With only 17 officially announced cases, Ecuador recently declared COVID-19 a health emergency, but the announcement was not backed by precise scientific information to fully understand the reasons behind this decision or a contingency plan. Because it was the third country in the region to identify SARS-CoV-2, on February 29, the Ecuadorian government could have been expected to have a communication strategy in place by now. Especially, since the outbreak was globally announced two months before. However, evidence suggests the Ministry of Public Health (MoH) may not have a clear path forward.
Apart from the website www.coronavirusecuador.com, containing educational materials such as prevention measures also in the format of social media resources, and press conferences by the Minister of Health, the main source of official updates are short press releases on social networks. These remain limited to releasing news on identified COVID-19 cases, and incidental explanations related to particular events.
Anticipating this relaxed attitude by the government, on March 2, the Ecuadorian Society of Public Health publicly requested national authorities to share “information that is timely, transparent, sufficient, massive, plain and easy to understand, in the official languages, particularly designed for less informed populations, regarding the evolution of the epidemic and mitigation and prevention measures”. Not only is there ample consensus about the importance of an adequate communication strategy to contribute to contain or mitigate the spread of infectious diseases; WHO just declared COVID-19 a pandemic.
In the recently released Guidelines for communicating about coronavirus disease 2019, the Pan American Health Organization (PAHO) similarly recommends “keep the public fully informed” with “timely and transparent information that is technically correct”, “based on science”, “accessible” and “sufficiently complete”. Further, “information presented should minimize speculation and avoid overinterpretation”.
In Ecuador, abiding by these recommendations while largely restricting communication to social networks poses additional challenges. According to Vanderbilt University’s Latin American Public Opinion Project [in Spanish] and contradicting the official discourse, social media use in the poorest quintile of Ecuador reach only 47.4% and in the richest, only 90.3%, with frequent use also being higher in the latter group. Concurrently, social network users in Ecuador trust the executive and local governments, and the media, less than non-users.
In addition, MoH online weekly epidemiological reports for 2020 still do not mention coronavirus and the link to coronavirus updates only briefly summarizes the situation in less than 200 words. This mirrors the general organization of epidemiological alerts, which are distributed on different webpages instead of consolidating all years in one searchable place. Moreover, the news section of the MoH website does not list all the COVID-19 press releases.
In contrast, countries in the region give clear and easily accessible examples of how Ecuador could improve its reports. In Chile’s MoH website, one can find information by age and gender, according to region and in total, of confirmed COVID-19 cases. Argentina updates online epidemiological information on confirmed cases by provinces and in total. Brasil’s public reports may be the most complete, because they geolocate confirmed, suspected and discarded COVID-19 cases with detailed transmission status —using graphics, tables and maps— alongside updated medical and public health instructions and protocols, a contingency plan released last month, and a detailed timeline of actions by the MoH.
In contrast, Ecuador is not communicating to the media, and the international and national scientific community, essential epidemiological data such as the number of COVID-19 tests that have been conducted or has made easily accessible the precise criteria guiding decisions on testing. To improve information delivery also to the general public, to reduce rumors and speculation, and improve local and national population reach, Ecuador’s MoH must rapidly design a scientifically-oriented communication strategy.
To begin with, self-referral and self-quarantine contributing to timely identification and containment of COVID-19 depends on this. Also, researchers with continuous access to scientific information may help conduct analysis towards activating specific alerts or local preventive measures. Finally, this may aid in holding back self-appointed experts and journalists that could promote needless alarm or disseminate misleading information, but, more critically, so that the MoH may build much-needed relationships of trust with the population.
Of course, and especially because Ecuador has experienced private information leaks related to government databases, the government must ensure that patient confidentiality is adequately protected. Therefore, any communication endeavor must be undertaken by an interdisciplinary team that considers the different ethical, technological and social factors involved.
About the authors:
Irene Torres, PhD, researches health promotion and health education, rural health and primary health care. She is board member of the Ecuadorian Society of Public Health and Fundacion Octaedro.
Fernando Sacoto, MD, MPH, is a health systems and policy consultant with experience in Dominican Republic, El Salvador, Honduras and Ecuador. He is the president of the Ecuadorian Society of Public Health.
The authors declare that there is no conflict of interest.