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

Author summary In this study we summarize the epidemiological trends of the early phase of the novel coronavirus disease (COVID-19) pandemic in Ecuador, the country with the highest excess mortality reported at the beginning of the global health crisis due to COVID-19 worldwide. We have carried out a complete analysis of the epidemiological trends, clinical features, risk factors associated with death and the main demographic characteristics of the first 9,468 patients. Ecuador has officially reported 474 COVID-19 confirmed deaths, nevertheless, at least 4,780 deaths were reported as acute respiratory distress syndrome (ARDS) during the same period of time, suggesting an important underreporting and undertesting of COVID-19 cases in the country. In Ecuador, COVID-19 is five times more lethal among unemployed patients when compared to white-collar workers, suggesting a strong association between poverty and mortality. This is the first epidemiological report from Ecuador that uses the official bases of the reported cases of COVID-19 in Ecuador. High altitude dwellers have lower attack rates than their sea-level counterpart, nevertheless mortality is higher among those living above 2,500 m, possibly due to reduced access to health care services. 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.