Country narrative: Lebanon
February 25, 2020
The health minister confirmed on Friday that a woman who arrived the previous day on a flight from the Iranian city of Qom had the virus. She was taken directly to hospital and quarantined after showing symptoms on the plane. Two others from the same flight are being monitored and all other passengers have been asked to stay at home for 14 days.
Lebanon reported a second confirmed case on Wednesday. Both cases are women who returned from a religious visit to Iran on the same flight. Lebanon announced on Tuesday that it will "restrict" flights to countries affected by the virus and will completely stop religious pilgrimage flights.
Lebanon confirmed a third case on Thursday – an Iranian who arrived in the country on 24 February and was taken to hospital after developing symptoms.
Lebanon reported a fourth confirmed case – a Syrian woman in Beirut. The Education Ministry announced on Friday that "all educational institutions including kindergartens, schools, high schools, vocational institutions and universities" will be closed until March 8.
Three new cases were confirmed on Saturday, bringing the total to eight. The latest three, who were apparently already quarantined, are reported to have caught the virus from others in Lebanon who were known to be infected. Amir Wang, a Chinese student at a university in Lebanon, has posted a video on YouTube complaining of verbal abuse. He says in the video: "When I walk in the streets, in Beirut, Sidon, or even Shheem [where he lives], there are always people who are scared of me, or who avoid me or call me 'Corona'."
The total number of cases has risen to 13, with six new cases reported since Sunday. Arab News says most of those detected were either passengers or relatives of passengers on a flight that arrived in Beirut from the Iranian city of Qom a week ago.
Tests carried out on 50 people suspected of having the virus led to the detection of two new cases.
A Lebanese woman arriving from Britain has become the sixteenth confirmed case.
The Rafiq Hariri University Hospital in Beirut reported that it had tested 127 people and six of them proved positive. This brings Lebanon's total to 22 cases. Health minister Hamad Hasan said on Friday that "the phase of containing the coronavirus outbreak in Lebanon is over".
Lebanon anounced its first coronavirus death on Tuesday morning – a 56-year-old person who recently returned from Egypt.
A second death was reported on Wednesday morning – a 55-year-old man who is said to have had a weak immune system.
There are reports of a strike by workers at the Rafik Hariri University Hospital in Beirut – the country's main centre for testing and treating coronavirus cases. It is said to be the only one with quarantine facilities that meet global standards.
The strike appears to be at least partly a result of Lebanon's political malaise and the accompanying economic crisis.
The committee of employees and contract workers blames "indifference" by the hospital's management and stakeholders. Staff have reportedly not benefited from pay raises awarded to public sector employees and there have been complaints about late payment of salaries.
The government has also been accused of neglecting the university hospital for the benefit of private hospitals owned by political figures – though this has been denied.
Beirut airport is to be closed from Wednesday, as will points of entry by land and sea.
Lebanon reported a fourth coronavirus death, though the health minister said 80% of those diagnosed so far show no symptoms. The authorities are following up three cases where the source of infection is unknown. The minister also said the dispute reported earlier involving staff at the Hariri hospital in Beirut – the main centre for treating coronavirus – has been resolved.
The Hariri hospital in Beirut issued a statement about a woman who died shortly after being admitted on Wednesday. It said she had died of heart failure and a scan showed she had no lung infection – which may indicate she did not have coronavirus. The health ministry also noted the death of a nine-year-old child who is said to have been suffering from chronic diseases and, again, it's not yet clear if coronavirus is implicated.
Lebanon reported its largest daily increase so far, with 67 new cases. However, the official figures are a bit deceptive. Previously they only showed the positive test results from university hospitals accredited by the health ministry. The latest figures include 24 cases detected in private hospitals (which are awaiting re-confirmation by the Hariri university hospital in Beirut).
The health ministry warned yesterday that the figures "indicate the start of the stage of proliferation", and emphasised that observance of preventive measures, especially adherence to complete home quarantine, "has become an individual and societal moral responsibility that is incumbent on every citizen". Police have issued warnings to people found breaching home quarantine and carried out raids on businesses ignoring the preventive measures.
Human Rights Watch has voiced concern about the ability of the Lebanon's medical services to cope:
"The country’s financial crisis has caused a dollar shortage that, since September, has restricted the ability of medical supply importers to import vital medical supplies, including masks, gloves, and other protective gear, as well as ventilators and spare parts.
"The government has also not reimbursed public and private hospitals for bills, including from the National Social Security Fund and military health funds. This has made it harder for them to purchase medical supplies, hire additional staff to reduce the burden on overworked nurses, and provide necessary protective gear."
Health ministry figures suggest at least half the people diagnosed with the virus have caught it from others inside the country. While 29% of Lebanon's cases are travel-related, 50% are the result of contact with a confirmed case. The origin of the remaining 21% of investions is unknown.
Earlier this week the ministry included positive test results from some private hospitals in its official figures. It says "some" of these have now been discounted as a result of further testing by accredited laboratories.
