key: cord-0987263-kr6s13gd authors: Santander-Gordon, Daniela; Iturralde, Gabriel A.; Freire-Paspuel, Byron; Zambrano-Mila, Marlon S.; Morales, Diana C.; Vallejo-Janeta, Paolo A.; Coronel, Barbara; Galvis, Heberson; Jaramillo, Tatiana; Bilvao, Christian D.; Rodriguez-Paredes, Maria B.; Rodriguez-Pazmiño, Sebastian; Laglaguano, Juan C.; Herrera, Henry; Tito, Ana Maria; Ortiz-Prado, Esteban; Rivera-Olivero, Ismar A.; Henriquez-Trujillo, Aquiles R.; Lozada, Tannya; Garcia-Bereguiain, Miguel Angel title: The crucial contribution of the universities on the SARS-CoV-2 surveillance in Ecuador: Lessons for developing countries date: 2021-05-25 journal: One Health DOI: 10.1016/j.onehlt.2021.100267 sha: ee060c11243655699991d9740f4b54f20eb635ed doc_id: 987263 cord_uid: kr6s13gd COVID-19 pandemic has challenged public health systems worldwide, particularly affecting developing countries in Latin America like Ecuador. In this report, we exposed the fundamental role of the Ecuadorian universities to improve COVID-19 surveillance in the country, with an overall contribution over 15% of the total SARS-CoV-2 RT-PCR tests done. We highlight the role of our university during the first semester of the COVID-19 pandemic, contributing to a massive free SARS-CoV-2 testing up to almost 10% of the total diagnosis completed in the country, mainly focus on underserved urban, rural and indigenous communities. Finally, we described our contribution to a high quality and low-cost SARS-CoV-2 RT-PCR diagnostic in Ecuador. Humanity is facing the largest pandemic and the worst public health crisis since the "Spanish flu" in 1918. The Coronaviruses Disease 2019 (COVID-19) pandemic, caused by infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has challenged public health systems worldwide since the initial outbreak in the Chinese city of Wuhan in December 2019 (1, 2) . By January 31st 2021, SARS-CoV-2 has caused more than 100 million infections and 2.2 million deaths worldwide (https://coronavirus.jhu.edu/map.html). Latin America has been deeply affected by COVID-19 pandemic, as many of the public health systems in these countries have been traditionally neglected in government funds. So, when the COVID-19 pandemic landed in Latin America, testing laboratories and hospitals were quickly overflowed (3) . Among the Latin American countries, Ecuador has suffered a severe countrywide COVID-19 outbreak since the first case was reported on February 29th 2020 in the city of Guayaquil. By January 31st 2021, the Ministry of Health (MoH) of Ecuador reported 250,828 cases and 10,177 deaths caused by SARS-CoV-2. However, with a population over 17 million people and a total number of 885,074 PCR tests realized during the whole COVID-19 pandemic period, Ecuador is among the leading countries for positivity rate (28.3%) and poor testing capacities (an average 2,626 PCR test/day). So, the true number of SARS-CoV-2 cases and deaths are probably much higher than the officially recognized ones (2) . Under this scenario, several universities have played an important role to improve SARS-CoV-2 testing capacities in Ecuador by adapting their research facilities and staff towards clinical diagnosis that were successfully certified by the Ecuadorian public health authorities. The "Pontificia Universidad Católica del Ecuador" with more than 50.000 PCR tests done, "Escuela Superior Politécnica del Litoral" and "Universidad de Las Américas", with more than 30,000 PCR tests each, are leading the universities contribution to SARS-CoV-2 PCR testing. Additionally, "Universidad Central del Ecuador" with more than J o u r n a l P r e -p r o o f 10,000 PCR tests, "Universidad Tecnológica Equinocial", "Ikiam Universidad Regional Amazónica", "Universidad Yachay Tech" and "Universidad Nacional de Loja" with more than 5,000 tests each, have contributed to SARS-CoV-2 surveillance in Ecuador. Also, other universities with certified clinical microbiology laboratories prior to COVID-19 pandemic has been actively performing SARS-CoV-2 testing, like "Universidad San Francisco de Quito" and "Universidad de Especialidades Espiritu Santo". Among all the universities, our laboratory at the "Universidad de Las Américas" (UDLA) leads the number of free SARS-CoV-2 tests during the first semester of COVID-19 pandemic. Since April 2020 until September 2020, 22,545 PCR tests were done at our facilities, 91.8% of them performed at no cost for the patients to help some of the most neglected communities in Ecuador. This effort was possible thanks to UDLA internal funds and the donations received by "Fondo Sumar Juntos" ("Banco de Pichincha") and "Fondo Salvar Vidas" ("Banco de Guayaquil"). Up to January 31st 2021, we estimate that at least 140,000 SARS-CoV-2 RT-PCR tests were developed at research laboratories at Ecuadorian universities that were successfully converted to clinical laboratories, representing more than 15% of the SARS-CoV-2 diagnosis