Doctors warn of a global outbreak while official statistics capture only a fraction of total cases.

Rising infections and global origins

Respiratory infections have been increasing across Ecuador in recent weeks, fueled by the recirculation of a Covid-19 variant and a spike in flu-like illnesses. Doctors in both the public and private sector say the current situation reflects a “global outbreak” that began in the United States and Europe before reaching Ecuador.

“This outbreak has been going on for two weeks. It only reached us, but it started in the United States and Europe. The outbreak is global,” said intensive care physician John Cuenca, who practices in private clinics in Guayaquil. He urged particular care for children, the elderly, and patients with chronic conditions.

The variant driving the increase is identified as BN.181, a subline of the Omicron strain. While the mutations are relatively small, the body’s lack of immunity has allowed the virus to circulate widely. Symptoms typically include severe headaches, sore throat, fever, chills, and in some cases cough and hoarseness. Cuenca reported a 30% rise in laboratory testing demand as more patients seek confirmation of their illnesses.

A patient’s experience

For 71-year-old Mercedes Andrade, the onset was rapid. She first noticed a sore throat in the morning, followed by fever and chills that same day. By the next morning her voice was hoarse. Because she suffers from pulmonary hypertension, she immediately sought medical help to prevent complications. “Last year I developed bronchitis that lasted three months,” she recalled, emphasizing the importance of early treatment.

Official statistics and limitations

The Ministry of Public Health (MSP) has registered 1,605 cases of Severe Acute Respiratory Infections (SARI) nationwide between January and September 2, 2025. These include Covid-19 as well as Respiratory Syncytial Virus (RSV), AH1N1, influenza, parainfluenza, adenovirus, and others.

However, doctors stress that the numbers are far higher, as many patients self-medicate, buy drugs directly at pharmacies, or visit private clinics that do not report cases to the national system. Moreover, the MSP does not compile reports from all hospitals but instead relies on 19 sentinel hospitals strategically selected for epidemiological surveillance. These include facilities such as Guasmo Sur Hospital, Francisco de Ycaza Bustamante Hospital, and the Naval Hospital in Guayaquil, as well as Quito’s Vozandes, Baca Ortiz Children’s, Eugenio Espejo, and Pablo Arturo Suárez hospitals.

Most confirmed cases are concentrated in five provinces: Pichincha with 562 cases, Guayas with 466, Manabí with 121, Azuay with 105, and Cañar with 90. Together they account for 84% of nationwide infections.

RSV takes the lead

Data from the MSP shows that RSV is currently the most prevalent respiratory pathogen. It represents 50.5% of identified viruses, followed by AH1N1 at 15.3% and SARS-CoV-2 at 10.5%. In some provinces, including Carchi, El Oro, and Orellana, RSV accounts for as much as 80% of all cases.

“RSV circulation accounts for the majority of infections, far outnumbering Covid-19 and influenza,” stated the MSP in its epidemiological bulletin. Between weeks 1 and 25 of 2025, hospitalizations surged with RSV peaking between weeks 13 and 20.

Medical advice and prevention

Physicians emphasize preventive measures similar to those recommended earlier in the pandemic. Cuenca advises mask-wearing, frequent handwashing, avoiding crowded places, and seeing a doctor for proper diagnosis. “At-risk patients can develop pneumonia between the fifth and seventh days. Those who suffer the most complications are usually either very young, very old, or chronically ill,” he said.

Julio Guato, president of the Local Health Committees of Zone 8, expressed concern that many patients still refuse flu vaccinations. He recommended boosting immunity with vitamin C, maintaining a healthy diet, and avoiding excessive paracetamol use, which can damage the liver if misused.

Deaths and hospitalizations

Severe acute respiratory infections claimed 58 lives in 2024. In just the first eight months of 2025, they have already caused 51 deaths among patients treated in intensive care units and hospital wards of sentinel hospitals. Doctors fear that without broader prevention and more widespread vaccination, the toll could climb as the global outbreak continues into the coming months.