Tracking the spread and outcome of the coronavirus in Ecuador: UPDATED FOR TUESDAY, NOVEMBER 17, 2020
Across the country, reported cases of coronavirus are going up, hospitals are seeing more admissions and ICU beds are becoming scarce, and places that had seemed to stop the virus—for example, Guayaquil—are seeing it surge back with rapid spread.
And yet, the government continues to follow its same rule book on how it tests and tracks the spread of the disease.
And because of that, as we wrote last week, most of the numbers that are coming out from the government each week are only somewhat of a “barometer,” something to tell us what direction the spread of the coronavirus is going in.
It is not an actual weekly count of cases, as the government continues to run a backlog of samples (almost 50,000 of them this week), that are tested in a somewhat disorganized way.
Since multiple labs are testing the samples, and they have multiple sample collections sets, there appears to be no rhyme or reason as to why a certain week’s tests of samples are being completed and reported. Nor is it clear that the test results are from multiple other weeks, not necessarily the week they are reported.
To make this clearer, last week we began providing a new graphic that tracks how many cases were added or subtracted to the national number, by the epidemiologic week. So, you can see how for example, that5,114 of the cases added to this week’s national numbers were actually spread over 34 other weeks. Of the 5,388 new cases reported this week, only 1,380 were from samples collected last week.
What this also means, is that we can never get a true number of how many cases happen in one week, since this backlog reporting is a continuous problem. In otherwords, if we try to only look at the 1,380 cases that the government posted for new cases for this past week, we would not be taking into account any numbers they add to this epidemiologic week in the future. That number will most certainly rise.
So, we will never have a “fixed” number that pinpoints exactly how many cases occurred in what week. The only solution for that problem would be if the government suddenly catches up on its sample backlog and can ensure that the weekly reports are done in real time.
Again, because of this, we are now taking the stance that the best real indicator of improvement (or worsening) of the COVID-19 situation will be the daily number of hospitalizations, and recorded COVID-19 deaths. For this reason, last week we added a new data set of hospitalizations, and a new graphic illustrating those numbers.
Case numbers are no more than historical snapshots
There are a lot of ways to slice the datasets into individual provinces, sample collection dates, test completion dates, and even percent of backlogged tests versus completed tests. But the point to be taken from all of this is that the current method of sample collection to test completion is completely unreliable and the results of those tests offer little in terms of epidemiologic study.
What we see in general across all the provinces, is a time-delayed snapshot of what was going on in the country. Obviously the farther out we get from a specific fixed date, the more accurate this historical reference becomes. But it does not allow a response to virus: epidemiologists can’t identify “hot spots” or causation for most of the new cases.
Two weeks ago, the Minister of Health, Juan Carlos Zevallos, acknowledged that there are thousands of backlogged tests but said that, as of November 1st, a new change was made in the system so that, in “the next phase” there will be timely data. We have seen no more reports about this “next phase.” As we still have almost 50,000 tests in backlog, we can say with confidence that we are not in the “next phase” yet.
What is perhaps even more alarming is that Zevallos said that selective tests are being made, not broad population testing, like in other countries. In other words, only spot tests are being done, which contradicts the recommendation of the World Health Organization (WHO) to contain infections through broad population testing and then isolation of the infected, either in hospitals or at home.
Furthermore, selective tests exclude asymptomatic patients, who must also be kept in isolation for 14 days. By not testing these asymptomatic patients, the epidemiological surveillance recommendation given by the WHO, in mid-March, does not apply.
How to make use of the data
What the government’s failure in the testing program tells us is this:
- The positivity rate is of little value due to spot testing.
- Weekly assumptions about increases in infections are false.
- At most, the reported numbers can only help us to identify trends in the spread of the virus.
- The graphical charts provided for the nation, Pichincha, Guayas, Manabi and Azuay, do offer both historical and real-time figures of infection and can be considered to be useful tools. However, even in these charts, there will be trailing test results that cause a skew in the data.
- Deaths and hospital admissions and transfer to ICU beds (which are reported daily by the hospitals), may be the best way to track the pandemic in Ecuador.
With these things in mind, while we will continue to track and report the analysis of some of the numbers as we have been, but we will put additional emphasis on the reported number for hospitalized patients and reported deaths(see new datasets and graphs). We have added a new section to the “COVID-19 Test Results” spreadsheet that gives a picture of the hospitalizations rates.
In four provinces—Pichincha, Guayas, Azuay and Manabi—and on a national level, the graphical charts provided by the Ministry of Health (page 3 of the graphical charts) do offer some real-time analysis of the rate of infection, if they are compared to the preceding week.
However, there will still be a trailing of results that will mean that each of these graphs will completely change each week, and there may be peak weeks that will not show up in the graphs until weeks later.
So, while they are the best set of data available from the poorly run testing program, the interpretation of the data should always be suspect.
Test collection and processing pales in comparison to other countries
Ecuador remains behind six 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 3.36% of its population. With 596,203tests completed, Ecuador has tested 33,604/1 million people, sitting at 144th out of 215 countries tracked worldwide. 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 19.18 million people) have tested 11.23%, 14.49% and 25.15% of their populations, respectively.
