The COVID-19 pandemic caused by the new zoonotic coronavirus, the SARS-CoV-2 virus, has caused the worst health crisis worldwide, becoming one of the deadliest public health problems of this century (1). The rapid transmission, often driven by asymptomatic carriers, disseminated the virus globally. During the early phase of the pandemic, many low-and-middle-income countries (LMIC) faced the arrival of the virus before having the opportunity to prepare (2, 3). Poor epidemiological surveillance, limited testing capacities, and intensive care units (ICUs) working at full capacity were the norms (4).

In Latin America, the crisis was immense; fragmented health systems, weaker economies, and high demographic density as well as poverty, were the perfect formula for a disaster (5, 6). The earliest measure adopted by most countries was implementing country-wide lockdowns declaring the state of emergency (7). Implementing social distancing within communities required a multidisciplinary action plan, having police officers, special forces units, and the military deployed in every corner of the country. These security forces were permanently exposed to guarantee that control and prevention measures were followed by the population to reduce the spreading of COVID-19 (8, 9).

In spite of this, law enforcement agencies around the world are still facing unprecedented challenges due to the COVID-19 pandemic (10). Police officers, as security service providers, have been required to remain on duty during the entire length of the pandemic even during strict lockdowns worldwide (11, 12). Due to the nature of their activities, police officers are at higher risk of person-to-person spread through respiratory droplets and aerosols when close to someone coughing, sneezing, or talking (13). Among the police staff, special forces units included in our study may experience a higher occupational risk of exposure to COVID-19 as they cannot carry out many of their functions without being in close personal contact with others and may not have immediate access to all necessary personal protective equipment (PPE) and disinfection supplies in the field. Guidelines in accordance with the Center for Disease Control and Prevention (CDC) were placed among law enforcement worldwide. Nevertheless, 145 out of 264 police officers who died in the line of duty in 2020 were COVID-19 victims in the United States (14). In Latin America, dramatic numbers of SARS-CoV-2 infections and COVID-19 related deaths among police have been reported, with 534 victims in Peru, 465 victims in Brazil, and more than 1,000 soldiers and policemen infected in Colombia by June 2020 (15–17). In Ecuador, within the 1st month of the COVID-19 pandemic, there were 248 police officers and soldiers infected (3).

Under this scenario, the SARS-CoV-2 diagnostic laboratory at “Universidad de Las Américas” carried out a preventive screening among special forces police units in Quito (GOE/GIR), during July 2020, just a few weeks after the population lockdown was lifted. This study aimed to analyze the data obtained from this surveillance and describe the infection rates of SARS-CoV-2 infection among these essential workers to assess their potential occupational risk to COVID-19.

In the city of Quito, we covered 81% of the total number of special forces officers. Within this cohort, 88.3% (144/163) of the police officers were men and 11.7% (19/163) were women police officers. The average age for the policemen and policewomen recruited was 37 and 39 years, respectively (Figure 3).

Since the WHO declared the COVID-19 pandemic, many countries around the world have taken drastic measures, establishing public regulations to slow viral transmission. Several countries chose to declare a state of emergency, prior to the arrival of the virus to avoid a rapid explosion of contagion (1). Despite these measures, the virus spread rapidly in several places, prompting the government to implement more aggressive measures, such as the use of law enforcement to prevent population crowding (26, 27).

During the entire length of the pandemic, most countries deployed their police and police special units to ensure order and to prevent the spread of the disease in the population (14, 26). In March 2020, the government of Ecuador decided to declare a state of emergency establishing a population lockdown (3). However, after the lockdown restrictions were lifted, scenarios in which disorder, overcrowding, and non-compliance with social distance among the population prevailed in places, such as markets, public transportation, and population traveling from the cities to the countryside (3). This not only increased the risk of transmission among citizens but also puts police officers at risk, who in the performance of their work, try to enforce government regulations sometimes with inadequate precautionary measures and insufficient protection (28, 29).

While total COVID-19 cases and deaths worldwide have been regularly monitored and reported, less is known from the contribution to this number related to occupational risk for different types of workers. This is particularly worrying about essential workers, such as police officers or the military, as severe COVID-19 outbreaks among these groups may compromise their ability to work on the field. For instance, in our neighboring country of Peru, there were 1,300 positive cases and 11 deaths from COVID-19 among police officers by April 2020; those numbers rose to 4,098 cases and 82 deaths by May 2020; a dramatic number of 524 deaths of police officers was reported up to May 2021 (30). Another example comes from India, where up to August 2020, there were 71,832 infected and 428 deaths of police officers reported (31). Moreover, this is not an issue necessary associated with developing countries, as in the United States, more than 2,000 law enforcement officers had already been tested positive for SARS-CoV-2 by April 2020 (10). Our results confirm severe COVID-19 outbreaks among community dwelling special forces police officers with a high infection rate of 12.3% in Ecuador, suggesting that a massive COVID-19 transmission could be happening among other police officer groups or the military. Moreover, we found 2 individuals among the 20 SARS-CoV-2 positive ones, which means 10% of the infected population with viral loads above 10⁸ copies/ul that would represent community dwelling COVID-19 super spreaders (32–34).

