Brutto et al. assessed the prevalence, distribution, and risk factors in middle-aged and older populations associated with SARS-CoV-2 seropositivity in the Atahualpa Project’s populationbased prospective pre-existing cohort. SARS-CoV-2 antibodies were identified using a lateral flow antibody test. Antibodies were identified in 303 out of 673 Ecuadorian adults. Clinical manifestations of disease was reported by 77% of seropositive individuals (positive response to IgM and/or IgG) and 15% of seronegative individuals. Seropositive persons were also more spread across the village and reported greater use of open latrines. The authors suggest that the high seroprevalence of disease (45%) across the village confirms concerns of widespread transmission of SARS-CoV-2 in rural Latin America and suggests fecal-oral transmission cannot be excluded.