'We open, people die; we close, people die.' COVID surge leaves Lebanon with no good options

Patients cram hospital corridors and spill into driveways. Intensive care units are full as the coronavirus thins the ranks of already-overstretched medical personnel. People scramble from pharmacy to pharmacy, plead with friends or resort to the black market for ventilators, medicines and baby milk.

Lebanon’s medical system is buckling under a post-holiday COVID-19 surge that has killed almost as many people in January alone as died from the disease all last year.

To stave off a catastrophe like those seen in Italy and Iran, the Lebanese government has imposed the harshest lockdown the country has seen since the beginning of the pandemic. But that has taken its own devastating toll: the near-evisceration of an economy already on the brink. Public frustration with the coronavirus restrictions boiled over last week in Tripoli, Lebanon’s second-largest city and also its poorest, where for four consecutive nights protesters stormed government buildings, set off fireworks and threw rocks as police lobbed canisters of tear gas.

The lockdown is set to end next week, despite warnings from medical officials that a hasty reopening could wipe out its hard-won gains. But with Lebanese turning desperate and more than half the country living below the poverty line, even they acknowledge that further economic pain could be just as lethal.

The dilemma underscores the grim calculus facing governments across the world, especially in poorer nations, as they operate in the razor-thin margins between a public health meltdown and economic oblivion.

“We open, people die; we close, people die,” says Dr. Firass Abiad, who heads Lebanon’s primary public hospital treating COVID-19 patients. “If they’re not dying from COVID, they’re dying from hunger.

“It’s just different faces of the same bad coin.”

Early in the pandemic, Lebanon was touted as a success, marshaling its meager resources into a response that limited the spread of infection. But a series of crises — including the massive Aug. 4 blast in Beirut’s port and a financial collapse that has wiped out 80% of the local currency’s value against the dollar — has hampered Lebanon’s capacity to deal with the pandemic, said Iman Shankiti, the World Health Organization’s representative in the country.

So when the government allowed what critics said was an ill-timed opening for the holidays in December, it precipitated a coronavirus cataclysm.

By mid-January, authorities imposed a complete lockdown, with an exemptions system that was strictly monitored. It reduced transmission rates, giving hospitals some respite.

“We’re stable. We’re holding,” Abiad said. “The question now is how do we come out of lockdown? Do we extend it? Do we ease it gradually?”

Other indicators remain dismal, including the test positivity rate, a measure of how widespread infection is in the area where testing occurs. The World Health Organization recommends it remain under 5% for two weeks before considering reopening; in Lebanon it stands at 21.8%.

On Wednesday, authorities reported 89 coronavirus-related deaths, a record number in one day for Lebanon, along with 3,320 new cases, which brought the country’s cumulative tally to 309,162 confirmed infections.

Those numbers mean the country’s healthcare system is still in the red zone and cannot handle another surge, experts say. Though a loan from the World Bank had in the last few months expanded the capacity of public and private hospitals handling COVID-19 cases, a shortfall of about 200 ICU beds remains, Shankiti said.

The biggest limiting factor for further expansion, Abiad said, is the unavailability of medical personnel. Hospitals have wrangled staff from other wards into dedicated coronavirus floors and canceled elective surgeries. But that hasn’t compensated for the coronavirus’ toll on medical staff.

“Too many working the floor got corona and had to stop,” said one nurse at the American University of Beirut Medical Center, a top-flight medical facility in the capital. He spoke on condition of anonymity to discuss work-related issues.

Those remaining can barely keep up, he said.

“We’re like a car going flat-out all the time. It’s just too much,” he said. Making things worse, some 30 of his colleagues have left the country in the last few months to pursue better-paying jobs in the Gulf, where nurses can earn more than $2,400 a month — an irresistible offer compared to staying in Lebanon, where many seen their salaries cut or gone unpaid.

The currency crash has also caused problems across the healthcare sector’s supply chains. Importers now wait months for the central bank to pay the bill for subsidized dollar transactions on medical supplies.

Salma Assi, head of Lebanon’s syndicate of medical equipment importers, complained of waiting for months for shipments of ventilators and oxygen concentrators — a non-invasive method of providing patients oxygen — to get cleared by the central bank. That has led to a black market in ventilators of dubious quality for $700 to $1,500 apiece — twice their normal price.

“You’re seeing people like the neighborhood grocer or florist buying this kind of equipment and selling it to their customers. The other day I saw someone selling a Chinese-made ventilator on OLX,” Assi said, referring to a popular online marketplace.

Medications are a bigger problem. The central bank burned through some $1 billion in 2020 to subsidize medicines. But with hard currency reserves falling quickly, government officials in recent months discussed lifting all subsidies. That kicked off a wave of hoarding that emptied pharmacy shelves of even basic medication such as cortisone, blood thinners, diuretics and painkillers.

“There are shortages of all of these even in hospitals. If these medications are missing, it can lead to death,” said Ghassan Amin, who heads Lebanon’s pharmacies’ union.

“Our problem is that everything is unknown. The central bank hasn’t told us anything. We don’t know how much money there is to determine our priorities.”

The backdrop to the shortages has been a wider crisis in which 94% of the country’s population earn below the minimum wage, according to a recent study from humanitarian group CARE International, with almost three-quarters of those interviewed living in debt.

Monday brought news of another economic blow: The price of flatbread, a staple subsidized by the government, would increase by more than 20%, the state-run National News Agency said.

Meanwhile, Hassan Diab, the country’s caretaker prime minister, said Wednesday that the army had begun distributing a long-promised government monthly aid package of 400,000 Lebanese lira — amounting to less than $50 at the market rate — to 230,000 families.

With no good options available, authorities have pinned their hopes on a rapid COVID-19 vaccine rollout. But Lebanon, which operates under a power-sharing agreement between the country’s 18 fractious sects, is suffering from a months-long political stalemate, along with a deeply unpopular caretaker government. Few believe it is up to the job.

In recent statements to local media, government officials as well as sectarian leaders say they have secured some 6 million vaccine doses — enough for only half the country’s 6.8 million people. Last month, the health minister in Lebanon’s caretaker government, which has been in charge since the Beirut blast, said the first batch of vaccines would arrive in mid-February.

Abiad, the hospital doctor, warned that slow distribution of the vaccine could allow the coronavirus to mutate into a new strain before enough people are inoculated against the current one.

“COVID is a stern test, and major nations are being humiliated by it,” he said.

“You have to get your act together. You have to do an excellent job. Even a good job is no longer enough.”