Measuring the impact of the COVID-19 outbreak in Ecuador using preliminary estimates of excess mortality, March 17-October 22, 2020.

Abstract Objectives Ecuador is among the worst-hit countries in the world by the coronavirus disease 2019 (COVID-19) pandemic. In terms of confirmed deaths per million inhabitants, as of October 22, Ecuador ranks fourth in the Americas and ninth worldwide according to data from the World Health Organization. In this report, we estimate excess deaths due to any cause in Ecuador since the start of the lockdown measures on March 17, 2020 until October 22, 2020. Methods Estimates of excess deaths were calculated as the difference between the number of observed deaths from all causes and estimates of expected deaths from all causes. Expected deaths were estimated for the period March 17–October 22, 2020 from forecasts of an ARIMA model of order (3,0,1) with drift which was applied to daily mortality data for the period from January 1, 2014 to March 16, 2020. Results The number of all-cause excess deaths in Ecuador was estimated to be 36,922 (95% bootstrap confidence interval: 32,314–42,696) during the study period. The peak in all-cause excess mortality in Ecuador may have occurred on April 4, 2020, with 909 excess deaths. Conclusions Our results suggest that the real impact of the pandemic in Ecuador was much worse than that indicated by reports from national institutions. Estimates of excess mortality might provide a better approximation of the true COVID-19 death toll. These estimates might capture not only deaths directly attributable to the COVID-19 pandemic but also deaths from other diseases that resulted from indirect effects of the pandemic.