‘Very anxious’: Lebanon’s ICU doctors fear unfolding COVID surge

Beirut, Lebanon – “I’m very anxious about what we’ll see in the next few weeks,” a 33-year-old intensive care doctor, on a short break from a 24-hour shift at a Beirut hospital’s intensive care unit (ICU), said.

The doctor, who spoke to Al Jazeera on condition of anonymity due to the sensitivity of the matter, said ICUs at two hospitals he worked at between Beirut and Lebanon’s eastern Bekaa Valley had become full over the past week.

Across the country, the number of new cases has spiked after officials significantly relaxed restrictions on going out during the holiday season.

Records have been smashed each day for the past four days, jumping from 3,620 new cases on Tuesday to 5,440 on Friday – the day after a new 25-day lockdown with a night-time curfew was imposed.

Though numbers vary, ICU capacity across the country is reportedly about 550 beds. Five-hundred and twenty five, or more than 90 percent, were full as of Friday, according to the health ministry.

This means COVID-19 patients whose lives are in immediate danger have had to remain in the emergency department rather than being transferred to the ICU.

“They are not being provided optimal care,” the doctor said.

“The emergency rooms are overcrowded and overwhelmed and are not able to accept more patients. We’re not yet at the stage where we have to make those hard choices of triaging patients [deciding who gets care based on their chances of survival], but it’s becoming difficult.”

The survival prospects of many depend on whether an ICU bed becomes free – sometimes by someone getting better, but often after someone dies.

Last March, during a huge COVID-19 outbreak in Italy’s Lombardy region, healthcare workers had to make the difficult decision not to treat patients older than 75 or 80, instead opting to provide care to younger patients with a better chance of survival.

It is something like that dreaded “Italian scenario” that health workers fear on the front-line of Lebanon’s fight with COVID.

“I think we are going to have to make decisions like in Italy, if not next week or the week after, then in a month. That means the number of deaths will increase,” a second, 35-year-old ICU doctor told Al Jazeera, also speaking on condition of anonymity.

“The healthcare system is weak, officials are useless and many people don’t seem to care. The situation is miserable and I’m afraid of what’s to come, but I’m honestly at the point now where I just say, ‘whatever happens, happens’.”

Health minister Hamad Hasan could not be reached for comment, nor could an adviser.

The ministry has asked private hospitals to increase their COVID-ready bed capacity, and hospitals say they have complied to the furthest extent possible given the effects of the country’s unprecedented economic crisis.

“Even if hospitals increase their bed capacity, they cannot keep up with the sharp rise in COVID numbers,” warned Firas Abiad, the head of Lebanon’s main COVID-fighting hospital, in a tweet.

“A tougher approach is now required. If we wait for hospital beds to be full, it will be too late. Judging by the noticeable laxity on the street, things are not going well.”

‘There is no strategy’

Many in Lebanon draw a direct line between the spike in cases and the government’s decision to significantly ease a nighttime curfew over Christmas and New Year – allowing hundreds to congregate indoors for concerts and other events.

At least two singers who held jam-packed New Years Eve events have since announced they tested positive.

“This was a decision tied to business interests,” Assem Araji, the head of Lebanon’s parliamentary health committee told Al Jazeera, decrying the shortsightedness of the decision.

Araji’s committee has also criticised the new lockdown for exceptions that allow flower shops, factories and other non-essential businesses to remain open.

“They might as well have made a list of what is not excepted, practically everything other than clothing shops is open,” he said.

At the same time, the interior ministry mandated that only cars with odd-numbered licence plates drive some days, and those with even-numbered plates on others – despite the objection of both the health minister and the health committee, who say the regulation actually increases the chances of exposure.

“This forces people to use public transport or get in the car with their neighbour,” Araji said.

“There is no strategy and [officials] are contradicting each other.”

Holding out for vaccines

Araji said the government was on the cusp of signing a deal with Pfizer pharmaceuticals for some two million vaccine doses after the final decision was held up over a clause that shielded the US-based company from any responsibility for potential side-effects.

He said the first batch of vaccines was promised for mid-February. At the same time, he said Lebanon was looking to secure some 1.5 million doses through the World Health Organization’s COVAX programme that aims to ensure vaccines are distributed to the developing world.

As two doses each are needed for the vaccines that will be procured, they will cover 1.75 million Lebanese – less than a third of the country’s six million population which includes at least one million refugees.

Araji said it would likely take until the end of 2021 to administer all these doses, adding that privately bought and administered vaccines would also soon be available.

Meanwhile, the 33-year-old ICU doctor said healthcare professionals are trying to hold out until Lebanon begins vaccinations – but expressed anxiety over the time it will take for the resulting immunity to lower the case-load.

“There is frustration and there is a lot of pressure on us,” he said, “to always do the right thing, to find places to treat these patients, deal with their families and the misconceptions and misinformation, and also see our colleagues become sick and tired.”