A critical narrative of Ecuador's preparedness and response to the COVID-19 pandemic.

Ecuador's National Health System has been severely overwhelmed by the COVID-19 pandemic despite public health efforts. This was primarily due to limited health emergency planning responses. Ecuador's COVID-19 mortality rate was 8.5% in early June 2020. The capital city (Quito) and Pichincha province, Guayaquil city and Guayas province, as well as Manabi, Azuay, the El Oro and Tungurahua provinces were the most severely impacted locations by the COVID-19 pandemic, resulting in thousands of positive cases. Using the World Health Organization (WHO) Operational Planning Guidelines to Support Country Strategic Preparedness and Response Plan for COVID-19 as a reference point, we highlight the urgent need to implement a proactive preparedness and response plan to address the COVID-19 pandemic, with the aim of improving Ecuador's public health system. The mitigation of COVID-19 transmission and hazard reduction is crucial in protecting the most vulnerable at-risk populations in this nation.