Optimización de metodologías para la detección de Sars-Cov-2 y aplicación a la vigilancia epidemiológica en Ecuador

Abstract

The global COVID-19 pandemic, caused by the SARS-CoV-2 virus, emerged in China at the end of 2019 and quickly spread worldwide. In Ecuador, the first case was reported on February 28, 2020, and subsequent cases surged as people from countries with active transmission entered the country, leading to an increase in cases across different cities around the country. Recognizing the inevitability of pandemics, countries in the region implemented various measures to combat COVID-19. These measures included strict lockdowns, mobility restrictions, online classes, home office, social protection, and bolstering the healthcare systems. However, the response in some cases was delayed due to the unprecedented impact and devastation caused by the pandemic. It became evident that healthcare systems were unprepared and overwhelmed, diagnosis were not adequate, and inter-institutional communication, especially in developing countries like Ecuador, was insufficient. Nevertheless, numerous public and private research institutions conducted studies to enhance SARS-CoV-2 diagnosis and supported the Ministry of Health's reference centers in diagnosing COVID-19 in Ecuador. Several studies were conducted to improve diagnostic protocols for COVID-19 in Ecuador, as well as to assess the quality of available diagnostic tests, including RT-qPCR and antigen tests. These efforts demonstrated the feasibility of developing cost-effective diagnostic protocols for SARS-CoV-2 infections, which is particularly crucial for resource-constrained countries like Ecuador that faced constant challenges in containing the pandemic. Additionally, it was discovered that many substandard molecular diagnostic tests for SARS-CoV-2 infection were being marketed in Ecuador, despite lacking authorization for clinical use in developed countries. Moreover, since April 2020, our laboratory at the Universidad de Las Américas has actively participated in COVID-19 diagnosis, providing free diagnostic services to vulnerable communities in Ecuador. This initiative has yielded valuable epidemiological data on SARS-CoV-2 prevalence in neglected areas across provinces such as Esmeraldas, Manabí, Tungurahua, Cotopaxi, Bolívar, Napo, the Amazon region, and the Galapagos Islands. These findings indicate that community transmission of COVID-19 occurred as early as the first months of the pandemic in 2020. Importantly, they underscore the necessity of conducting diagnostic tests beyond symptomatic patients attending healthcare facilities. The research also focused on analyzing at-risk groups, including individuals residing in shelters, police units, funeral home workers, and hospital personnel, confirming their heightened vulnerability to SARS-CoV-2 infection. Additionally, studies were carried out to investigate coinfections with other respiratory pathogens among hospitalized and outpatient individuals in Ecuador. The publications derived from this doctoral thesis can serve as a valuable resource for effectively managing future pandemics, emphasizing the importance of ensuring quality diagnosis in all countries, regardless of their socioeconomic context. Furthermore, our results emphasize the need for widespread diagnostic testing, including the non-hospitalized population, to control future pandemics caused by pathogens capable of asymptomatic transmission.