COVID-19: Pandemic in Ecuador: a health disparities perspective / COVID-19: pandemia en Ecuador desde una perspectiva de las disparidades de salud

ABSTRACT The global COVID-19 pandemic initiated in Ecuador with the patient zero in February 2020 and since more than 40,000 persons have been tested positive to the virus, leaving some 3,500 deceased, while approximately about 10,500 persons above annual average numbers died within March to May. A strict lockdown was applied by mid-March, which resulted to a severe economic crisis in the country. Although during the lockdown occurred a notable decrease in the number of new cases, the spread of the infection was already massive, untechnical, political and economic decisions will certainly lead to continuous wave of infections for months. Objective Our study postulates, that persons who are most likely to be infected during such secondary wave will be people who have already health issues to which we count besides the known ones, especially those who are already suffer by the distribution of volcanic ashes, as such pyroclastic material is known to affect lunges and thyroids. Methods A descriptive ecological study of information related to COVID-19 infection at a national level using official data from the Minister of Public Health and volcanic ash fall by geographical area in Ecuador. Results The mortality rate per canton indicated that those with lower attack rates are the ones with highest mortality rate. For instance, Portovelo (21.3/100,000), Playas (18.4/100,000), Santa Rosa (15.8/100,000), Suscal (15.3/100,000) and Penipe (14.3/100,000) reported the highest mortality rate per 100,000 people. The main distribution of such volcanic material is within the central to northern area of the Highlands and Inter-Andean Valley of Ecuador, due to the analysis of some 7394 satellite images of the last 21 years. Conclusions We conclude that areas with high vulnerabilities are also most susceptible to develop COVID-19. Such areas with their respective populations will be affected above average and shall be protected in particular within the presently starting during possible second wave of infection.(AU)

RESUMEN La pandemia de COVID-19 inició en Ecuador en febrero de 2020. Desde el inicio más de 40 000 personas han sido oficialmente diagnosticadas con el virus, que ha dejado al menos 3 500 fallecidas, mientras que aproximadamente unas 10 500 personas por encima del promedio anual murieron entre marzo y mayo de 2020. A mediados de marzo se aplicó el confinamiento absoluto en el país, lo que provocó una grave crisis económica y social en Ecuador. Aunque el bloqueo produjo una reducción en el número de casos, la infección estaba propagada ya entre la comunidad y los diagnósticos aumentaron notable debido a decisiones políticas y económicas, que, sin lugar a duda, conducirán a oleadas posteriores de infección por incluso meses. Objetivo Nuestro estudio postula que las personas que tienen más probabilidades de infectarse durante dicha ola secundaria serán las personas que ya tengan problemas de salud. A la vez, proponemos que aquellos pobladores que ya están sufriendo por la caída de cenizas volcánicas y flujos piroclásticos pueden tener más riesgo tal como lo describimos en casos relacionados con cáncer de tiroides y ceniza. Métodos Es un estudio ecológico descriptivo de la información relacionada con la infección por COVID-19 a nivel nacional, utilizando datos oficiales de contagio del Ministerio de Salud Pública y caída de cenizas volcánicas por área geográfica en Ecuador. Resultados La tasa de mortalidad por cantón indicó que aquellos con tasas de ataque más bajas son los que tienen la tasa de mortalidad más alta. Por ejemplo, Portovelo (21,3 / 100.000), Playas (18,4 / 100.000), Santa Rosa (15,8 / 100 000), Suscal (15,3 / 100 000) y Penipe (14,3 / 100 000) registraron la tasa de mortalidad más alta por cada 100 000 personas. La principal distribución de dicho material volcánico se encuentra dentro de la zona centro-norte de la Sierra y Valle Interandino del Ecuador, debido al análisis de unas 7 394 imágenes satelitales de los últimos 21 años. Conclusiones Concluimos que las áreas con alta vulnerabilidad también son más susceptibles a desarrollar COVID-19. Tales áreas con sus respectivas poblaciones se verán afectadas por encima de la media y estarán protegidas, en particular, dentro del inicio actual durante una posible segunda ola de infección.(AU)

Impact on the Respiratory Airways of Acute Exposure to Volcanic Ash in the Patagonia: Cross-Sectional Study

