Beyond the Capacity to Cope in Ecuador

"The situation is dire in Guayaquil at this moment."
"There are dead bodies in the streets, and the health system is collapsed, so not everybody who has symptoms can get tested or treatment."
Tati Bertolucci, director, Latin America and the Caribbean, CARE

"I work in a very wealthy part of the city, north of Guayaquil."
"I can tell you that people are starting to understand that even having all the money and political contacts, you might not survive this."
"People are dying like flies here."
"I don't have a single colleague not telling me they don't cry every day after a shift. This is overwhelming."
Marcelo Castillo, intensive care physician, Kennedy Clinic Hospital, Guayaquil

"She was coughing, and I had to fight for her to even enter to the hospital."
"I fought with all the doctors and nurses. There were so many people there."
"I should have taken her to a private clinic. I thought that as a hospital they would be more prepared for this."
"Before leaving her at the hospital that day, she told me her vision was blurry and I remember saying that everything was going to be OK. I didn't know it was going to be the last time I would see her face."
"If I saw her now, I would tell her, I will love you forever. And that I'm sorry it wasn't me."
Dante Logacho, 49, publicist, Guayaquil, Equador

"The lockdowns were less effective in Guayaquil."
"In other parts of the country, more people complied. In Guayaquil, you also have areas with no basic services, really small housing units and denser living."
Sebastian Hurtado, head, Ecuadoran political consulting firm, Profitas

Men with protective suits load a coffin into a car in front of a Guayaquil hospital.

It is in the largest city in Ecuador, a city of close to three million population where the most intense infection rate and swiftest collapse of the medical system is taking place as the epicentre of the novel coronavirus outbreak in Latin America. Aid workers, officials and others in the metropolis are all reporting dead bodies being left uncollected on sidewalks, or corpses left to decompose within homes for days at a time, where temperatures rise to 90F.

The country's initial case of COVID-19 was brought in by a 71-year-old Ecuadoran women returning from Spain on Valentine's day, to Guayaquil, with the disease emerging on February 29. The infection rate has climbed steadily since then, to the current 2,200 cases representing about 70 percent of Ecuador's total numbers; far in excess of the numbers infected in the capital, Quito.

Hospitals in the city were swiftly overrun with cases and mortuary workers refused or were unable to collect bodies from homes. In the overheated atmosphere where decomposition is swift, families saw little option but to remove the bodies of their dead ones from their home interiors to the street beyond, waiting for them to be taken away. And they haven't been.

Where the Italian army mobilized to haul cadavers out of Bergamo, the epicentre of the epidemic in Italy when the crematoria there were overwhelmed, and authorities in Iran dug mass graves, and the Spanish military discovered elderly patients in care homes dead in their beds, abandoned, Guayaquil now adds to the inventory of hard-hit countries incapable of coping with overwhelming numbers of seriously ill and dying citizens.

Relatives wait outside of a hospital for information on family members infected with Covid-19 in Guayaquil on April 1.

In Guayaquil, about 30 bodies daily have been recovered by a joint military-police operation. A citywide curfew interfered with mortuary workers' efforts to remove bodies, according to Jorge Wated, co-ordinator of a government task force with the assignment of managing the crisis. "We recognize any errors and ask for forgiveness from those who have had to wait to remove their loved ones", he announced, while warning the death toll could reach 3,500 dead in Guayaquil alone.

As an international port city, impoverished harbour workers feeling little option left to them but to continue earning a living despite calls for social distancing, helped to fuel the infection rate. Gallons of soapy water have been poured on city streets by dump trunks, in a sanitation effort. Shipping containers had been placed at hospitals to store cadavers.

"The images (of bodies in the streets and corpses left in homes for days) that are going around the world are real", said the city's mayor, Cynthia Viteri, herself struck by the novel coronavirus. "Why? Because our health system is the same one we had before the pandemic, a health system that in the midst of a pandemic has collapsed."

A coffin containing the body of a person who is supposed to have died from Covid-19 lays wrapped in plastic and covered with cardboard, outside a block of family apartments in Guayaquil on April 2.