Looking for the dead in Guayaquil, Ecuador

His death and disappearance illustrate how the health care system in Ecuador’s second largest city, roughly the size of Chicago, collapsed within a few weeks after the explosion in March.

Bodies in hospitals

Guayaquil was sadly unprepared to confront the coronavirus.

Three doctors in Guayaquil, each working in different hospitals, described similar scenarios during the months of March and April at CNN: hospitals completely overwhelmed by a pandemic that quickly fell on an unprepared health system, leaving no chance of really helping people, let alone provide patients with basic levels of care. Everyone spoke to CNN anonymously for fear of losing their job.

“People were terrified and scared,” said a doctor on some of the worst days. “The really sick people were coming to the hospital, dying. You tended to one, you did what you could do, then that person dies, and you move on to the next, and that person dies, and so on.”

“At one point there were dozens of bodies between the hospital rooms and the morgue waiting to be taken away,” said the doctor. “There were no body bags left.”

The death rate far exceeded the capacity of morgues and funeral homes. A second doctor told CNN that he usually saw three or four corpses lying on the floor every day in the hospital. “We had nowhere else to put them,” he said.

In a video obtained by CNN, a family is seen extracting the body of a loved one from their car and placing it in a hospital parking lot, unsure of what to do next.

Nobody would accept it

In January, Flavio Ramos celebrated his birthday surrounded by family and friends.

During the last week of March, he started to feel sick. On the 31st, his breathing became so labored that the 24 year old Arturo Ramos had to act.

He accompanied his father to the nearest hospital, expecting the serious sick engineer to be admitted quickly and get the help he desperately needed. But when he arrived, hospital staff told him that the facility was already full.

“The doctors said, ‘There are no beds for patients,’ that’s it,” Ramos told CNN with a video call from his home in Guayaquil. “If I stayed at the door they told you they would call security to kick you out.”

Undaunted, he tried again in another hospital, another and yet another. After four hours of driving, Ramos says that his father was hospitalized at General Guasmo Sur Hospital. It was the eleventh structure he had tried.

Ramos recalled that his father spent his last hours in a room with two patients who had already died.

“Both bodies were on the floor,” he said. “One was wrapped in a black sack, a garbage bag to be exact, and the other was dead on the floor. Nobody was taking care of it.”

Ramos left the hospital around 9:30 am on April 1st to have breakfast. He says he’s gone for about 15 minutes. Upon his return, his father was dead.

“Nobody was with him when he died,” said his son. The hospital declined to comment on the case.

“If you keep it here, it will die.”

Arturo Ramos told CNN that the hospital was like a war zone. 38-year-old Ana Maria, who refused to give her surname, said the same thing about her experience.

He said he took his 67-year-old mother to a local clinic because she was experiencing Covid-19 symptoms. A quick X-ray later and the attending physician said that Ana Maria needed to take her mother to the hospital immediately: she had severe pneumonia, said the doctor, probably because of Covid-19.

When Ana Maria arrived at the nearby Los Ceibos hospital on March 26 in search of treatment, her mother’s lips were turning blue and she could barely walk. They waited inside for almost 24 hours to open a bed.

But as she watched the patients in adjacent rooms and nearby corridors and heard the anguished cries of their loved ones, she thought of keeping her mother in the hospital.

He took decisive action after talking to a nurse.

“He said, ‘If you have the money to treat your mother at home, do it,'” Ana Maria recalled. “‘If you keep it here, it will die.'”

She took her mother home, hired a private nurse to treat her, and survived. But the vast majority of people in Guayaquil don’t have those financial means.

Before Ana Maria left the hospital, another patient’s daughter spoke to her in their hospital room. “She cried and said to me, ‘Your mother will survive because you have the money. We don’t have the money.”

Senior officials in President Lenín Moreno’s cabinet publicly apologized for the government’s poor response to the pandemic, saying that health officials were not ready for an outbreak with such a staggering death toll.

According to government data, 533 people died of Covid-19 in Guayaquil in March and April, put together. However, over the same time period, the government recorded at least 12,350 total deaths in the city – far more than the 2,695 and 2,903 who died in the same period of 2018 and 2019, respectively.

In Guayaquil, the death toll for Covid-19 could be over 9000 deaths, according to three Ecuador-based epidemiologists who spoke to CNN.

Dr. Esteban Ortiz-Prado, an epidemiologist from the University of the Americas in Quito, the capital of Ecuador, said there was no way of knowing exactly how many excess deaths were directly or indirectly related to Covid-19, but that the pandemic was the only reasonable way to explain this year’s sudden spike in the count of total deaths. “For me, those are Covid [deaths] until proven otherwise, “he said.

The government has admitted that the actual coronavirus death toll is higher than the official count, but said the real number will never be known because of its inability to test multiple people.

“We can’t say the government is lying,” said Marco Coral, an infectious disease researcher at the University of the Americas as well. “But what we can say is that the government hasn’t done enough tests on people,” an irreplaceable part of any attempt to identify the true number of coronavirus cases and deaths.

Fortunately, the death toll in Guayaquil is decreasing. Since the first week of April, when some of the highest total deaths per day were recorded, the daily number of total deaths has fallen dramatically – at least 30 total deaths were reported in the city on April 30, well below the peak seen in earlier in the month.

Social removal measures, which are now slowly being eased in the country, seem to have worked.

But as the number of daily deaths decreases, attention turns to finding those who are already lost.

Lose the right to say goodbye

Amid the chaos of rising bodies, disorganization has led to incorrect placement and incorrect identification of those who have died.

Many families have not been able to say goodbye to their loved ones.

When Arturo Ramos returned to the hospital the day after his father’s death, the authorities said they could not find his remains.

The only way he could try to locate him, officials said, was to go to the morgue and search for himself among the unidentified remains.

“[Inside the morgue] there were bodies on top of each other, “said Ramos.” Going to that room is like hell. ”

He said the bodies in the room were separate from those who had already been identified and those who were not.

He went body to body over the course of an hour looking for his father, accompanied by a hospital employee who, after failing to find his father, told him to return the next day.

For the next four consecutive days, Ramos estimates that he has examined around 250 corpses, both inside the morgue and in containers that had been set up outside to manage the overflow.

The video of the containers for reasons of the General Guasmo Sur Hospital was delivered to CNN by the person who shot it. The bodies are seen in a heaped container at least three high, which decomposes inside different types of body bags.

Ramos said that only part of the morgue and one of the containers were refrigerated.

“I wasn’t lucky,” said Ramos. “I never found it.”

The problem of missing remains is so widespread that the attorney general started an investigation last month about mismanagement of the remains in the hospital morgue.

CNN asked the government for exact figures on how many remains are missing, but had not been answered at the time of publication.

More than a month after Flavio Ramos’ death, a search for his name launches a pop-up window that just says: “No results found.”

Ramos is mourning his father alone these days. He is separated from his family for his own safety.

Last week, he tested positive for the virus.

Ana Maria Cañizares of CNN Español in Quito, Ecuador contributed to this report.