The health ministry is inviting tenders for the supply of 70 ventilators. This sounds like a very small number.
Considering Lebanon's political and economic chaos its efforts to control the spread of Covid-19 infections have been surprisingly effective. Eleven weeks after the virus first arrived in the country there have been only 870 confirmed cases among a population of almost seven million.
Lebanon had begun relaxing its restrictions but over the past week there has been a sudden rise in new cases and the authorities have now imposed a "total" shutdown which will last until Monday morning. People have been told to stay at home and avoid going out unless it's imperative.
In comparison with many other countries Lebanon's surge is quite small – 129 new cases over seven days – but enough to raise a red flag.
At least 39 of those cases have been detected among citizens returning to Lebanon on repatriation flights, including 10 on a flight from Russia and 25 on another from Nigeria. These should not pose a risk to the public if they are properly quarantined. The problem, though, is with people whose infection is so recent that they initially test negative. They are told to isolate themselves for two weeks but don't necessarily take isolation seriously.
This is what happened in Jordan with a truck driver returning from Saudi Arabia: having tested negative he was sent into home isolation but didn't follow the rules and went on to infect dozens of people. In response to that, the Jordanian authorities have now decided to place returning truck drivers under supervision in a quarantine centre.
A similar thing has happened in Lebanon where a returnee from Nigeria received visitors while supposedly in self-isolation and infected 10 of them. "One of those infected, an army soldier, then carried the virus to a military court where 13 others also caught it," Reuters reports.
That, in turn, resulted in 40 or more lawyers, judges and other soldiers having to be tested.
On Sunday, a statement from the health ministry highlighted a “lack of commitment of many citizens to preventive and public safety measures, and due to the selfishness, disregard and indifference to their health and the health of their communities”.Lebanon's non-compliance problem isn't confined to returnees, however. The authorities have warned about it repeatedly and President Aoun is now threatening legal action against those who fail to abide by the safety rules.
The newly-imposed shutdown is no doubt intended as a signal that this must change, though its main aim is reduce the infection rate and return it to a more manageable level.
It's particularly important at the moment not to overburden the health services with locally-generated cases because they will also have to cope with new cases that are expected to arrive shortly from abroad.
Phase three of the government's repatriation programme is due to start on Thursday, lasting for 10 days. More than 50 flights are planned, bringing Lebanese citizens back from the US, Canada, South America, Saudi Arabia, the UAE, France, Britain, Turkey, Belgium and Germany. It's a foregone conclusion that some of those arriving will be infected, but as yet the numbers can only be guessed at.
There are also concerns about social distancing on these flights. The Beirut-based Daily Star reports that passengers on an earlier repatriation flight from London were charged £1,200 ($1,475) or more on the understanding that the high ticket price would allow half the seats to be kept empty. In the event, the flight was packed with around 185 people.
In the midst of a political and economic crisis Lebanon is fortunate in having only about 1,500 recorded cases so far. Many of the recent infections have been among people returning from abroad. On Thursday the health ministry warned that there could still be "an uncontrollable surge" in Covid-19 cases as the lockdown measures and travel restrictions are lifted and said everyone who tests positive should be put in institutional isolation – either in hospital or an isolation centre.
A survey by the World Food Programme, which included Palestinian and Syrian refugees as well as Lebanese citizens, found that "due to a combination of containment measures for Covid-19 and a worsening economic crisis" two out of every three households have seen their income fall. Almost one-third have lost their job because of employers reducing staff or closing their business and Syrians in Lebanon have been disproportionately affected.
On Tuesday the government extended its "general mobilisation" against the virus until August 2.
Beirut airport reopened on Wednesday but with only a small number of flights, mainly for travel between Lebanon and the Gulf. The government has said passengers will not be quarantined on arrival because they are "expected" to have been tested for the virus before departure.
Lebanon reported 65 new cases on Thursday and 71 on Friday – the highest daily figures since the outbreak began.
New cases are now running at more than 80 a day – four times the level during the first week of this month. These include more than 130 employees of Beirut's waste collection company. Seven cases were also confirmed following 70 random tests on Palestinians in the Rashidiya refugee camp.
Although Lebanon's overall figures are still relatively low, an alarming sign is that most new cases seem to be the result of community transmission. Previously, many of them were among returnees from abroad. Of the 91 cases recorded on Wednesday, 68 were among the local population and only 23 among people arriving from abroad.
In an interview this week, Firas Abiad, director general of Rafic Hariri University Hospital in Beirut suggested the authorities had eased restrictions too soon, because of economic pressures.
There is currently no curfew but the "general mobilisation" against coronavirus has been extended to August 2.
Health minister Hamad Hassan said on Friday that Lebanon is "going through the test" and its capabilities are in dealing with the outbreak are being challenged. "Cases of coronavirus have become widespread in all Lebanese regions. We cannot let the numbers rise, uncontrolled. We need to catch up."
