVID on vulnerable populations. 23 …”
ObjectiveThis article presents the Americas regional results of the WHO non-communicable diseases (NCDs) Country Capacity Survey from 2019 to 2021, on NCD service capacity and disruptions from the COVID-19 pandemic.SettingInformation on public sector primary care services for NCDs, and related technical inputs from 35 countries in the Americas region are provided.ParticipantsAll Ministry of Health officials managing a national NCD programme, from a WHO Member State in the Americas region, were included throughout this study. Government health officials from countries that are not WHO Member States were excluded.Outcome measuresThe availability of evidence-based NCD guidelines, essential NCD medicines and basic technologies in primary care, cardiovascular disease risk stratification, cancer screening and palliative care services were measured in 2019, 2020 and 2021. NCD service interruptions, reassignments of NCD staff during the COVID-19 pandemic and mitigation strategies to reduce disruptions for NCD services were measured in 2020 and 2021.ResultsMore than 50% of countries reported a lack of comprehensive package of NCD guidelines, essential medicines and related service inputs. Extensive disruptions in NCD services resulted from the pandemic, with only 12/35 countries (34%), reporting that outpatient NCD services were functioning normally. Ministry of Health staff were largely redirected to work on the COVID-19 response, either full time or partially, reducing the human resources available for NCD services. Six of 24 countries (25%) reported stock out of essential NCD medicines and/or diagnostics at health facilities which affected service continuity. Mitigation strategies to ensure continuity of care for people with NCDs were deployed in many countries and included triaging patients, telemedicine and teleconsultations, and electronic prescriptions and other novel prescribing practices.ConclusionsThe findings from this regional survey suggest significant and sustained disruptions, affecting all countries regardless of the country’s level of investments in healthcare or NCD burden.
“… 22 A large excess death rate of 64% more deaths in 2020 than 2019 were also reported in Ecuador, where it was found that indigenous populations had four times the excess death rate of the majority mestizo group, indicating unequal impact of COVID on vulnerable populations. 23 …”
ObjectiveThis article presents the Americas regional results of the WHO non-communicable diseases (NCDs) Country Capacity Survey from 2019 to 2021, on NCD service capacity and disruptions from the COVID-19 pandemic.SettingInformation on public sector primary care services for NCDs, and related technical inputs from 35 countries in the Americas region are provided.ParticipantsAll Ministry of Health officials managing a national NCD programme, from a WHO Member State in the Americas region, were included throughout this study. Government health officials from countries that are not WHO Member States were excluded.Outcome measuresThe availability of evidence-based NCD guidelines, essential NCD medicines and basic technologies in primary care, cardiovascular disease risk stratification, cancer screening and palliative care services were measured in 2019, 2020 and 2021. NCD service interruptions, reassignments of NCD staff during the COVID-19 pandemic and mitigation strategies to reduce disruptions for NCD services were measured in 2020 and 2021.ResultsMore than 50% of countries reported a lack of comprehensive package of NCD guidelines, essential medicines and related service inputs. Extensive disruptions in NCD services resulted from the pandemic, with only 12/35 countries (34%), reporting that outpatient NCD services were functioning normally. Ministry of Health staff were largely redirected to work on the COVID-19 response, either full time or partially, reducing the human resources available for NCD services. Six of 24 countries (25%) reported stock out of essential NCD medicines and/or diagnostics at health facilities which affected service continuity. Mitigation strategies to ensure continuity of care for people with NCDs were deployed in many countries and included triaging patients, telemedicine and teleconsultations, and electronic prescriptions and other novel prescribing practices.ConclusionsThe findings from this regional survey suggest significant and sustained disruptions, affecting all countries regardless of the country’s level of investments in healthcare or NCD burden.
“…When working with national data in the first half of 2020 8 , Orellana et al (2021) showed excess deaths of 112% in Manaus (state of Amazonas, Brazil) and 72% in Fortaleza (state of Ceará, Brazil), above the MRJ, which had 42%. In Ecuador, the percentage of excess deaths was 64% in 2020, and only 20% of these were attributed to COVID-19, mainly due to the low number of available tests 19 . In another study, researchers estimated an excess of 73% in Peru, the highest in the group of 77 countries studied 20 .…”
Objective: To evaluate excess mortality in the city of Rio de Janeiro, Brazil, due to the COVID-19 pandemic (March 2020 to January 2022). Methods: Ecological study using secondary data from the Brazilian Mortality Information System, having the city of Rio de Janeiro as the unit of analysis. Excess mortality was estimated by the difference between the mean number of all expected deaths and the mean number of observed deaths, considering the 2015–2019 period. The quantile regression method was adjusted. The total value of cases above that expected by the historical series was estimated. Among all deaths, cases of COVID-19 and Influenza as underlying causes of death were selected. The ratio between excess mortality and deaths due to COVID-19 was calculated. Results: We identified an excess of 31,920 deaths by the mean (increase of 26.8%). The regression pointed to 31,363 excess deaths. We found 33,401 deaths from COVID-19 and 176 deaths from Influenza. The ratio between the verified excess mortality and deaths due to COVID-19 was 0.96 by the mean and 0.95 by the regression. Conclusion: The study pointed to large excess deaths during the COVID-19 pandemic in the city of Rio de Janeiro distributed in waves, including the period of the Influenza outbreak.
“…Variations between countries may be attributed, at least in part, to differences in the extent of COVID-19 testing, political leadership, wealth, and equality, as well as the existence of informal economies and having regions and populations with limited access to health services [ 19 , 20 ]. In Ecuador, for example, all-cause mortality rose by 64% in 2020, and was markedly higher in indigenous groups, which have been historically underserved by healthcare services [ 21 ]. Notably, confirmed COVID-19 deaths in Ecuador accounted for only 21% of excess deaths, highlighting limitations in diagnostic testing [ 21 ].…”
Section: Regional Epidemiology Of Covid-19mentioning
confidence: 99%
“…In Ecuador, for example, all-cause mortality rose by 64% in 2020, and was markedly higher in indigenous groups, which have been historically underserved by healthcare services [ 21 ]. Notably, confirmed COVID-19 deaths in Ecuador accounted for only 21% of excess deaths, highlighting limitations in diagnostic testing [ 21 ]. Fig.…”
Section: Regional Epidemiology Of Covid-19mentioning
Since its initial detection in Brazil in February 2020, SARS-CoV-2 and the associated COVID-19 pandemic have continued to devastate Latin America. Specific comorbidities, as well as sociodemographic and lifestyle factors that may be more prevalent in underserved areas, have been identified as risk factors for COVID-19 infection or associated adverse outcomes. Dynamics of infections and deaths in Latin America have varied by country and temporally, as has SARS-CoV-2 variant prevalence; however, more recently, the Delta and subsequent Omicron variants have become ubiquitous. Successful pandemic responses have involved robust infection mitigation measures, testing, and smart deployment of healthcare resourcing. While in some Latin American countries up to 90% of the population is fully vaccinated (i.e., 2 doses) against COVID-19, other countries have failed to reach the World Health Organization’s 70% target. Continued focus on comprehensive surveillance, strategies to maximize vaccine availability and uptake, and mitigation of collateral damage on other aspects of public health and social services are critical for managing the COVID-19 pandemic. This review summarizes the COVID-19 experience in Latin America, including epidemiology and vaccination. Key learnings and future considerations for the ongoing pandemic response are also discussed.
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