Background: Latin America is the most affected region by the COVID-19 pandemic in terms of excessive mortality. Diagnostic and health care capabilities are limited in this region, deficiencies resulting in poor contact tracing, insufficient medical treatment and an unprecedented number of deaths. One of the key issues to estimate the pandemic's actual impact is to track deaths as one of the most reliable indicators when SARS-CoV-2 under-diagnosis is evident. Objective: This study's objective was to estimate the number of deaths attributed to COVID-19 based on excess mortality data in Ecuador. Method: ology: An ecological study of all-cause mortality recorded in Ecuador during the year 2020. In order to calculate the total excess death relative to the historical average for the same dates in 2017, 2018 and 2019, a Poisson fitting analysis was used to identify trends on officially recorded all-caused deaths and those attributed to COVID-19. A bootstrapping technique based on central tendency measures was used to emulate the sampling distribution of our expected deaths estimator μ deaths by simulating the data generation and model fitting processes. Results: : In Ecuador, during the first year of the pandemic, at least 115,070 deaths were recorded. At least 42,453 of those were catalogued as excessive mortality when comparing with the last 3-years average (2017-2019). Ecuador is the country with the highest recorded excess mortality in the world with 6 / 100,000 deaths per capita in one single day while Peru had 2 / 100,000. This value represents an additional 408% of the expected fatalities. The province with the highest number of excess deaths was Santa Elena on Ecuador's coast, with more than 154% increment versus previous years. Conclusions: : Adjusting for population size and time, the hardest-hit country due to the COVID-19 pandemic was Ecuador. The mortality excess rate shows that the SARS-CoV-2 virus spread rapidly in the country, especially in the coastal province of Santa Elena and Guayas. Our results and the new proposed methodology could help to address the actual death toll situation during the early phase of the pandemic in Ecuador.
The World’s Deadliest Outbreak During the COVID-19 Pandemic: A Proposed Analytical Approach to Estimate Excess Mortality in Ecuador During the First Year of the Pandemic