Fears a new COVID wave could overwhelm Lebanon’s health system

Beirut, Lebanon – Doctors have warned that hospitals in Lebanon would struggle to cope with a large influx of coronavirus patients amid a surge in the number of new cases spurred by the highly contagious Delta variant.

Lebanon recorded 577 new COVID-19 infections in a 24-hour period on Friday, according to the health ministry, the first time that more than 500 daily cases have been reported since May. The number of new cases recorded on Saturday was slightly lower, with 488 new confirmed infections, bringing the total number of cases since the beginning of the outbreak to 550,492.

Dubbed as the “fastest and fittest” of the coronavirus variants by the World Health Organization (WHO), the Delta variant is highly transmissible and has spread to dozens of countries around the world.

Medical experts warned that a new wave of the coronavirus could put unbearable pressure on the fragile health system, which has come under increased strain since the beginning of country’s economic and financial crises in late 2019.

“This [rise in coronavirus cases] is an exacerbation of what is already a difficult situation,” Dr Firass Abiad, Head of the Rafik Hariri University Hospital (RHUH) told Al Jazeera.

“Our resources to deal with a new [COVID-19] wave are not what they were a year ago, or even last summer,” he said. “We are not well-prepared against what appears to be a dangerous variant [Delta],” he said.

Dr Abiad said that RHUH, the largest public hospital in Lebanon, was able to cope with the devastating coronavirus wave at the beginning of 2021 because the hospital had received donations following the Beirut explosion that took place in August 2020.

The number of patients with coronavirus admitted to RHUH had increased in recent days, he noted.

“Whether it’s because other hospitals have closed down their coronavirus wings or because cases have increased, it’s early to say,” Dr Abiad explained.

RHUH has played a central role in Lebanon’s coronavirus response since the virus was first detected in the country in early 2020.

Like many other hospitals in Lebanon, RHUH is already facing an array of challenges stemming from the country’s economic crisis. In recent weeks, there have been severe power cuts with some areas receiving as little as one hour of state-provided electricity per day, which has, in turn, placed immense pressure on backup power generators. Separately, a fuel crisis has meant that these generators cannot run around the clock.

“We need a large amount of fuel for our generators but there is a shortage,” Dr Abiad said, adding that RHUH’s generators are under the risk of breakdown.

This is in turn has put the patients’ wellbeing in jeopardy, Dr Abiad said.

A doctor at the Sibline Governmental Hospital, who requested anonymity, said that the hospital cannot take in coronavirus patients.

“We don’t have enough electricity to plug in an oxygen machine,” he said.

The hospital, located south of Beirut, threatened this week to cease operations and only continue emergency services, demanding payments from the government for reimbursements – which are long overdue – to keep its doors open.

The healthcare sector has also struggled amid a shortage of medical supplies and equipment, much of which is imported, due to the extreme devaluation of the local currency, which has lost about 90 percent of its value since late 2019.

“We run out of something every day. Anaesthetics, at one point steroids … the market is very erratic, even when something is available, it is available in small quantities,” Dr Abiad said. “It’s a daily struggle.”

Even private hospitals, with significantly more resources than public hospitals, are struggling amid the shortages.

“Basic medications for pain management and hypertension, antibiotics, anesthetics, are hard to find these days,” Dr Georges Ghanem, Chief Medical Officer at the Lebanese American University Medical Center-Rizk (LAUMC-Rizk) said.

As the number of COVID infections continued to rise, LAUMC-Rizk reopened its coronavirus wing last week after having transformed that area for normal operations.

“We have had few admissions so far, mostly mild to moderate cases, with a few severe ones,” Dr Ghanem said.

Dr Ghanem said he does not expect the wave to be severe for the time being in terms of hospitals admissions, but added that the hospital is “preparing the ground to be able to at least handle a few cases”.

He warned that things are “moving in the wrong direction”.

“Hopefully we won’t experience the rush after Christmas,” he added.

Lebanon was hit with its most severe coronavirus wave after the December-January holiday season. More than daily 6,000 cases were recorded at one point in January, a month that ended with more than 1,600 deaths from coronavirus.

“The rise in coronavirus cases hasn’t hit an alarming level yet but should be cautiously observed,” Dr Ghazi Zaatari, Pathology and Laboratory Medicine professor at the American University of Beirut Medical Center (AUBMC), said.

“Hopefully we are spared this time,” he added.

Meanwhile, hundreds of healthcare workers have left the country in recent months to seek better opportunities abroad, after they saw their salaries devalued to as little as $100 per month amid the financial crisis. The exodus has left several hospitals facing staff shortages.

“If the January scenario is repeated hospitals will be in very bad shape, since then, even more of healthcare cadre have left the country,” Dr Zaatari said.

As a result, the physicians and nurses who have remained in the country are being overworked.

“Healthcare workers are spent,” Dr Abiad said.

Dr Ghanem predicts yet another wave of healthcare worker emigration will take place in the coming weeks because workers “don’t have good tools to practise medicine”.

Vaccination the only way out

To stem the spread of the Delta variant, the Lebanese government last week issued new restrictions on travellers from certain countries such as Brazil, India, the United Arab Emirates and the United Kingdom, requiring them to quarantine after arrival. All other passengers except those who are vaccinated two weeks before travel are required to take a PCR test on arrival.

“While on one hand we are happy expats are coming and want to spend their summer in Lebanon and somehow supporting the economy, they are also bringing in variants,” Dr Zaatari said.

Besides these restrictions, officials say it is too early to impose harsher measures. “The numbers don’t allow for it,” Petra Khoury, public health adviser to caretaker Prime Minister Hassan Diab said.

“Our number one priority is to increase vaccination drives and contact tracing,” she added.

While inoculation is deemed as the only effective preventative measure, the vaccination rollout has suffered from logistical issues since it was launched in February and only about 14 percent of the population has been fully vaccinated.

The government rollout has mostly relied on the Pfizer and AstraZeneca vaccines, but only about 30 percent of the population has registered on the government’s official platform for the jab.

Sputnik V and Sinopharm jabs have also been provided to certain sectors through donations and procured by the private sector.

Vaccine “marathons” designed to speed up the process were cancelled in the past week due to none other than electricity cuts and internet issues.

As restrictions on businesses and daily life loosened, adherence to physical distancing guidelines has reduced, with large crowded events commonplace and the wearing of face masks far less common than during previous waves.

“We are begging people to obey restrictions, it is not a joke when the country’s economy has collapsed,” Dr Assem Araji, head of the parliament’s health committee said.

“I’m scared that when we get to the month of September, cases will be very high again..the health sector is already in shambles” he added.

Dr Zaatari also projected that if a new wave hits it will come in late August or early September.

“The issue with COVID-19 restrictions is the implementation. Nobody is abiding. People have lost trust in their government and that is reflected in their adherence to these measure,” Dr Abiad added.

“Public health is about trust.”