Lebanon began a new lockdown on Thursday. The current lockdown will last five days. Shops and other businesses will then reopen on Tuesday and Wednesday next week before another five-day lockdown starts, ending on August 10.
New infections have surged during the last three weeks. Earlier this week President Michel Aoun called for “stricter application” of the new lockdowns, complaining about “people’s disregard for the preventive measures.” According to health minister Health Hamad Hassan people arriving in Lebanon have also not been respecting the isolation period.
New cases this week averaged 299 a day – almost double the level at the end of July.
Lebanon is due to start a two-week lockdown on Friday amid a sharp rise in coronavirus infections, though there are doubts about how widely it will be observed or enforced.
The Lebanese outbreak is still relatively small, with 10,347 cases confirmed since it began in February but more than half of those have been diagnosed since the beginning of this month. New cases averaged more than 400 a day during the past week – double the level before the devastating explosion in Beirut on August 4. Yesterday, 589 new cases were reported – the highest daily total so far.
Many of Beirut's health facilities were damaged in the blast and are now under severe strain due to the combined effects of the virus and injuries from the explosion.
Covid-19 infections were already rising before the explosion – a situation that President Michel Aoun blamed on “people’s disregard for the preventive measures”. Towards the end of July the authorities declared two five-day lockdowns separated by a two-day reopening but the second lockdown was largely forgotten in the aftermath of the explosion.
The new two-week lockdown means private businesses, including markets, shopping malls, gyms and swimming pools, have to close and there will be a 12-hour night curfew starting at 6pm each day.
However, there are plenty of exceptions. Clear-up and relief work in connection with the explosion will be allowed to continue and Beirut airport will remain open.
Given the political and economic turmoil in Lebanon it's unlikely the lockdown will achieve very much. The authorities have so far shown little inclination to make it effective and the public have plenty of other problems to worry about.
Quoted in the Daily Star newspaper, Dr Firass Abiad, head of the Rafik Hariri University Hospital in Beirut, said:
“Let’s be clear that this is a partial lockdown. It is clear they didn’t want to cripple whatever is left of the economy; they wanted to give people the opportunity to fix their homes [after the blast], and to be able to go out and buy groceries.
“If we want to give this loose lockdown a chance to work, people have to do their part ... otherwise nobody should be surprised at the end of these two weeks to find ourselves back where we started.”
At a news conference this week cardiologist Assem Araji, who heads the parliament's health committee, accused the interior ministry of failing to enforce the preventive measures decreed by other ministries. “Whether it was weddings or funerals, in supermarkets and all gathering places, there was no commitment,” he said. People who were supposed to be in quarantine had also been allowed to mix with others.
One aim of the lockdown is to relieve the pressure on hospitals. Six major hospitals and 20 clinics sustained damage in the Beirut explosion and on Monday caretaker health minister Hamad Hassan warned that medical services were "on the brink".
“Public and private hospitals in the capital in particular have a very limited capacity, whether in terms of beds in intensive care units or respirators,” he told a news conference.
New cases this week averaged 505 a day – about three times as many as at the end of July.
New cases this week averaged 576 a day – more than three times the level at the end of July.
A new partial lockdown began last week but the restrictions were relaxed almost immediately following objections from restaurants and cafes, among others. This means infections are likely to continue increasing and the relaxation has been strongly criticised on Twitter by Firass Abiad, director of the Rafik Hariri University Hospital in Beirut.
Lebanon's outbreak is still relatively small, though the number of confirmed cases has more than trebled during the past month. The sharp rise during August led to a rather half-hearted two-week lockdown which appears to have brought new infections to a plateau of 500-600 a day.
Dr Firass Abiad, head of the Rafik Hariri University Hospital in Beirut, warned this week that the numbers are unlikely to decline without proper preventive measures. “As universities and schools open, even in a hybrid format, there will be more contact in the community. The virus is still present, and adherence to preventive measures is selective and scant at best,” he said.
Assem Araji, head of the Lebanese parliament’s health committee, said on Wednesday that the country has "lost control" and complained about a lack of coordination between government ministries regarding preventive measures.
Dr Firass Abiad, director of Rafik Hariri University Hospital, also expressed frustration: “You go into lockdown – two weeks – you get some measure of control but then you have to open up again. If you open up and you go back to where you were before, the same behaviour, the same contact, the same compliance, you’ve really not done anything.”
The start of the school year has been postponed until October 12.
Current rules for travellers arriving in Lebanon are explained here.
The level of new infections, which averaged 1,173 a day this week, has doubled since mid-September.
On Friday the imterior ministry announced a lockdown of 11 towns and villages which are regarded as virus hotspots. It is due to begin on Sunday and last for eight days.
Update on vaccines: Lebanon has reserved vaccines under the Covax scheme which should be enough for the "most vulnerable" 20% of its population. It also has an agreement with Pfizer to supply vaccines for a further 15% of the population.
The first vaccines are expected to arrive in February next year.