BEIRUT: Lebanon is unprepared for a large-scale coronavirus outbreak, experts have told The Daily Star. The country’s third confirmed case of the disease in less than a week was announced Thursday.
Asked whether the nation is ready to deal with a surge of infections, World Health Organization representative for Lebanon Dr. Iman Shankiti told The Daily Star, “If we have a huge number, no ... with current supplies and capacities it will be difficult.”
According to Shankiti, Rafik Hariri University Hospital is able to accommodate 128 mild cases and around 11 severe cases.
The public hospital has just seven intensive care units and four isolation rooms in which to quarantine patients. While efforts have been made by the Health Ministry to establish other treatment facilities, no other public hospitals have been identified as equipped to handle coronavirus cases.
Health Minister Hamad Hasan confirmed Lebanon’s third case of coronavirus to The Daily Star Thursday.
The patient is a male Iranian national who arrived in Beirut on a flight from Iran Monday. He has been placed in quarantine in Rafik Hariri University Hospital and is now in a stable condition, Hasan said.
The first and second cases of the infection, also known as COVID-19, were confirmed Friday and Wednesday. The two female patients had traveled to Lebanon from Iran on a flight that arrived on Feb. 20.
“Until now, we don’t have local transmission. All cases identified have been related to travel to Iran,” Shankiti said.
“But once we have local transmission it will be a different story ... Given the high level of infection rate, you will have cases escalating in an exponential manner. We’re hoping we don’t reach that stage.”
STRATEGY AND POLICY
A spokesperson from Iran's Health Ministry said Thursday that out of 245 cases in the country, 26 have been fatal – the highest recorded number of coronavirus deaths outside China.
This has raised questions among experts about the policies and strategies implemented by Lebanese authorities.
“In dealing with epidemics and pandemics, the key is prevention not control,” Fadi el-Jardali, director of the Knowledge to Policy Center at the American University of Beirut, told The Daily Star. “The moment you have cases it’s already too late.”
Following a Cabinet session Tuesday, the government announced its decision to limit flights to and from countries with large numbers of coronavirus infections. As part of the restrictions, the government ordered a halt for all religious pilgrimage trips. Many Lebanese Muslims fly to Iran for this purpose.
Jardali believes that stricter preventive measures should be put in place. “If you don’t have the capacity to deal with it internally, then you need to limit the risk of importation. It’s as simple as that,” he said. “In these cases you don’t have many other options” Shankiti, however, said that tighter travel restrictions would do little to prevent the spread of the virus in the long-term.
“By stopping flights, you might delay it, but you won’t stop it,” she said. “There will also be huge economic repercussions in a country that imposes such sanctions.”
COORDINATION AND COLLABORATION
According to Jardali, now that coronavirus has reached Lebanon, the most important thing is for authorities to implement an “intersectoral approach.”
This requires the coordinated efforts of all ministries, non-governmental organizations, citizens, municipalities and the private sector.
“This is not only a governmental issue,” he said. “The private sector should have a coordinated strategy with the government, in case the public sector will not be able to isolate and host all the people that will be infected. “We need to work on a contingency plan. This is a litmus test for all sectors to pitch in – for the private sector to come in and provide a generous strategy to work with the public sector.”
Jardali estimates there are 150 private hospitals in Lebanon.
President of the Syndicate of Private Hospitals Suleiman Haroun told The Daily Star, “We are still trying to find which [private] hospitals have the capacity to deal with big numbers.
“You can’t just give the cases to any hospital. You have to pass them to [facilities that are] well prepared to fight the coronavirus.”
Factors that determine whether a hospital is capable of treating the virus include human resources, size, equipment and even certain architectural considerations.
The syndicate is now conducting a survey of the readiness of private hospitals across Lebanon, according to international standards. Haroun said the results will be ready next week.
“We are ready to support,” he added. “In the meantime, we’re not just sitting and watching. We’re working to be more prepared.”
CONFUSION AND MONITORING
Confusion and concern has also surrounded recent recommendations for self-quarantine made by the Health Ministry. Passengers arriving in Lebanon on flights from countries with a large number of coronavirus infections have been asked to self-quarantine for a total of 14 days – the length of time it can take for symptoms to develop.
Jardali believes that a mechanism must be put in place to make sure that people are abiding by the government’s requests, adding that municipalities must play a larger role in monitoring self-quarantine cases.
“People coming on these flights should be closely monitored,” he said. “They should be tracked and educated. Their families should be educated. Municipalities need to follow up on this.”
Shankiti confirmed that no plan has been established to ensure that proper self-quarantine procedures were being followed.
“The mechanism is still not in place but we’re working on it,” she said.
Hospitals are also facing a shortage of personal protection equipment, such as masks, gowns and gloves. According to Haroun, this began around six months ago, way before the global coronavirus outbreak.
“Because of economic issues like bank restrictions, suppliers have not been able to make transfers to import medical supplies,” he said.
“For me to say that we are ready for a big outbreak would be an exaggeration,” the health minister told The Daily Star.
“Currently, the plan is to make a quarantine room in each hospital. We might need private hospitals to be ready to receive infected cases,” Hasan added.
Coronavirus has infected around 83,000 worldwide.
While the it is highly contagious, its fatality rate remains low, killing only 2.3 percent of all those infected so far.
“We can be worried, but there is no need to panic if we do things properly,” Jardali said.
“This needs to be No. 1 on the government’s agenda. This is more critical than the economic situation. Any delay in decision-making is catastrophic. The government should put everything aside and bring all the sectors together.” – additional reporting by Jad Ramadan