Lebanon, which has reported 298,913 coronavirus cases and 3,031 deaths since the start of the pandemic, has been under strict lockdown since January 14. Despite the lockdown, positivity rates remain high at about 20%. Daily cases peaked on January 15 with 6,154 new diagnoses, and have dropped since then, but remain alarmingly high. On January 30, there were 2,631 new cases, and 117,410 active cases, including 955 people in serious or critical condition, creating a serious strain on the country’s health system.
With hospital beds running out, Dr. Fadi El-Jardali, a professor of health policy and systems at the American University of Beirut (AUB), points to the privatization of Lebanon’s health system as a major cause for its inability to cope.
“Many hospitals now face the challenge of where to draw the line between making money and saving lives,” El-Jardali told The Media Line. “Some are saying yes, we want to save lives regardless, but some are saying COVID-19 patients aren’t profitable.”
“The situation is very alarming,” Dr. Firass Abiad, general manager of Rafik al-Hariri University Hospital in Beirut, told The Media Line. The country has “reached almost 100% of hospital capacity.”
With hospitals full, people are staying home and putting themselves at risk of a life-threatening deterioration in their condition.
Many hospitals now face the challenge of where to draw the line between making money and saving lives. Some are saying yes, we want to save lives regardless, but some are saying COVID-19 patients aren’t profitable
Another aspect of the situation is the heavy burden placed on hospital staff. The hospital manager said, “We have seen signs of burnout of hospital teams,” adding that the financial pressure currently felt by all Lebanese understandably affects medical staff as well, adding to the weight on their shoulders.
Among the structural causes that have brought Lebanon to its present crisis is the fact that while some hospitals are collapsing, others are unwilling to accept COVID-19 patients. “More than 60 private hospitals in Lebanon did not prepare, did not scale up and are still not accepting COVID-19 patients,” El-Jardali, who heads the Knowledge to Policy Center at AUB, told The Media Line.
“Our health system is predominantly private sector. So we don’t have a strong public sector that can meet the demands and needs of the population during a pandemic,” he said. More than 80% of the country’s health budget is directed toward private institutions. The government has contractual agreements with these institutions, setting yearly quotas of publicly funded hospitalizations. But what works in normal times does not necessarily work in an emergency. “The COVID-19 pandemic exposed a lot of inefficiencies in the existing system.”
Some private hospitals, El-Jardali stresses, have gone beyond expectations. But others are too focused on the bottom line, despite the current crisis. “There is no public-private partnership, only a transactional arrangement with the private sector. … Many private hospitals haven’t scaled up their capacity, haven’t opened COVID-19 units, haven’t added intensive care unit beds; for them, there is more focus on profit-seeking.” As a result, “although some private hospitals have done a fantastic job … the capacity of the health system [overall] has been challenged,” creating a “significant strain on the health system.”
According to the professor, over the last nine years “we have made the wrong political choice of not investing in public hospitals, in public infrastructures, in public health.” Looking beyond the pandemic, “The future government should invest, and I think they must invest. … We cannot have a good economy without good public health infrastructure.” The coronavirus pandemic, he said, “should be used as an opportunity to rethink the health system arrangements … to rethink building more capacity within public health, and more importantly, to rethink the arrangements with the private sector.”
As a more immediate source of respite for the country, Drs. El-Jardali and Abiad both pointed to the expected vaccine rollout. “All eyes are focusing on the vaccine,” Abiad said.
But both experts agree that this will not be enough.
“Vaccines, as you know, are important but they are not magic bullets. … You cannot vaccinate all people at the same time. It will take a good year to vaccinate at least 80% of the population,” El-Jardali said.
Both health experts said that for the ailing country to put this crisis behind it, the population must adhere to COVID-19 regulations more strictly. But to ensure this compliance, the social and financial aspects of steps taken to battle the virus, like the nationwide lockdown, must be taken into account.
“We are in the midst of a strict lockdown, Abiad said, “but no one is taking notice of the financial and social aspects.” People of low income are already living hand-to-mouth in Lebanon’s crumbling economy, he explained. With no one taking heed, and no solutions on offer for those who face losing their livelihood, people are pushing back against regulations, as was seen last week in the series of countrywide demonstrations, some of which turned violent.
With wide pushback against social distancing guidelines, the vaccination campaign alone will not solve the crisis, even if it were a resounding success.