Searching for the dead in Guayaquil, Ecuador

His death and disappearance illustrate how the healthcare system in Ecuador’s second-largest city, roughly the size of Chicago, collapsed within a matter of weeks after the outbreak exploded in March.

Bodies in hospitals

Guayaquil was woefully unprepared to confront the coronavirus.

Three doctors in Guayaquil, each working at different hospitals, described similar scenarios during the months of March and April to CNN: Hospitals completely overwhelmed by a pandemic that descended rapidly on an unprepared healthcare system, leaving no chance to truly help people, let alone provide patients with basic levels of care. All spoke to CNN anonymously for fear of losing their jobs.

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

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

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

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

No one would accept him

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

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

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

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

Undeterred, he tried again at another hospital, and another, and another. After four hours of driving, Ramos says his father was admitted at General Guasmo Sur Hospital. It was the 11th facility he’d 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 bag, a garbage bag to be exact, and the other was just dead on the floor. No one was taking care of them.”

Ramos stepped out of the hospital around 9:30 am on April 1 to grab some breakfast. He says he was gone for about 15 minutes. When he returned, his father was dead.

“No one was with him when he died,” his son said. The hospital declined to comment on the case.

“If you keep her here, she will die.”

Arturo Ramos told CNN the hospital was like a warzone. 38 year-old Ana Maria, who declined to give her last name, said the same thing about her experience.

She said she brought her 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 Ana Maria needed to get her mother to a hospital immediately—she had severe pneumonia, the doctor said, likely due to Covid-19.

By the time Ana Maria arrived at nearby Hospital Los Ceibos on March 26th looking for treatment, her mother’s lips were turning shades of blue and she could barely walk. They waited inside for nearly 24 hours for a bed to open up.

But as she watched patients in adjoining rooms and nearby hallways, and heard the anguished screams of their loved ones, she had second thoughts about keeping her mother in the hospital.

She took decisive action after speaking to a nurse.

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

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

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

Top officials in President Lenín Moreno’s cabinet have publicly apologized for the government’s poor response to the pandemic, saying 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, combined. However, during that same time period, the government recorded at least 12,350 total deaths in the city — far more than the 2,695 and 2,903 that died in the same period of 2018 and 2019, respectively.

In Guayaquil, the Covid-19 related death toll might well be over 9,000 deaths, according to three Ecuador-based epidemiologists who spoke to CNN.

Dr. Esteban Ortiz-Prado, an epidemiologist at the University of the Americas in Quito, Ecuador’s capital city, said there was no way to know exactly how many of the 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 total death count. “For me, those are Covid [deaths] until proven otherwise,” he said.

The government has admitted the actual death toll from the coronavirus is higher than the official count but said the true number will never be known due to its inability to test more people.

“We cannot say the government is lying,” said Marco Coral, an infectious disease researcher also at the University of the Americas. “But what we can say is that the government did not do enough tests on the people,” an irreplaceable part of any attempt to identify the true number of coronavirus cases and deaths.

Fortunately, the number of deaths in Guayaquil is dropping. Since the first week of April, when some of the highest daily death totals were recorded, the daily number of total deaths has fallen dramatically — at least 69 total deaths were reported in the city on April 30, far below the peak seen earlier in the month.

Social distancing measures, now slowly being eased off in the country, appear to have worked.

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

Losing the right to say goodbye

Amid the chaos of mounting bodies, disorganization has led to the misplacement and misidentification of those who have passed away.

Many families have been unable to say goodbye to their loved ones.

When Arturo Ramos returned to the hospital the day after his father died, authorities said they couldn’t find his remains.

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

“[Inside the morgue] there were bodies stacked one on top of each other,” said Ramos. “Going into that room, it’s like hell.”

He said the bodies in the room were separated by those who had already been identified and those that hadn’t.

He went through body after body over the course of an hour looking for his father, accompanied by a hospital employee who, after they failed to find his dad, told him to come back the next day.

For the next four straight days, Ramos estimates he looked at roughly 250 corpses, both inside the morgue and in shipping containers that had been set up outside to handle the overflow.

Video of the containers on the grounds of General Guasmo Sur Hospital was given to CNN by the person who shot it. Bodies are seen in one container piled at least three high, decomposing inside different types of body bags.

Ramos said only part of the morgue and one of the shipping containers was refrigerated.

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

The problem of missing remains is so widespread that the attorney general launched an investigation last month into the mismanagement of remains at hospital morgues.

CNN asked the government for exact figures on how many remains are missing, but as of publication, had not heard back.

More than a month after Flavio Ramos’ death, a search for his name launches a pop-up window that reads only: ‘No Results Found.’

Ramos grieves for his father alone these days. He’s separated from his family for their own safety.

Last week, he tested positive for the virus.

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