completed in Ecuador at that time. COVID-19 pandemic is cause by the zoonotic virus SARS-CoV-2 and supports the need of the One Health approach to address current and upcoming human and animal public health issues. Actually, the leading research teams from the universities involved in SARS-CoV-2 diagnosis in Ecuador come from a previous experience on tropical medicine and One Health topics like arboviruses, chagas disease, tuberculosis, brucellosis, leptospirosis among other zoonotic diseases. So, those research groups already had the technical and scientific capacities to support the extraordinary surge in demand for diagnostic testing of human samples not ever seen before COVID-19 pandemic; but not that uncommon on animal infectious diseases surveillance. Moreover, those skills include good biosafety and biosecurity training, and high throughput and quality testing, all of them absolutely mandatory to improve successful COVID-19 surveillance programs. J o u r n a l P r e -p r o o f UDLA was the first university in the country to undertake SARS-CoV-2 diagnostic out of the public and private network of clinical microbiology laboratories, in collaboration with "Agencia de Regulación y Control de la Bioseguridad y Cuarentena para Galápagos" (ABG), by deploying personnel, equipment and reagents to the Galapagos Islands since April 2020. By the end of May 2020, our research laboratories in the capital city of Quito were converted to a SARS-CoV-2 diagnostic facility, where we have been running SARS-CoV-2 RT-PCR tests since then. Moreover, our medical brigades have mostly tested asymptomatic or mild symptomatic non-hospitalized population from neglected urban, rural, and indigenous communities in 18 out of the 24 provinces of Ecuador ( Figure 1 and Table 1 ). The strategy of the MoH for SARS-CoV-2 testing has mainly focused on symptomatic population attending hospitals, with a limited average testing capacity below 3,000 samples per day. According to the last COVID-19 pandemic epidemiological bulletin from the MoH That means a high positivity rate of 40% (Table 1) , clearly above the 5% recommended by the World Health Organization. As we have detailed above, a total number of 22,545 samples were analyzed for SARS-CoV-2 RT-PCR diagnostic at the laboratory of UDLA during the first semester of the COVID-19 pandemic. That number of tests represents 9.23% of the total SARS-CoV-2 RT-PCR diagnosis performed in Ecuador during that period of time. Samples were collected countrywide, with more than 1,000 tests done at 6 of the 18 provinces attended (Figure 1 ). Our contribution to SARS-CoV-2 surveillance was particularly relevant for the provinces of Pichincha, Manabí, Esmeraldas and Chimborazo, where more than 10% of the total SARS-CoV-2 RT-PCR tests were done at our laboratory (Table 1) In collaboration with our colleagues from ABG, we were responsible for 86.4% of the SARS-CoV-2 diagnostics done at the Galapagos Islands ( Figure 1 , Table 1 ). Up to date, Galapagos Islands is the province of Ecuador with the highest number of SARS-CoV-2 tests per capita. Moreover, this intervention made Galapagos Islands the only province of Ecuador achieving the WHO recommendation of a positivity rate below 5% during the first months of COVID-19 pandemic; actually, by the end of May 2020, Galapagos was declared free of SARS-CoV-2 for several weeks (8) . It is important to notice that ABG is a public institution within the Ecuadorian Ministry of Environment not the MoH that controls companion and livestock animal health in Galapagos Islands with a One Health scope. Moreover, ABG and UDLA previous experience and collaboration on zoonotic diseases surveillance and One Health research on Galapagos Islands prior to COVID-19 pandemic was fundamental to improve the most successful SARS-CoV-2 diagnosis program in Ecuador. Overall, we have identified 5,198 positive cases of SARS-CoV-2 infection. Our positivity rate of 23.06% was significantly lower than the 40% for the whole country. Moreover, that was the case for all the provinces where we carried out SARS-CoV-2 testing, except for Tungurahua and Sucumbíos provinces where the positivity rate was above the one reported for MoH (Table 1) . Largely, UDLA has contributed with almost 10% of the total SARS-CoV-2 testing during López-Cortés A. Clinical, molecular, and epidemiological characterization of the SARS-CoV-2 virus and the Coronavirus Disease Microbiol Infect Dis Epidemiological, socio-demographic and clinical features of the early phase of the COVID-19 epidemic in Ecuador COVID-19 in the Americas and the erosion of human rights for the poor Bolletin Epidemiologico COVID-19. Ministerio de Salud Pública UDLA-COVID-19 Team. High prevalence of SARS-CoV-2 infection among food delivery riders. A case study from Quito Tannya Lozada and Miguel Angel Garcia-Bereguiain; on behalf of "UDLA COVID-19 Team". 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