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In the last few days and weeks, media outlets around the world have been publishing shocking stories and images of the COVID-19 crisis in Ecuador. Scenes of corpses abandoned in the streets of Guayaquil, Ecuador’s second-largest city, have shaken audiences in Latin America and beyond. Statistics, even the highly untrustworthy official ones, have confirmed the dire picture of a fast accelerating crisis. Whereas on March 17 just 111 people had tested positive for COVID-19, by April 13, 7,529 were reported to be infected, and 355 people were reported to have died. Bearing in mind the difficulties of cross-country comparisons and disparities in testing, Ecuador now has the highest per capita COVID-19 death toll in Latin America and the Caribbean, and the second-highest per capita number of COVID-19 cases. So how did Ecuador, and the city of Guayaquil in particular, with 70 percent of national cases, reach this point?

On February 29, 2020, the Ecuadorian government announced that it had detected its first case of COVID-19, thus becoming the third country in Latin America, after Brazil and Mexico, to report a case. That afternoon, authorities claimed they had located 149 people who may have been in contact with the first COVID patient, including some in the city of Babahoyo, 41 miles from Guayaquil, as well as passengers on her flight into Ecuador from Madrid.

The next day, the government announced that six more people were infected, some in the city of Guayaquil. We now know that these numbers were greatly underestimated, and that many people had contracted the illness before displaying any symptoms. In fact, the Ecuadorian government has since established its own late projection of what may have been closer to the real numbers: rather than the seven people infected with COVID-19 it announced on March 13, a more accurate figure was probably 347; and when on March 21 it reported 397 people had tested positive, contagion had probably already extended to 2,303.

From early on, Guayaquil and its surroundings seemed to be the most affected by the spread of the virus. Despite this, initial measures to slow infections were late coming and even slower to be implemented. On March 4, the government authorized the holding of a Libertadores Cup soccer game in Guayaquil, which many commentators have blamed as a major contributor to the massive outbreak of COVID-19 in the city. Over 17,000 fans attended. Another smaller national league game was held on March 8.

By mid-March, and despite numbers of infected people quickly rising, many guayaquileños continued to go about their lives with minimal — if any — social distancing. Contagion also seems to have spread aggressively in certain well-to-do areas of the city, for example in the wealthy gated communities of La Puntilla in the suburban municipality of Samborondón, where, even after authorities had issued stay-at-home ordinances, inhabitants continued to mingle. A high-profile wedding was attended by some of the city’s “finest,” and authorities later intervened to cancel at least two more weddings and a game of golf. On the weekend of March 14 and 15, guayaquileños congregated on the nearby beaches of Playas and Salinas.

By the end of the first week of March, the situation had deteriorated sharply. On March 12, the government finally announced that it was closing schools, establishing checks on international visitors, and limiting gatherings to 250 people. On March 13, Ecuador’s first COVID-19 death was reported. The same day, the government announced it was imposing quarantines on incoming visitors from several countries. Four days later, the government limited gatherings to 30 people and suspended all incoming international flights.

On March 18, the conservative mayor of Guayaquil, Cynthia Viteri, attempted an audacious political stunt. Facing rising infections in her city, the mayor ordered municipal vehicles to occupy the runway of Guayaquil’s international airport. In a clear breach of international norms, two empty KLM and Iberia aircrafts (with only crew on board) that had been sent to repatriate European citizens to their home countries were thus prevented from landing in Guayaquil and forced to reroute to Quito. (The next day Viteri announced that she had contracted COVID-19 and would be self-isolating. She has since recovered.)

On March 18, the government finally imposed a stay-at-home quarantine. The next day, it imposed a curfew from 7 p.m. to 5 a.m. (from 4 p.m. in Guayaquil), which was later extended from 2 p.m. for the whole country. Four days later, Guayas province was declared a national security zone and militarized.

For hundreds of thousands of less privileged guayaquileños whose livelihoods depend on their daily income, staying at home was always going to be problematic, unless the government was able to intervene with an unprecedented program to cover the basic needs of the population. With a high percentage of the labor force being informal and non-salaried, and therefore especially vulnerable to the impact of income lost because of people staying at home, Guayaquil is in many regards an archetypal example of a vulnerable urban context in the developing world.