History: People exposed to volcanic ash show increased respiratory symptoms. The duration of exposure, the characteristics and ash concentration are determinants of the impact on respiratory health. Objectives: To describe the prevalence of wheezing over the past year within the adult population exposed to volcanic ash spilling in two cities with different levels of exposure. Secondarily, to describe the prevalence of ocular and respiratory symptoms in those populations. Materials and methods: A cross-sectional study was conducted five days after the eruption of the Calbuco volcano in two Patagonian cities with different levels of exposure (high and low levels of exposure). The prevalence of wheezing and respiratory and ocular symptoms was evaluated by means of telephone surveys conducted through an interactive voice response system. Results: The prevalence of wheezing was similar both in cities with low and with high levels of exposure (30.2% vs. 31.0%; p: 0.82). The respiratory and ocular symptoms were 32% and 57%, respectively (p: NS). Conclusion: After the eruption of the Calbuco volcano, a high proportion of the exposed population showed wheezing and respiratory and ocular symptoms. No differences were shown between the analyzed cities. The prevalence of wheezing in these cities was higher than that reported on the national level. The respiratory symptoms and the prevalence of wheezing in adults were higher than those reported on the national level.

Prevalencia de síntomas de asma en niños expuestos a ceniza volcánica / Asthma Prevalence among Children Exposed to Volcanic Ashes

Introducción: Las erupciones volcánicas tienen diversos impactos sobre la salud de la población expuesta y el sistema respiratorio es uno de los más afectados debido a la inhalación de los productos volatilizados. Estudios experimentales en ratones demostraron que la exposición crónica a ceniza volcánica de la erupción del complejo Puyehue-Caulle se asoció con respuesta inflamatoria de la vía aérea. A la fecha, no se ha reportado el impacto sobre la salud respiratoria de los niños expuestos a este evento. Objetivo: Determinar la prevalencia de síntomas de asma en niños 2 años después de la erupción del complejo Puyehue-Caulle. Materiales y Métodos: Se realizó un estudio de corte transversal en niños de 13 y 14 años asistentes a 11 colegios secundarios de la Ciudad de San Carlos de Bariloche, Rio Negro. Se encuestaron usando los cuestionarios ISAAC, y se realizaron mediciones de espirometría y monóxido de carbono en aire espirado a cada uno de los sujetos. Resultados: Se encuestaron 303 sujetos, 56% fueron varones y 47% asistían a escuelas del sector público. El 12,8 % reportaron ser fumadores activos. El cuestionario ISAAC más video-cuestionario reportó 27% de sibilancias alguna vez en la vida y 14% de sibilancias en el último año. El análisis de las espirometrías mostró 1% de la muestra con patrón obstructivo. Conclusiones: En una muestra de niños residentes de una ciudad con alto nivel de exposición a ceniza volcánica se observó una alta prevalencia de síntomas de asma, los mismos fueron significativamente más prevalentes que en estudio previo realizado en esa ciudad.

Background: Volcanic eruptions have different health impacts on exposed population and the respiratory system is one of the most affected due to the inhalation of volatilized products. Experimental studies in guinea pigs showed that chronic exposure to volcanic ash from the eruption of the Puyehue-Caulle complex is associated with inflammatory airway response. To date, it has not been reported respiratory health impact of children exposed to this. Objective: To determine children´s asthma symptoms prevalence 2 years after Puyehue-Caulle complex´s eruption. Methods: Cross-sectional study was conducted among 13 and 14 years old children attending 11 secondary schools in San Carlos de Bariloche City, Rio Negro. They were surveyed with ISAAC´s questionnaires and spirometry and carbon monoxide in exhaled air measurements were performed to each subject. Results: 303 subjects were surveyed, 56% were male and 47% belonged to public schools. 12,8% were active tobacco smokers, 27% had wheezing sometime in the life and 14% had wheezes in the last year (based on ISAAC questionnaire). Only 1% of the spirometry had airway obstruction. Conclusions: The prevalence of last year asthma symptoms increased compared with a previous study.

Cultivo de cepas de levaduras de suelo trumao en ®vinaza¼ / Cultivation of yeast strains of the trumao soil in ®vinasse¼

30 cepas de levaduras aisladas desde un suelo trumao (Hapludans) usado como pradera en rotación, se cultivaron individualmente (100 µl = a 102 ufc delevaduras/mL) en matraces con 50 mL de ®vinaza¼, estos fueron incubados en un agitador orbital a 150 rpm, 23 °C por 5 días, luego de la incubación el contenido de cada matraz se centrifugo a 3.500 rpm por 20 min., a los pellet obtenidos se les determino: el peso seco (PS); fosforo total (FT) por digestión ácida y posterior lectura a 400 nm; proteínas totales (PT) por colorimetría Biuret a 595 nm y lípidos totales (LT) mediante el método colorimétrico de la sulfo-fosfo vainillina a 520 nm. Las 30 cepas de levaduras crecieron en la vinaza. El mayor PS lo registro la cepa 25 (331 g de levadura L-1 de ®vinaza¼). FT lo registro la cepa 28 (4,8 mg g-1 de levadura seca). PT lo registro la cepa 24 (25,90 mg g-1 de levadura seca) y LT lo registro la cepa 18 (287,4 mg g-1 de levadura seca).

