Ecuadoran Health System in a State of Collapse

Though the government reports that only 503 Ecuadorans have died of Covid-19, The New York Times estimates that the toll is 15 times greater.

Soldiers deliver food to poor people quarantined against the novel coronavirus in Zambiza near Quito, Ecuador, on April 2. (AP photo/Dolores Ochoa)

(CN) — With hundreds of cadavers waiting to be picked up from Ecuadoran homes in late March and early April, the cadaver collection system collapsed. Guayaquil, Ecuador’s largest city, suffered the nightmare of a horror movie.

With no way to get rid of those who had died at home, when the bodies began to decompose families without robust males hired men to wrap the body in a sheet and drag it outside.

The images were broadcast across the world: people pulling the dead into the streets and leaving them there. Some bodies were driven to hospitals and dropped in the street, others driven to cemeteries and dumped, according to local news reports and many social media contributions.

How could this have happened?  And could it happen again?

Ecuador, like nearly every country in Latin America, was introduced to Covid-19 by travelers who arrived from Spain and Italy during the last week of February, according to the Council of the Americas, the office reporting Latin America’s official statistics of the emergency. The contagion took root in cities with direct airline connections to Italy and Spain and slowly spread outward, similar to the pattern in the Eastern United States.

A woman who had been living in Spain was identified as case number 1. She flew to Guayaquil from Spain and tested positive. The Ecuadoran government was aware of other new cases in and around Guayaquil but was slow to recognize the rapidity of the spread. 

In spite of a decree to limit crowds, a soccer match with 17,000 spectators was permitted in Guayaquil on March 4. El Comercio, an Ecuadoran daily, reports that despite the previous appearance of six Covid-19 cases, the game against Barcelona was too big to cancel.

Within 10 days Guayaquil was filled with infection. Despite the warnings and calls for social distancing, Guayaquileños refused to abide by the restrictions. The threats to human health were ignored by authorities and by the population of Guayaquil, according to Expreso, another Guayaquil daily.

In the wealthy neighborhood of Puntilla, a gated community in the suburbs filled with folks who regularly travel to Europe, the rich kept partying in defiance of the warnings. The Pacific beaches were packed in mid-March. The first death from Covid-19 was reported on March 13. Gatherings of more than 250 people were banned. Four days later the airport was closed to international flights.  

On March 18 the national government issued a stay-at-home order. But half of the people of Guayaquil, as in most of Latin America, live in the informal economy, peddling things. They simply cannot stay home without government assistance.  

On March 23 the government promised $60 cash to the neediest families. People jammed the streets around the banks that were passing out the money, in defiance of the distancing recommendation, according to El Universo, a Guayaquil daily.

People kept mingling. Within days the hospitals were full, doctors were overwhelmed and hundreds of people had died in their homes. The municipal employees in charge of removing bodies were unprepared. Funeral companies shut down rather than risk proximity to infected corpses.

On Thursday the government acknowledged that it had underreported the number of deaths by half, but The New York Times reported that same day that the official number of deaths was more likely just one-fifteenth the true number.

The government reported 503 deaths from Covid-19 from March 1 to April 15, but the Times said the number of deaths during that period this year exceeded the toll from the year before by 7,600 deaths. But with accurate tests in short supply, the true numbers will never be known.

President Lenin Moreno has slashed the health care budget, vowing to reprivatize a health system that had been nationalized by his predecessor, Rafael Correa. Funding for health care dropped from $306 million during Correa’s final year in 2017 to $130 million in 2019 under Moreno — a drop of 58%.

In 2019 alone, 3,680 jobs were eliminated in the Health Ministry. El Universo reports that an additional 2,500 to 3,500 health workers have been notified that their jobs are being cut. The slashing of the health budget followed the political battle in 2019 over increases in the price of fuel, which was won by protesters who shut down the country.

Moreno not only eviscerated the health budget, he ordered the 400 Cuban doctors working with the Health Ministry in rural areas to leave the country in December. He also ordered all diplomatic stations to call the Guayaquil cadaver catastrophe “fake news,” and blamed the lack of readiness for the pandemic on ex-president Correa.  

Until there is a massive increase in testing, the reality of Covid-19 in Latin America will be simply a confused nightmare of health and burial systems in collapse. Many governments may prefer not to have the true numbers known, rather than acknowledge their failures.

The situation is no better in Brazil, where President Jair Bolsonaro continues to deny the severity of the pandemic of what he calls “a little flu.”

Reports today describe a situation of complete collapse in the Brazilian city of Manaus, the major city of the state of Amazonas on the Amazon River, in the middle of the rain forest.  Reports and photos indicate a massive increase in deaths of Covid-19, with overworked gravediggers becoming infected by the corpses, according to Virgilio Neto, the mayor of Manaus.

Em Tempo, a Brazilian daily, reported 409 new cases in Manaus on Thursday and 28 more deaths, bringing the confirmed dead so far to 234 in a city of 1.8 million.

Thirty-one Indian villages along the Amazon and its tributaries have reported Covid-19 infection. Throughout his reign, which began on Jan. 1, 2019, Bolsonaro has treated Brazil’s indigenous people with nothing short of contempt. With virtually no testing in Amazonia, the true number of Covid-19 deaths will never be known.

Courthouse News correspondent Miguel Patricio is based in El Salvador

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