Tracking the spread and outcome of the coronavirus in Ecuador: UPDATED FOR TUESDAY, SEPTEMBER 8, 2020
Earlier this week, Ecuador’s Ministry de Salud Pública (MSP) announced that it would be publishing a new infographic model effective September 6, 2020. In its announcement it said, “the main change will be seen in the number of confirmed cases, since those detected with rapid tests will no longer be counted, only those with PCR tests.” Click here to download the infographic.
This obviously has an impact on how numbers have been tracked epidemiologically over the last four months. By subtracting 20,572 Rapid tests from its numbers, it now means that this week’s figures cannot be analyzed relative to last week’s (or the prior 16 weeks) numbers.
Of the 20,572 tests that have been removed, 11,616 were negative and 8,956 were positive.
These figures cannot simply be pulled out of the total figures and discarded; they have been pulled out of each province’s numbers for positive cases and deaths. This means that any prior comparisons on week to week data at the provincial level now have no relevance.
More changes than announced
If this was the only change that the MSP made, it would have had a short-term effect on reviewing the numbers that could potentially have been worth the change (the PCR test is considered to be more accurate than Rapid testing, and therefore may offer better statistical analysis in the long-term).
However, what the MSP failed to announce in its notice, was that they were also changing the death figures; all previous “Probable COVID-19 deaths,” that had been tracked as a separate number since March 30, 2020, have suddenly been added to all the recognized COVID-19 deaths.
So, instead of seeing an increase in the rate of new death in the 2.5%-4% range—as we have seen over the last month—this week’s death rate increased by more than 60%!
This is because the MSP added the 3,752 “Probable” deaths it had on Saturday, to the 6,772 confirmed deaths it had, to come up with a new total of 10,524 deaths related to COVID-19.
The 60.55% increase in the rate of new deaths this created, is in contrast to the 3.31% it would have been using the prior tracking method it had been providing for four months. This would have meant a more than ½ percent drop in the rate of new deaths over the prior week (3.88%).
It’s also important to note that the MSP, by removing those 8,956 positive Rapid tests from its figures, significantly changed the presentation of the curve of cases that had been appearing over the last four months. And for tracking purposes, it is nearly impossible to go back and determine (from what is published) how and when those cases had previously appeared.
In other words, there is no way to tell what epidemiologic week those cases were pulled from. Likewise, it is impossible to determine where the 3,752 “Probable” deaths have been added in.
In short, this means that we will not be doing a comparison of provincial figures this week, against last week.
We will be starting back with our comparisons of the data next week, when the country is no longer under national rules and begins transferring all policing and restrictions related to COVID-19 to the provinces and cantons.
Minor improvements made by MSP
There were several improvements in the Infographic data that the government has added.
As opposed to the nearly unreadable epidemiological curves that had been presented in the past for the national and Pichincha, Guayas, Manabi, Azuay and Santa Domingo de los Tsachilas provinces data, this week the MSP provided clear, easy-to-read curves for the national figures and the provinces of Pichincha, Guayas, Manabi and Azuay.
Also, and perhaps even more useful, the MSP added two graphical country images that detailed by province, the “Cumulative incidence rate of COVID-19 cases per 10,000 inhabitants,” and the “Percentage of positivity of RT-PCR tests in the last four epidemiological weeks.”
The cumulative incidence rate of COVID-19 cases is defined as the number of confirmed cases that occur per 10,000 inhabitants, in each province. The INEC population projected for 2020 was used.
This may have been added to bolster the argument that the number of cases as a whole, by population numbers in each province, is relatively low.
It may be a useful tool for those who are considering traveling to other provinces and are curious to see how widespread the disease was/is before traveling.
The figure illustrating the positivity rate gives a useful indication of which provinces have the highest rate of the disease against the number of tests given.It’s important to understand that different rates of testing in each province mean that comparisons between provinces is likely of little value.
Backing into some figures, we can analyze the number of Samples, Tests, Backlog Tests, Positive Tests and the Rate of Positivity
While it is impossible to analyze provincial numbers this week because of the changes the MSP has made, we can back into the figures for “SAMPLES” and“TESTS.”
By adding back in the number of positive, negative and total Rapid tests that were sampled and completed, we come up with the following figures for comparison to last week.
For SAMPLES collected, we would have 20,572 (that were removed) plus the 330,470 now being reported, for a total of 351,042. Comparing that to last week, it is an increase of 6.87%, which is lower than the 7.02% increase in sampling done last week. That is the second week in a row that this number has fallen (and 6th out of the last 7 weeks).
Using the same process for TESTS, we would have 293,553 completed tests this week compared to 278,838 last week, for a rate of increase of 5.28%, down from 6.15% last week. This is the 4th week in a row that the rate of tests completed has fallen.
We can use this week’s numbers for BACKLOG TESTS to compare to last week, without an adjustment in the figures. The 57,489 tests in backlog this week increased by 15.78%, well above the 12.22% reported last week.
The number of POSITIVE TESTS increases to 118,740, when adding back in the Rapid tests that had been removed. This gives us an increase of 4.48% in positive tests, a near 1% improvement over the 5.46% we saw last week.
As for the Positivity Rate, by adding back in the Rapid tests, we would have a total of 293,553 tests (as illustrated above), with a total of 118,740 positive tests (as illustrated above), which would give us a POSITIVITY RATE of 40.45%, an insignificant drop from 40.76% last week.
