Editor’s Note: Writing a COVID-19 article about Lebanon is one task, keeping it up-to-date in 2021 is quite different. As local policies change erratically, and the scope of the crisis continues to escalate, we aimed to establish a balance between relevance and key developments from the last few months. We hope this piece keeps our readers sufficiently informed on the latest, as our thoughts are with all of those who have been directly affected by the pandemic.
Domestic Virus Updates
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.
Critical Data and Trends
After the near complete easing of restrictions before the holiday season, new cases accelerated at an alarming rate. The January lockdown slowed the burst of cases, but a corresponding decrease in testing and persistently high positivity rates suggest many cases are being missed and the outbreak remains uncontrolled. Positivity among tests conducted locally, in fact, averaged 14% during December and exceeded 20% in January, indicating higher rates of transmission and insufficient testing. Identifying and isolating cases of COVID-19 in the community is necessary to curb the spread of the virus. Lebanon did receive and distribute PCR machines across the country in the fall to boost testing capacity – largely funded by the State of Kuwait – which increased the number of reported tests in winter. Although the four-phase plan intends to maintain and build on the limited gains demonstrated as a result of January’s lockdown, it is unlikely to result in a sustained decrease unless a nationwide coordinated plan is enacted.
For more detailed information about critical COVID-19 data and trends in Lebanon, please visit this Lebanon COVID-19 Dashboard based on publicly available key indicators at tiny.cc/covidlebanon.
The recruitment of COVID-19 sniffing dogs at Rafic Hariri International Airport has shown promise in detecting infections. Over the summer, Lebanon joined several other countries in training and deploying dogs to identify the virus in sweat samples. The experiment trained 18 dogs and operationalized two, each of which is said to have the ability to search about 4,000 people per day.
To understand the potential of this approach, researchers worked with Rafic Hariri International Airport to collect samples from passengers that were then checked against conventional testing methods. Initial results reported in November stated that the dogs identified negative results with 100% accuracy and positive results with 92% accuracy.
The animals, originally trained for detection of explosives and colon cancer, are framed by researchers as a critical tool in countries with limited testing capacity and hold potential to efficiently screen large numbers of people. Schools, banks, prisons and malls have expressed interest in utilizing the dogs, although it is unclear if this method will be scaled up effectively. There is only one pilot study to date examining effectiveness, and sample sizes of international trials have been small.
The World Health Organization country office in Lebanon continues to partner with local agencies to participate in the global SOLIDARITY trial of treatments for COVID-19. Launched in March 2020 to study untested treatments for the infectious virus, the World Health Organization initiative collaborates with hospitals around the world – including Rafic Hariri University Hospital – to understand the effectiveness of remdesivir, chloroquine or hydroxychloroquine, lopinavir plus ritonavir, and interferon-beta.
Participants must already be admitted to hospitals for COVID-19 and receive the local standard of care or the local standard in addition to one of the study drugs. Patients are monitored during their entire length of stay to examine the impact of treatment on mortality, likelihood of ventilation, and duration of hospital stay. While all experimental treatments have been shown to be relatively safe, patients are informed of the possibility of side effects and a worsening of the illness as a result of experimental interventions.
What to Know Before Visiting Lebanon
Entry Requirements: The Beirut Rafic Hariri International Airport is open and operating at a reduced capacity, welcoming about two to three thousand passengers daily. As part of the latest January lockdown, rules around testing and quarantine in Lebanon have shifted for arriving passengers and at the time of writing are as follows:
- Travelers to Lebanon 12 years of age or older must take a COVID-19 test upon arrival before quarantining for seven days.
- Upon receipt of a negative test result, passengers may then continue quarantining in other accommodation.
- A week after arrival, another COVID-19 test must be completed, and quarantine ends after this second negative result.
However, it’s important to note that requirements vary based on where travelers are arriving from, so it’s crucial to refer to the Ministry of Public Health, airline(s), and the airport of origin for more specific information. The above information is intended to give readers a general idea of entry requirements.
COVID-19 Testing: Several hospitals and laboratories are sanctioned by the Ministry of Public Health to administer PCR tests. Whether tests are taken at home, in a hospital or in a drive-thru tent, results are typically available in 24-48 hours. Call the Ministry of Public Health’s COVID Hotline at 01-594459 for more information.
In Focus: State of the Health Sector
Lebanon’s healthcare system has suffered tremendously in the past year due to the economic collapse, the Beirut Port explosions, and COVID-19. Some healthcare workers are unpaid or have endured significant pay cuts. Many are overworked and subjected to the physical and mental effects of deteriorating living conditions and poor working environments. Primary healthcare centers are facing shortages of critical supplies and medicines, while reports show many households are still unable to access healthcare or obtain medication.
The explosion that rocked the city on the 4th of August left half of Beirut’s hospitals completely or partially damaged, translating to an estimated $71.5 million in repair costs excluding medical equipment. WHO Lebanon also found that 500 hospital beds were lost, over half of the 55 clinics and health centers in Beirut were deemed non-functional, and 4 of 23 primary healthcare centers were destroyed.
Many would describe the healthcare workforce as resilient in the face of these multiple crises, but with flu season in full swing amidst the COVID-19 pandemic and immediate improvements in living and working conditions unlikely, attention must continue to be given to the state of Lebanon’s healthcare system and its ability to meet the needs of its own workforce and patient community. Domestic and foreign support measures are critical, both for the provision of equipment, supplies, and medicine and the achievement of political and economic reforms.
If you are in a position to help vulnerable communities in Lebanon, consider donating to vetted non-profit organizations like Hand in Hand, Baytna Baytak and Anera that support local healthcare institutions.
Sara is a US-based public health professional with over 15 years of experience spanning government and non-profit agencies. From HIV/AIDS prevention efforts in South Africa to health education in a US county jail, her passion for health and activism has led her to work in diverse settings across the world. She provided support for the US response to Ebola and Zika and has worked extensively in positions related to infectious disease and social justice. She recently relocated from Beirut, where she provided consulting support for non-health actors in the COVID-19 response in Lebanon. Her current projects include data tracking and analysis on COVID-19 in Lebanon, supporting a fundraising initiative to help Lebanese students receive their diplomas, and advocating for the rights of migrant domestic workers in Lebanon. She obtained a Master of Public Health in Management & Policy from Oregon State University.