On March 23, the government announced, and later started to implement, a $60 cash transfer for the most vulnerable families. Sixty dollars in the context of Ecuador’s dollarized economy, in which the minimum wage is $400 per month, can be an important supplement in the fight against extreme poverty. But it can hardly be considered adequate to guarantee subsistence for many people barred from exercising other economic activities. Moreover, recent images of people lining up in vast numbers in front of banks in order to cash in on the government offer should raise alarm if the objective is for people to stay home.

On March 21, Minister of Health Catalina Andramuño resigned. That morning she had announced in a press conference that she would be receiving 2 million testing kits and that these would arrive shortly. But on March 23, her successor announced that there was no evidence 2 million kits had been purchased and that only 200,000 were on their way.

In her resignation letter to President Moreno, Andramuño complained that the government had not allocated her ministry any additional budget to face the emergency. In response, the Finance Ministry argued that the Health Ministry had plenty of unused money and that it should use what had been assigned to it for the fiscal year 2020 before requesting more. But this is easier said than done, as preapproved spending in ministerial budgets inevitably leads to difficulties in freeing up liquidity for unforeseen activities, especially on a grand scale.

In the last week of March, disturbing images of abandoned corpses in the streets of Guayaquil started flooding social media and, soon afterward, international news networks. The government cried foul play and claimed it was “fake news” being pushed by supporters of former president Rafael Correa, still the main opposition figure in Ecuadorian politics, despite residing abroad and despite persecution against leaders of his Citizens’ Revolution political movement. While some videos posted online did not correspond to what was going on in Guayaquil, many horrifying images were completely authentic. CNN reported that bodies were being left in the streets, as did the BBC, The New York Times, Deutsche Welle, France 24, The Guardian, El País, and many others. Several Latin American presidents started referring to the events unfolding in Ecuador as cautionary examples to be avoided in their home countries. Ecuador, and Guayaquil in particular, had suddenly become the pandemic’s epicenter in Latin America and a showcase for its potentially ravaging effects.

Yet, the Moreno government’s response has been denial. Government ministers and diplomatic representatives abroad were told to give interviews denouncing it all as “fake news.” The Ecuadorian ambassador in Spain denounced the “false rumors, including the one about the corpses, supposedly on the sidewalk,” as propagated by Correa and his supporters to destabilize the government. The attempt backfired; global media added to its coverage of the drama unfolding in Ecuador the government’s brazen negationism.

On April 1, after Salvadoran president Nayib Bukele tweeted, “After seeing what is going on in Ecuador, I think we have been underestimating what the virus will do. We weren’t alarmist, rather we were conservative.” Moreno replied: “Dear fellow presidents, let us not echo fake news that have clear political intentions. We are all making efforts in our fight against COVID-19! Humanity requires us to be united.” Meanwhile, corpses continued to pile up.

Guayaquil’s authorities had announced on March 27 that these abandoned bodies would be buried in a mass grave, and that a mausoleum would be erected later. This provoked national outrage. The national government was forced to intervene to say this would not be the case, but it took four more vital days for it to act. On March 31, under tremendous pressure, President Moreno finally took the decision to appoint a task force to deal with the problem.

The man at the head of the task force, Jorge Wated, explained on April 1 that the problem stemmed in part from the fact that several funeral parlors, whose owners and workers were afraid of COVID-19 contagion through their handling of corpses, had decided to close down during the crisis. This, added to the increase in deaths from COVID-19, had created a bottleneck and prevented timely burials. The bottleneck had gradually grown as the Moreno government failed to intervene in the funeral parlors or mobilize other urgent private assets, such as refrigerated infrastructure (trucks, coolers, etc.) to manage the growing number of bodies.

