BEIRUT: As countries across the world begin to cautiously ease coronavirus lockdown measures, discussion has ramped up on how Lebanon will begin to reduce its own restrictions and reopen society.
However, the criteria for a pandemic exit strategy is more complex for a country like Lebanon, which does not have enough resources, ventilators or hospital beds to withstand a major outbreak and is teetering on the verge of economic collapse.
Easing lockdown measures, implemented to slow the spread of coronavirus, could invite a renewed surge of infections and result in the collapse of the country’s health care system.
Public health experts say the path to unwinding Lebanon’s lockdown measures will be gradual, based on trial and error, and will hinge on citizen cooperation.
“The plan needs to be organized and based on facts. It should be based on the argument that health comes first, before any economic argument,” says Fadi El-Jardali, director of the Knowledge to Policy Center at the American University of Beirut.
PREREQUISITES TO EASING LOCKDOWN
Jardali says a number of prerequisites need to be guaranteed and implemented before Lebanon begins loosening its measures.
“Easing lockdown is like trial and error. Until there is a vaccine available we will have periods of stricter lockdown measures and periods of looser measures. You can expect for new cases to emerge so we need to make sure our hospitals are prepared for a surge,” he adds.
Jaradli says that before measures are eased, there first needs to be undeniable data and evidence of a sustained decrease and reduction in the number positive coronavirus cases in the country.
This data can only be gained through mass testing, whose absence can result in misguided decisions based on inaccurate information.
To date Lebanon has not started to implement testing on a broad scale, but Health Minister Hamad Hasan said during a news conference in Zahle Saturday that mass testing of the population for coronavirus would commence next week.
Hasan said the ministry’s plan was to increase the number of PCR tests to approximately 1,500 a day next week, in addition to random testing, for more accurate data on coronavirus infections in the country, local media reported.
Public health experts agree that mass testing for COVID-19 needs to be scaled up in regions across the country to evaluate whether containment measures are actually working.
“Lockdown can’t be relaxed without mass testing and getting a clearer picture of infections. It will be a catastrophe,” explained Dr. Mahmoud Hassoun, head of the coronavirus unit at Rafik Hariri University Hospital.
So far, Lebanon’s reported coronavirus infection rate remains low, but testing should be at a rate of at least four times the current level for a more accurate representation of the outbreak in the country.
“In a population of 6 million, 2,500 tests per day would be required for a more accurate picture of the number of infections in the country,” said Firas Abiad, head of Rafik Hariri University Hospital, in a tweet in early April.
Before lockdown measures can be scaled back, hospitals also need to have adequate resources in preparation for a potential surge in number of infections.
“In the face of a second or third wave of infections – which can happen – there needs to be readiness of hospitals and other health care facilities ... if there is suddenly a large influx of people going into hospital,” Jardali explains.
Currently, Rafik Hariri University Hospital, which has taken in almost 50 percent of COVID-19 patients, has the capacity to take in 150 patients with moderate symptoms and 22 critical.
“If we get to a stage of 1,000 [infections] per day, where are you going to go with all the patients?” Hassoun says.
WHAT OPENS FIRST?
When time comes for Lebanon to gradually reopen businesses, Jardali stresses that essential services need to be made a priority.
“Essential services means essential to the survival of people,” Jardali says, adding that this is country-specific and a government decision that needs to be made based on the needs of the Lebanese.
“Until there is effective treatment or a vaccine, social distancing needs to be maintained when we’re easing lockdown. So anything that gathers crowds together like entertainment should not be a priority right now,” He cautions.
This strategy must include adequate communication to the public on the reasoning behind why certain sectors or services will open over others.
“All Lebanese have to agree on these essential services to make sure everyone is complying with lockdown. This is because we’ll see competition between sectors ... one might think they are essential when they are not,” he says.
However, the question of reopening the airport depends on international policies and cooperation.
“Opening the airport depends on the international strategy in other countries as well and what measures are they putting in place,” Jardali explains.
IMPACT OF LOCKDOWN ON ECONOMY
Lebanon’s fragile economy has ignited debate on the best way to reduce lockdown measures.
“This is not merely an economic cost like we are seeing in first world countries. In Lebanon it is a humanitarian cost,” says Mohammad Faour, a postdoctoral researcher in finance at University College Dublin.
Lockdown measures, which have so far been extended twice and are in effect until at least April 26, have wreaked havoc on an economy already suffering from steep recession.
The International Monetary Fund said earlier this week that Lebanon's economy would shrink by a massive 12 percent in 2020, compared to shrinking 6.5 percent last year. This is the biggest contraction expected in the Middle East region.
The decline will likely take a massive toll on a population in which over 30 percent of people are already living beneath the national poverty line.
“When the time is right, the priority will have to be on easing lockdown measures enough to allow those people who are not able to make a living to make that living,” Faour says.
Currently, there is no official social safety net for families who have been disproportionately affected by lockdown measures.
Almost a month ago the government announced that these families would receive a one-off cash donation of L.L.400,000 which will be coming from a fund of L.L.72 billion that Cabinet allotted for the Higher Relief Commission.
This amount, which comes to a meager $130 on the secondary market, has yet to be distributed.
“It is a delicate balance we have to strike. Lockdown is very important and we need to be careful, but we need to bear in mind that this is having massive humanitarian consequences on some of the most deprived in the country,” Faour says.
AUB’s Jardali agrees, saying: “The government needs to be clear on not only what citizens have to do but what the government is doing for its citizens in order to actually make sure they can survive through this phase.”