Our results point out the need to improve SARS-CoV-2 testing among asymptomatic individuals at high occupational risk, such as the special forces police units included in this study. This group has a higher infection rate than healthcare workers in Ecuador, where the infection rate did not exceed 5% at the worst of the pandemic, according to official data from the Ecuadorian MoH. On the other hand, is a highly mobile group, with scarce economic resources and limited access to healthcare, such as delivery food-riders, we found very similar levels of 15% SARS-CoV-2 infection rate (35). In the only study available in Ecuador regarding occupational risk from official data by the Ministry of Health, our research group found that police and military personnel were almost two times more prone to die from COVID-19 than the general population within the same age range (3).

Under this scenario, additional measures to prevent the spreading of COVID-19 among police officers must be reinforced, such as sanitization of equipment used at work, cleaning of clothes and personal items before returning home, and use of proper disposable PPE, as recommended by the US CDC or INTERPOL. The Ecuadorian National Police has included these recommendations in its own guideline, nevertheless, police officers are always at risk of not being able to use them properly. Additionally, informational resources, such as the ones offered in the United States from the National Police Foundation, could provide updated regionalized information and all types of support for officers that are constantly exposed and at increased stress regarding their safety (National Police Foundation). However, law enforcement officers cannot carry out many of their duties without being in close personal contact with others and may not have immediate access to all necessary disinfection supplies in the field.

As the high prevalence of SARS-CoV-2 infection among police officers found in our study suggests, the precautionary measure may not be enough to protect police officers against COVID-19, and regular SARS-CoV-2 testing should be mandatory as they are constantly enduring public measures. Moreover, our results endorsed including police officers among priority groups for SARS-CoV-2 vaccination. By May 2021, more than 1,00,000 police officers and military personnel received the first dose of the SARS-CoV-2 vaccine in Ecuador (36). Those protective measures against COVID-19 for police officers and the military, particularly for special forces units described in this study, should be considered a matter of national security. For instance, police officers have been answering thousands of emergency calls related to public order disturbance and crowd control during the COVID-19 pandemic, and they had to act fast to restore order and implement social distancing measures (30). In Ecuador, the initial reduction in crime rates during the population lockdown was followed by an exponential increase in crime that demanded security forces at full capacity (37).

Our study supports that police officers are at high risk of occupational exposure to COVID-19, so they should be regularly tested for SARS-CoV-2 infection and included as a priority group for vaccination, not only to protect themselves, their families, and the community, but also as a matter of national security under the unfortunate scenario of social crisis imposed by COVID-19 pandemic.

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.

This study was reviewed and approved by the Ecuadorian MoHcertified IRB, code: CEISH-HGSF-2021-002. All participants signed written informed consent to participate freely and voluntarily in the molecular diagnosis of SARS-CoV-2.

Tatiana Jaramillo, Daniela Santander Gordon, Gabriel Alfredo Iturralde, Julio Alejandro Teran, Karen Marcela Vasquez, Jonathan Dario Rondal, Genoveva Granda, Ana Cecilia Santamaria, Cynthia Lorena Pino, Oscar Lenin Espinosa, Angie Buitron, David Sanchez Grisales, Karina Beatriz Jimenez, Vanessa Bastidas, Dayana Marcela Aguilar, Ines Maria Paredes, Christian David Bilvao, Maria Belen Paredes-Espinosa, Angel S. Rodriguez, Juan Carlos Laglaguano, Henry Herrera, Pablo Marcelo Espinosa, Edison Andres Galarraga, Marlon Steven Zambrano-Mila, Ana Maria Tito, Nelson David Zapata.

EO-P and MG-B were fully responsible for the conceptualization of this investigation. AH-T, IR-O, TL, and AV-J contributed to the process of data collection and raw data processing. FA, CE-E, and EV were responsible for part of the data analysis and graphical display of the manuscript. EO-P and FA were responsible for the construction of some figures and tables and they contributed equally with the descriptive statistical analysis. EO-P, EV, and MG-B elaborated the first draft of the manuscript. TL, AH-T, and IR-O added an important insight on the overall manuscript. All authors critically reviewed the entire final version of the manuscript, produced several comments prior to the submission, and participate in data collection and primary analysis.

This study was funded by Universidad de Las Américas and by Fundación CRISFE (Fondo Sumar juntos).

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.