The mortuary crisis was the result of COVID-19 in as much as the number of dead bodies rose and people were afraid of contagion. But the bottleneck affected the management of bodies from other causes of death. The system simply collapsed. More evidence is needed to evaluate whether fear of contagion, including the fear felt by health care workers in different capacities, has been a decisive factor in the weakening of appropriate institutional responses.

The special task force seems to have at least reduced the backlog of bodies awaiting burial, but the problem is still far from resolved. France 24 reported that nearly 800 bodies have been picked up from people’s homes, outside the usual channels, by police officers dispatched by the task force. Another emergency measure has been the use of cardboard coffins, which has also fostered much public anger — expressed on social media in the midst of physical distancing policies. These extreme measures have emboldened the notion that the official numbers of COVID-19 deaths cannot be trusted. How could a few hundred deaths suddenly throw the country in such disarray? When over 600 people died in a matter of seconds during the April 2016 earthquake, Ecuador did not face such consequences.

There are other, more structural and long-term problems related to the COVID-19 crisis. Convinced of the need and under pressure by the IMF to reduce the size of the state, the Moreno government has made damaging cuts to public health. Public investment in health care fell from $306 million in 2017 to $130 million in 2019. A few days before the COVID-19 outbreak, the health care workers’ union, Osumtransa, protested thatbetween 2,500 and 3,500 health care workers were notified during the carnival holidays (February 22 to 25) that their contracts were ending. More recently, researchers from the Dutch International Institute of Social Studies have confirmed that in 2020 alone, there were 3,680 layoffs from Ecuador’s Health Ministry, amounting to 4.5 percent of total employment in the ministry. And, of course, in November 2019, Ecuador put an end to the agreement it had with Cuba in health cooperation and 400 Cuban doctors were sent home by year’s end.

If leadership, trust, and good communication are important in times of crises, then the fact that President Moreno’s approval ratings oscillate between 12 and 15 percent, some of the lowest for any president since Ecuador democratized in 1979, reflect a serious problem. There can be no doubt that the Moreno government’s current lack of popularity greatly hampers its capacity to demand collective sacrifice and uphold the rule of law. The head of the task force’s singular April 1 public address thus sounded like a desperate attempt to make the government look serious, competent, and accountable. Wated went as far as to predict that things would get far worse before they got better, saying between 2,500 and 3,500 would die, in Guayas province alone, from the pandemic.

Wated’s admission seems to have sparked a new approach from the Moreno government. In his April 2 address to the nation, Moreno pledged to be more transparent with information on the victims of COVID-19 “even if this painful.” He publicly acknowledged that “whether for the numbers of infected or of deaths, the registers have been underestimated.” But old habits die hard, and Moreno again denounced “fake news,” even blaming the current economic hardship on public debt accrued under his predecessor, Correa. Moreno claimed that Correa had left him a public debt of $65 billion even as his government’s own figures indicate that the public debt at the end of the previous government was only $38 billion (it is now over $50 billion). All this pettiness, in the midst of a deadly crisis, will likely do little to improve the president’s credibility gap; polls show only 7.7 percent find Moreno credible.

Three days later, encouraged by the president’s call for transparency, the deputy minister of health reported that 1,600 public health care workers had contracted COVID-19 and that 10 medical doctors had died because of the virus. But the next day, the minister of health rebuked his deputy, and said only 417 medical workershad fallen ill; 1,600 merely referred to those who could be infected. These admissions nevertheless gave credence to health care workers’ recurrent complaints that they are ill-equipped to tackle the crisis which puts their own safety, and their families’, at risk.

Then, in this sudden flourish of ostensible governmental sincerity, Vice President Otto Sonnenholznerapologized, in another formal televised address, for the deterioration of Ecuador’s “international image.” A likely candidate in the February 2021 elections, Sonnenholzner has attempted to position himself as the leader of the government’s response to the crisis but has also been accused of exploiting the pandemic to promote his image. Time will tell whether Sonnenholzner succeeds in spinning his leadership, or whether Ecuador’s dramatic mismanagement of the pandemic and mortuary crisis becomes a death blow to his political ambitions. In the meantime, for the people of Guayaquil, the suffering seems far from over.

This article first appeared on CEPR.