Thirty strains of yeast isolated from a volcanic ash soil (Hapludans), used as pasture rotation, were individually cultured (100 µl = 102 cfu of yeast cells mL-1) in flasks with 50 mL of ®vinasse¼, these were incubated at 23 °C for 5 day, after incubation the contents of each flask was centrifuged at 3500 rpm for 20 min, the pellet obtained was determined: dry weight (DW); total phosphorus (FT) by acid digestion and later reading at 400 nm; total protein (TP) by Biuret at 595 nm and total lipid (TL) by the colorimetric method of the sulfo-phospho-vanillin at 520 nm. The Thirty strains of yeast grown on vinasse. The best DW, was determined for strain 25 (331 g yeast L-1 ®vinasse¼). FT was determined for strain 28 (4,8 mg g-1 dry yeast). TP was determined for strain 24 (25, 90 mg g-1 dry yeast) and TL was determined for strain18 (287, 4 mg g-1 dry yeast).

The acute effects of volcanic ash on pulmonary function in children

To evaluate the acute effects of the Mt. Pinatubo volcanic ash on pulmonary function, we studied 103 school children with ages ranging from 12 to 17 years and residing in Metro Manila where about 2.0 cm of ash had fallen. All study participants were involved in a previous study wherein their baseline pulmonary functions were measured. Two weeks after ash exposure, outcome variables measured included respiratory symptoms, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximal midexpiratory flow (MMEF), and peak expiratory flow rate (PEFR). Data on composition and particulate size of volcanic ash were obtained. Ashfall exposure produced only transient and tolerable respiratory symptoms, the most common being rhinorrhea, sneezing and cough. Mean fall in FVC was-0.06468+-0.207 liters and-0.0681 +-0.207 liters for FEV1. Males showed a greater decrease in these measurements compared to females. These differences were statistically significant but small and may not be clinically significant. Also, measures of pulmonary function did not correlate with a history of exposure to cigarette smoke nor with the presence of respiratory symptoms. The presence of a demonstrable but minimal adverse effect on pulmonary function may be partly due to precautionary measures taken during the ashfall. It is ideal to repeat pulmonary function tests on the population periodically to document any long-term exposure-related decline in pulmonary function and to validate the present observations against new spirometric measurements at a time of re-exposure and almost nil or absent ashfall exposure. Studies must be done in communities closer to the volcano where these observed changes in pulmonary function may be magnified The widespread destruction caused by the series of eruptions of Mt. Pinatubo in Castillejos, Zambales from May to August, 1991 has raised not only economic concerns but questions on environmental and health aspects as well. With its major eruption on June 15 to 16, 1991, volcanic ash was spawned far with a radius of 850 kilometers from the vent. Typhoon winds prevailing at that time facilitated the spread of volcanic ash to more populated areas as far as Palawan to the south and even as far as Cambodia to the west Analysis of volcanic ash yielded a predominance of respirable particles smaller than 10 micra in diameter and the minerals, silicon dioxide and aluminum oxide. Experience with clinical effects on the respiratory system of volcanic ashfall is rather limited. Recent reports have have dealt mostly on the May 1980 eruption of Mt. St. Helens in Washington, USA, where the composition of volcanic ash was comparable to that spewed by Mt. Pinatubo After eruption of Mt. St. Helens, there was note of an increase in medical consultations for wheezy bronchitis among young children. Questions raised included the possibility of silicosis developing in the exposed population and also on the acute effects of the ash, both in persons with pre-existing lung disease and, as a non-specific irritant, in normal individuals. Johnson, et. al 2 studied the pulmonary function of children residing within a 90 mile radius from the volcano 1 week after the eruption and did not find a significant decrease from normal values. A similar study by Buist et al.,3 on children attending a summer camp situated close to the volcanic site did not show either a within-day or between-day effect on lung function even among children with pre-existing lung diseases In Metro Manila, there were anecdotal reports of increased respiratory symptoms among residents, including school children, after the Mt. Pinatubo eruption caused volcanic ash fall. This study aims to evaluate the acute effects of inhaled volcanic ash on the pulmonary function of school children in Metro Manila Average ashfall in Metro Manila located 180 aerial kilometers from Mt. Pinatubo was 2.0 cm., average ashfall in areas within a 10 kilometer radius from the volcano was 50 cm.