COVID-19 Response in Lebanon

Abstract

OnFebruary21,2020,thefirstcaseofcoronavirusdisease 2019 (COVID-19) was identified in Lebanon.This occurred amid a backdrop of political and economic turmoil that began in October 2019, when a banking crisis and a civil uprising led to a change in political leadership and pushed the country into an economic crisis.On January 31, approximately 2 weeks after cases started to emerge outside of China,thenewlyappointedgovernmentinLebanonestablished a National Committee for COVID-19 (NCC) to oversee the COVID-19 national preparedness and response.Lebanon had specific challenges preparing for the emerging pandemic: in addition to economic and political unrest, the country is densely populated, with 6.9 million residents-87.2% of whom live in urban areasincluding 2 million displaced persons and 500 000 migrant workers, all within 10 452 km 2 (approximately the size of the state of Connecticut or Kosovo).Households are largely multigenerational, averaging 5 persons per household.The health care sector is fragmented with hospitals of varying capabilities, 84% of which are private and mainly concentrated in large cities.Furthermore, 80% of the health care budget is spent on acute care in private hospitals, leaving the public health systems underresourced.In addition, Lebanon relies heavily on foreign supply chains and has no local manufacturing capability to produce essential COVID-19 supplies, including N95 masks and ventilators.On February 21, with the confirmation of the first case of COVID-19, the government initiated a "whole government response" through a public-private partnership, with the NCC directing the strategy and the Ministry of Health (MoH)-alongside other ministriesoverseeing the implementation.Given the significant resource challenges in the country, the approach was centered around early aggressive containment to allow for building capacity to respond to COVID-19 cases.On February 22, Lebanon shut down public transport and banned flights to countries that had experienced exponential growth patterns of COVID-19, including Iran, Italy, China, and South Korea.Six days after the first case (at 3 cases), day care centers, schools, and universities were closed.A week later (March 6; 22 cases), nightclubs, pubs, gyms, and theaters were closed.Soon after (March 11; 64 cases), all malls, restaurants, tourist sites, and public gardens also were closed.By mid-March, when the infection count reached 99 cases, the government declared "public mobilization," issued stay-at-home orders, and closed the borders, with full lockdown of nonessential services.After these measures, the average growth factor per week (defined as the number of cases on a given day compared with the prior day, averaged over 1 week) declined from a peak of 4.6 (week 2, February 28-March 5) to less than 1 (week 6, March 27-April 2).During this time, hos-

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