Colombia has tested 112,266/1 million people and ranks 94th on the list. Peru has tested 144,910/1 million people and ranks 82nd on the list. Chile has tested 251,478/1 million people and ranks 50th on the list.
[Chile only has 8.1% more people than Ecuador but has tested 7.5 times more people!]
Venezuela, who’s economy is considered to be in the worse shape in South America has tested 7.91% of its 28.4 million people. Even Argentina, who also has serious economic issues, has tested 7.61% of its citizens.
Hospitalizations and deaths are now the focus
The number of new test results (not new cases)fell from 5,713 last week to 5,388 this week. The rate of new positive test resultsfell from 3.38% to 3.08%. Again, these figures may be across several weeks, or months. As the rapid rise in new confirmed cases in Guayas province over the last week shows, the numbers being reported showing a decline in positive tests have no real value; these figures report 410 “new cases” in Guayas, when in fact Guayaquil is reporting hundreds of new cases.
Officials in Guayaquil also announced that they recorded 426 more deaths than average in October, compared to the last two years of data. This was the highest increase in deaths above average in the last five months.
Even worse, the number of deaths above the average was 21 per day for the first 11 days of November.
Nationally, the number of hospitalizations rose slightly this week from 833 to 858, and the number of patients in the ICU rose from 343 to 354. Added to that, the number of new deaths rose from 146 to 178; this is the second week in a row of a rise in that number.
So, what we can seem to count on to establish the spread and impact of the coronavirus is the reporting of the number of new deaths and hospitalizations.
The fact that hospitalizations and the number of new deaths are rising, seems to be in conflict with the reported fall in the number of new cases.
More detail on both hospitalizations and new deaths can be found in the new graphs that follow.
The number of tests in backlog rose this week both in actual number and rate of rise. The number of tests in backlog rose from 49,175 to 49,584. The percent of tests in backlog rose 5.73% over last week.
Provincial death numbers rise
This week, 7 provinces had lower rates of new deaths than last week while the overall rate of new deaths rose from 1.15 to 1.39%. This accounts for 178 new deaths versus 146 reported last week.
Sample collection and testing both fall
With the new approach to analyzing the government provided figures, the number of new samples collected, and the number of tests completed (along with the number of tests in backlog), still remain to be very important. These figures will show us if the government shifts from its current “spot testing,” to the more appropriate broad testing recommended by the WHO.
Unfortunately, it appears that the government is taking the approach of simply trying to find “hot spots” by simply throwing test kits into the air and seeing where they land.
This week, they collected fewer 203 samples than last week, and they completed 3,144 less test than last week.
Here is a quick review of the graphical highlights below (as of Sunday, November15, 2020 at 8:00AM):
- 13,008deaths have been attributed to COVID-19.
- 596,203 test samples have been taken collected.
- 180,295tests have returned positive (+).
- 366,324 tests have returned negative (-).
- 49,584test samples remain “dammed” or backlogged in the testing process.
- 7% of the deaths have been among the ages 20 to 49 years old.
- 4% of the deaths have been among the ages 50 to 64 years old.
- Only 13.2% of the deaths have been among the ages 65 years and older.
- 0% of cases have been on males, 47.0% in females.
- Guayas province accounts for 12.9% (down from 13.0% last week) of confirmed cases (23,227) and 26.16% (down from 26.46% last week) of the confirmed deaths (3,403).
- Pichincha province accounts for 35.7% (up from 35.3%% last week) of confirmed cases (64,320) and 16.18% (down from 16.19% last week) of the confirmed deaths (2,105).
- Azuay province accounts for at6.2% of confirmed cases (11,098) and 1.64%of the confirmed deaths (214).
- No province has escaped deaths due to COVID-19.
HOW ACCURATE ARE THE NUMBERS?
The numbers from the government are only “accurate” as historical references, since they cannot guarantee that tests completed this week are from samples collected over the last seven days.
However, the graphic accompanying this article (it is provided by the government, but has been modified for easier readability), does offer some recent graphical dated information on four provinces, and at a national level.
The numbers and statistics below are based on all case data collected by the government as of 8:00 a.m. on Sunday, November 15, 2020. More detail of all of the numbers are available in the graphics that follow.
The numbers in the graphic reflect the number of people who tested positive or negative for the virus, with both the polymerise chain reaction or (PCR) test which looks for antigens and identifies the presence of the virus in the body, and the “Rapid” test which looks for antibodies to the virus and identifies a person’s immune response to the virus. The PCR test gives an earlier identification of those who have been infected by the coronavirus and whether they have an active infection. Ecuador is now only reporting new PCR test results (however, prior Rapid tests are included in its report).
These numbers do not reflect the actual total number of people infected across the country or the number of deaths that can be attributed to COVID-19. The dates on the graphic are also adjusted back to when symptoms began, not when the positive test occurred.
For those who want a deeper level of information for a particular town or city, see: https://www.gestionderiesgos.gob.ec/coe-nacional/