The USF College of Public Health’s (COPH) Dr. Ricardo Izurieta, professor, and Dr. Benjamin Jacob, associate professor, aim to identify hot spots for COVID-19 in Ecuador using cutting-edge epidemiological methods combining data with technology.

The “COVID-Zero: Minga for the Health and Work” project began in Quito, Ecuador, in March of 2020, according to Izurieta, and has now extended to the whole Ecuadorian territory.

“Ecuador was the Latin American country with the highest COVID-19 incidence and mortality rates in the region,” Izurieta said. “Despite more than 70 days of national isolation, in the city of Quito the transmission of the disease increased in the last two weeks of March-April 2021. Notwithstanding, due to pressures from business people and the underemployed population, the city went from a red light (total quarantine) to a yellow light (partial quarantine) with the imminent risk of explosive outbreaks.”

Izurieta said even though the number of COVID-19 beds were increased to 762 beds in Quito, there were only 5 percent of available beds in June 2021.

“The Ecuadorian health care system, as well as the government institutions by themselves, did not have the capacity to control the pandemic. Therefore, it was necessary to bring in the community through their Parish Health Committees (PAHCOs) and Community Control and Surveillance Posts (C-POSTs) in the prevention and control of this pandemic,” he said.

Izurieta said the aim of COVID-Zero is to implement a multidisciplinary and integrated COVID-19 community control program to reduce severe morbidity and mortality in the most affected areas of Ecuador.

They plan to combine three sources to combat COVID-19: information provided by trained community epidemiologists, information from the Ministry of Health’s surveillance system and in the third phase—to be implemented in 2022—information provided by geographical information systems (GIS), satellite images (SI) and drones or unmanned aerial vehicles (UAVs).

“This technology has already been validated and applied with malaria control in Africa by Dr. Jacob,” said Izurieta. “The information collected by the community epidemiologists provides a unique insight on thoughts and perspectives of the pandemic in Ecuador. Through this strategy, we are getting an understanding of potential confounders or future variables that may affect COVID-19 transmission and relief efforts as well as active surveillance information from the ground.”

According to Jacob, using this method to identify COVID-19 hotspots will allow for better outreach in the community, allowing public health practitioners to conduct targeted outreach in areas where people are gathering.

“There’s nothing more enjoyable than watching a disease fall. I’m taking down malaria and I’m going to take down COVID,” Jacob said. “I’m able to use the GPS technology and artificial intelligence ArcGIS to determine unknown locations where we can do interventions.”

Jacob said his job will be to find where aggregation centers, both known and unknown, are located so that Izurieta can then come in and create a protocol to address education in those areas on preventing the spread of COVID-19.

According to Jacob, drones will help gather data on possible centers of aggregation and gather what he calls “signatures” using GPS coordinates of that area. Drones gather data on where it finds hot spots of individuals gathering.

“Combining the role of the drone technology, satellite data, which is where we run systems with GIS, and artificial intelligence infused into a cell app, we’re able to now control the drone and see real time live stream data on a handheld,” Jacob said. “At the same time, we’re taking signatures of these aggregation centers and utilizing them to find unknown locations using satellite data systems of ArcGIS. So, it’s a combination where you use the artificial intelligence within ArcGIS and cell phone technology to infuse in one database.”

According to Jacob, this is what will make this a powerful mechanism in identifying where these clusters are, a vital piece of information in COVID-19 prevention efforts in Ecuador.  

Izurieta says the efforts of the project are supported by Ecuador’s Ministry of Health, which will plan to incorporate the epidemiological advances into their primary health care networks.

“Minga is an Inca tradition of community work/voluntary collective labor for purposes of social utility and community infrastructure projects,” Izurieta said. “In this specific community solution, our ‘Minga’ is for the health and work of the people. Since the ‘Minga’ is voluntary community work, no salaries are expected. All members of the community contribute with what they have, for example, scientists are contributing with their intellectual work, community leaders with their administrative work, community epidemiologists with their field work.”

While the researchers look to secure funding for this project, Izurieta said they have been able to partner with the Universidad Central del Ecuador, Ministry of Public Health of Ecuador, City of Quito Municipality and VECIS–Neighbors for the Health of our Communities–a grassroots organization of the popular neighborhoods of Quito.

“As immediate impacts, we have already seen a reduction in severe morbidity and mortality caused by SARS-CoV-2. Many COVID-19 intensive care units have been closed in the country because of the successful immunization and control program. Since Oct. 28, 2021, the whole country has been reporting zero COVID-19 deaths until today. In the short term, we expect the elimination of the community transmission of SARS-CoV-2 and a dramatic decrease in the burden of post COVID-19 disease among priority parishes in Ecuador,” Izurieta said.

In addition, the community epidemiologists of the project have actively participated in the National COVID-19 Immunization Program.

Izurieta was one of the professionals who developed the National Immunization Plan 9 Million Immunized in 100 Days program, implemented by Minister of Health Dr. Ximena Garzon, a COPH alumna.

“Currently, Ecuador is third in the Latin American region after Chile and Uruguay in terms of total population with complete COVID-19 immunization,” he said.

Izurieta is hopeful for the work of this project.

“This interventionist epidemiology project has the potential of affecting future SARS-CoV-2 outbreak protocols worldwide, as well as contributing to the efforts of controlling the pandemic and other pandemics. By conducting a spatial analysis, we can create predictive models used to mitigate future outbreaks of emerging infectious diseases,” he said.

Story by Anna Mayor, USF College of Public Health