Government efforts are still behind most of South America
As was announced last week, next week the government will remove itself from overseeing the nationwide restrictions on mobility and curfews (among other constraints), with the idea that the provinces and cantons may institute them under ordinances that do not need approval from the Constitutional Court.
There are theoretically a number of ways in which this can be accomplished (see: “End of “state of exception” may not mean end of restrictions,” in last week’s issue of The Cuenca Dispatch).
Some local governments have begun to announce measures they will put in place to prevent further spread of the virus. Most will continue the traffic light system (with most operating under a YELLOW level of restrictions), while others have passed ordinances against things such as social gatherings.
Even now, in the last week when the government has authority over how the country fights against the spread of the coronavirus, the lack of testing in the country continues to be inconceivable.In the most critical factor in establishing a response to the virus, Ecuador comes in last in South America (for countries with at least 1 million people) as a percent of population.
Ecuador is also behind 6 South American countries (Brazil, Peru, Colombia, Chile, Venezuela and Argentina) in both the total number of tests given and the rate of tests per million people.
Based on the Ecuadorian Institute of Statistics and Censuses (INEC) population projections, Ecuador has only tested about 1.87% of its population. With 293,553 tests completed, Ecuador has tested 18,709/1 million people, falling to 141st out of 215 countries tracked worldwide (from 139th last week). This is dismal when compared to Ecuador’s direct neighbors.
Its neighbors Colombia, Peru and Chile (who’s population is size is closest to Ecuador at 19.14 million) have tested 5.81%, 10.22% and 13.80% of their populations, respectively.
Peru has tested 102,237/1 million people and ranks 61st on the list. Colombia has tested 58,150/1 million people and ranks 91st on the list. Chile has tested 137,965/1 million people and ranks 46th on the list.
The country with the most cases on South America, Brazil, has tested 6.77% of its population. Venezuela, who’s economy is considered to be in the worse shape in South America has tested 6.35% of its 28.4 million people. Even Argentina, who also has serious economic issues, has tested 3.12% of its citizens.
Cuenca restrictions post state of emergency are still being analyzed
Control over the use of public space, prohibition of mass events and changes in the ordinances that help prevent contagion are part of the plan that Mayor Pedro Palacios presented Friday to the Cantonal Emergency Operations Committee (COE).
The Mayor also announced that reforms to the ordinances that regulate mobility, the use of a mask and social distancing will be sent to the Cantonal Council.
He acknowledged that the increase in cases in the canton is high, but he maintains that this is dueto the fact that Cuenca is one of the cities with the highest testing capacity in the country.
“The greater the number of tests applied, obviously there will be a greater number of positive cases,” said Palacios.
The application of tests is one of the axes of the deconfinement action plan, which seeks to detect positive cases in order to isolate them.
Palacios said that this action may be completed with a loan for$249,997 from the Development Bank of Ecuador (BEDE), at an interest of 7.11%, with a one-year grace period.
To improve health services, Palacios announced that an agreement has been reached with the Mayor of Guayaquil, Cinthya Viteri, for doctors from that city to analyze the situation in Cuenca and, based on their experience, provide guidelines to improve health containment of the virus.
At the moment, an information campaign is being carried out to raise public awareness about the importance of joint responsibility in the fight against the pandemic.
The Mayor clarified that the measures to be taken will be made within the scope of municipal powers, “in compliance with the law.” He added that the National Government will be asked to specify what powers will be given to the Municipalities for the control of the coronavirus.
For now, a curfew has been ruled out, and the possible restrictions that will govern the mobility of both private vehicles and public transport are being analyzed.
The Mayor said that the controls on the occupation of public space will continue, so that there are no activities that can lead to infections, such as drinking in streets and parks. Mass eventswill be totally prohibited until further notice, Palacios added.
HOW ACCURATE ARE THE NUMBERS?
As discussed above, it is impossible to analyze the provincial numbers for this week; the changes made by the MSP mean that we are starting fresh this week and will be able to start comparing figures again next week.
However, as pointed out earlier, we were able to compare numbers for Samples, Tests, Backlog Tests, Positive Tests and Positivity Rate.
The graphics accompanying this article were provided by the government; they have been modified for easier readability.
Here is a quick review of the graphical highlights below (as of Sunday, September 6, 2020 at 8:00AM):
- 10,524 deaths have been attributed to COVID-19.
- 330,470 test samples have been taken collected.
- 109,784 tests have returned positive (+).
- 163,197 tests have returned negative (-).
- 57,489 test samples remain “dammed” or backlogged in the testing process.
- 4% of the deaths have been among the ages 20 to 49 years old.
- 0% of the deaths have been among the ages 50 to 64 years old.
- Only 14.3% of the deaths have been among the ages 65 years and older.
- 4% of cases have been on males, 46.6% in females.
- Guayas province accounts for 17.4% of confirmed cases (19,050) and 31.25% of the confirmed deaths (3,289).
- Pichincha province accounts for 22.8% of confirmed cases (25,065) and 11.69% of the confirmed deaths (1,128).
- Azuay province accounts for at 5.90% of confirmed cases (6,453) and 1.26% of the confirmed deaths (133).
- No province has escaped deaths due to COVID-19.