key: cord-0967711-dgsc9u3o
authors: Molina, Gabriel A.; Ayala, Andres V.; Endara, Santiago A.; Aguayo, William G.; Rojas, Christian L.; Jimenez, Galo E.; Moyon, Miguel A.; Moyon, F. Xavier
title: Ecuador and Covid-19, A Pandemic we won't be able to run away from
date: 2021-06-02
journal: Int J Infect Dis
DOI: 10.1016/j.ijid.2021.05.077
sha: fdf1c7af56b42f674ad12179c7999c46d8998923
doc_id: 967711
cord_uid: dgsc9u3o

nan

virus moved through our country, the hospitals were overwhelmed. (1, 2) Most of the medical staff was transferred to Covid-19 care to cope with the high number of cases. Medical personnel struggled around the lack of protective personnel, multiple failed treatments (including hydroxychloroquine, antibiotic and antiviral therapies, and various ventilation regimes), and the lack of hospital beds. (3) Ecuador and Latin America already had severe healthcare limitations even in the absence of a pandemic. (4) We were not prepared for this disease, and it costed us;

we witnessed the human toll that Covid-19, in places like Italy, Spain, and New York. (5) It was only a matter of time before sites like Brazil, Colombia, Guayaquil, and Quito had their turn. (1) As the unprepared healthcare workforce tried to face this deadly and unknown disease, the remainder of the population fought against another. (6, 7, 8) The lack of economic resources, job opportunities, and interruptions on schooling plunged the economy into one of the worst recessions the region had ever faced and will likely impact our behavior for decades. (9, 10) In Ecuador, even as we knew that lifting restrictions could cause a rise in the cases (as it happened in places like Spain, Italy, and Germany). The government completely lifted travel restrictions and curfew restrictions on September 12, 2020, and implemented a new health policy far from ideal. (11) Social distancing, alcohol, and hygiene measures were implemented; nonetheless, the virus was and is still here. It spread again very quickly, causing a new spike in cases and more workload on already exhausted medical personnel. (12, 13) Surgeons, especially young ones, worked alongside gynecologists, traumatologists, anesthesiologists, and other surgical specialists. We have assumed the roles of clinicians and continue to treat Covid-19 patients. (4) We have relearned medical skills and put aside our surgical knowledge to help our patients in their time of need. (5, 6) Due to the need for more hospital beds, temporary tents were placed.

When they became insufficient, many non-traditional areas were transformed into clinics, J o u r n a l P r e -p r o o f including the endoscopy unit and even the cafeteria. As a result, the staff became increasingly exhausted. The long list of patients and the overwhelming days and nights in which many patients died due to the lack of ICU beds and ventilators have forever made us question our role in this critical scenario. (4, 5, 15 ) A year has passed since the pandemic began, and the general population had had to forget the fear of the virus, especially when there were many more immediate and deadly threats at hand. (16, 17) We had to turn our sight on political and social issues, especially when the news about Covid-19 became dangerously tedious. (16) Thus, more cases appeared, and the number of patients requiring intensive care is greater than ever. Hospitals are pushed to total ICU capacity, and ICU staff have been working tirelessly with this high patient load leading to a rise in Covid-19 mortality rate. (18, 19) What could we have done when we didn't have the tools to help our patients? Many professionals resigned due to this complex scenario. However, we continue to show resilience and keep working even in these extreme situations. Holidays and days off were and continue to be restricted; we simply don't have enough personnel to handle this pandemic. This feeling of self-reproach, emotional and moral distress, risk of infection, fear of transmission to family members, death of friends and colleagues, and the loss of many patients combined with long shifts and personal isolation have affected doctors' ability to cope with an already stressful profession. (8) Not only this, but we can't forget the many professionals, especially young attendings, who before the pandemic were seeking additional training or looking for a fellowship program, the residents who were looking for more suitable job positions, and the interns and students who were expecting to learn more surgical skills. (20) We were all denied these opportunities.

Covid-19 demanded our full attention, and despite this, we failed. The number of deaths is so underwhelming that the official numbers fell short. Many patients died undiagnosed without being able to access any testing or treatment. The Ecuadorian government acknowledges that the coronavirus crisis is more severe than reported, a fact that was recognized when the funeral system collapsed. (18, 20) The discovery of vaccines and the promise of job stability to the personnel who served in this pandemic gave us some hope. Yet, inadequate administration and delays have disturbed an already weakened medical staff; this feeling grows even worse when the wealthy and well-connected were given access to the vaccine even before the first responders, and long-term contracts were handed to personnel that never saw or worked beside a Covid-19 patient. (19, 20) We want to say that things are going to improve. We want to feel that there is a light at the end of the tunnel and that everything will be better when we are all vaccinated; however, the Ecuadorian reality is worrying. Many of us have lost faith in our leaders and our authorities. We fear the day when this feeling of helplessness will make us lose faith in our patients. We can only wait and show the same resilience we have shown since the beginning of this pandemic, not forgetting our calling. And above all remembering that we have a critical mission to serve our patients, not the system.

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. 

The ethics committee of our hospital has approved this manuscript

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