Inconsistent Lockdown Policies Thrust Lebanon Deeper into COVID Crisis

The world is one year removed from the start of a pandemic that has thus far defined this decade. After a month-long nationwide lockdown, Lebanese authorities began to ease restrictions on February 8th as part of a four-phase plan to reopen the country. The approach is intended to maintain and build on limited gains in decreasing the spread of COVID-19 during the lockdown, which came into effect due to surges in cases, hospitalizations, and deaths. Many experts attribute the relaxation of restrictions and increased socializing by residents during the holiday season for the rapid acceleration in the spread of the virus. Before the January policy, a nationwide two-week lockdown in November briefly stemmed the acceleration of infections. This was preceded by localized October lockdowns of various towns and villages which were much less effective.

As a result of the dramatic increase in hospitalizations in January, local healthcare infrastructures were forced into an unprecedented situation. While an increased number of hospital beds have been made available for COVID-19 patients in private sector hospitals as a result of negotiations between the Ministry of Public Health and the Syndicate of Private Hospitals, bed occupancy remains critical at nearly full capacity for both non-ICU beds and ICU beds. The total number of COVID-19 patients continues to climb and will continue to overwhelm hospital capacity unless additional beds are secured, mitigation measures bring down hospitalizations to manageable levels, or an increased proportion of patients can be diverted to home care or isolation centers. The Syndicate of Private Hospitals stated they are unable to expand capacity due to financial constraints exacerbated by overdue payments not yet received from authorities. It should be noted the addition of hospital beds does not address shortages of qualified and well-trained staff needed to manage those beds and support patients. 

Throughout the multiple lockdowns, demonstrations resurfaced in protest of the declining economy and deteriorating living conditions. More than half of the country’s population now lives under the poverty line. Intermittent provisions in the form of food parcels and cash assistance from authorities have not sufficiently addressed extensive needs across the country. Civil organizations have worked to distribute aid to those most in need, although some critics have expressed concern about the continued lack of coordination between said entities and the state. This further highlights the systemic inefficiencies and inadequacies that have exacerbated the local effect of the global pandemic. There is a tense imbalance between meeting public health needs related to the pandemic and economic needs due to the financial crisis, but one could say political inaction and instability pose the biggest threat to turning the tide in Lebanon.

Vaccine administration in Lebanon began this month. The Pfizer COVID-19 vaccine arrived first, with doses from AstraZeneca and the WHO COVAX program to come late winter or early spring. Health workers, older adults, and those at risk of severe illness have been prioritized to begin receiving the shots. The government submitted orders for a total of 6,830,000 doses, covering about half of the country’s population by the end of 2021. The Minister of Health, however, told local media the goal is to vaccinate 80% of the population this year. This means the government will need to reserve additional doses or look toward private entities to procure enough shots to meet this ambitious target.

While this comes as welcome news as the country struggles to mitigate the spread of the virus, there are valid concerns about the logistical challenges associated with the Pfizer vaccine in particular. The jabs require cold chain management – meaning dry ice and freezers are critical to maintain extremely cold temperatures necessary for the vaccine’s stability. This casts doubt upon local infrastructure’s ability to properly store and transport doses. Hospitals, clinics, laboratories and pharmacies are not exempt from electricity cuts, illuminating how Lebanon’s multiple crises compound each other. Additionally, the Ministry of Public Health reports the availability of 35 vaccination centers with capacity to administer 400 doses per day, which translates to 4.5 million doses over the course of the year. Administration capacity will need to increase significantly to reach 80% of the population. Experts estimate about 70% of people will need to be vaccinated to provide community-level protection and minimize the possibility of further outbreaks, often referred to as “herd immunity.” Critics point out vaccine hesitancy must be addressed in public communication campaigns, which may be best illuminated by the low number of people who have registered for the vaccine so far – about 450,000.