At dawn on Sunday, the moment that the director of intensive care Georges Juvelekian dreaded has finally arrived. His hospital was running out of breathing apparatus called BiPaps. It was up to his colleague to choose which of the two patients to treat with only one available machine.
As chairman of the ethics committee of Saint George’s Hospital, Dr Juvelekian had drawn up a protocol eight months ago on “how to allocate limited resources”. At the time, Coronavirus epidemic in Lebanon was contained – he expected politics to dust off. But now, for the first time, one of Lebanon’s three largest university hospitals did not have the equipment to help keep someone alive.
With everything from equipment to drugs in short supply, Lebanese doctors say they are on the verge of the “Italian scenario” – making life and death decisions about who should receive limited medical resources as cases arise. of coronaviruses increase after the Christmas holidays. More than 1,000 people died from Covid in Lebanon in January. A total of 2,477 people in Lebanon have lost their lives to the virus since the start of the pandemic. The government has instituted a 24-hour curfew. With some exemptions, people are prohibited from leaving their homes, relying on supermarket deliveries. “We are currently a low-resource country,” said Dr Juvelekian. “The whole system is about to break down.”
As many countries grapple with hospital bed shortages and the need to prioritize care, the Lebanese response has been hampered by the financial crisis of more than a year and explosion at the port of Beirut, which devastated the city, partially destroying four hospitals, including Saint George.
Lebanon remains in the hands of an interim administration as its political leaders failed to appoint a new government after the previous one resigned following the August 4 explosion in Beirut. The political stalemate and government inaction have made the World Bank, which last week granted its first loan for the purchase of vaccines in Lebanon, in an unusual way. “Our feeling is that the country is falling apart,” said Saroj Kumar Jha, regional director. He described the economic crisis, rooted in years of state mismanagement and alleged political corruption, as “self-inflicted”.
According to Firass Abiad, director of Rafik Hariri University Hospital, Lebanon’s largest public hospital, Lebanon’s intensive care units are 94% full after two weeks of a strict lockdown, enforced inconsistently. The whole country is affected: Dr Wael Harb, deputy medical director of a specialized Covid-19 unit managed by Médecins Sans Frontières in the Bekaa valley, one hour from Beirut, said he was receiving calls from the capital “for intensive care beds, which we do not have”.
With so many patients, intensive care specialists in Saint George last week ran out of outlets that provide oxygen and had to resort to cylinders. “We hooked people up to oxygen in their cars. It was how bad it was. We had critical patients sitting in chairs, ”recalls Dr Juvelekian in his office.
Families of covid victims are desperate for hospital spaces, “calling to find out where they know people.” . . if the hospital would accept them, ”said Mazen el Sayed, director of clinical operations in the emergency department at the American University of Beirut Medical Center (AUBMC).
At AUBMC, “we had to treat patients in the hallways[and]. . . in the [emergency department] entry, ”said Dr. Sayed. He is replenishing the staff to strengthen his intensive care team. “But honestly… it’s not enough,” he said.
Many are caring for loved ones at home, fueling a black market in ventilators – with used devices up to $ 7,500 online – and other equipment. Patients admitted to hectic emergency rooms alone are at risk of dying far from their families, said Toufic Chaaban, a specialist in pulmonary and intensive care. He holds the iPads to the dying so they can see their families one last time. “It’s better than nothing,” he says.
Meanwhile, Dr Juvelekian says he’s running out of drugs, a side effect of the financial crisis. The Lebanese pound has lost 80% of its value against the official exchange rate and, once commonplace, pharmaceutical imports have become extremely expensive. The Central Bank burns hard currency reserves to subsidize medical supplies, but shortages are widespread.
The coronavirus blast and outbreak have exposed weaknesses in the patchwork of healthcare providers in Lebanon. Many medical staff receive reduced or delayed salaries. Hospitals find it difficult to retain doctors; hundreds have emigrated.
Volunteers fill in the gaps. More than 80% of Lebanese hospitals are private, but 80% of emergency ambulance services are provided by the Lebanese Red Cross made up of volunteers, said its secretary general, Georges Kettaneh. They are the front line of the pandemic: in the first 20 days of January 2021 alone, Red Cross ambulances transported around 3,200 patients with Covid-19, almost as many as during the seven months from February to August 2020.
Economic pain – growth contracted 19% last year – makes it difficult to enforce lockdowns and stokes anger over the 24-hour curfew put in place in mid-January. About half of the population fell under the poverty line. Even as Covid-19 patients overwhelmed intensive care units, protesters in Lebanon’s second underprivileged city, Tripoli, clashed with security forces over the lockdown for the third night in a row on Wednesday.
Economic pressure meant the interim government removed most restrictions when expatriates armed with foreign currency arrived at Christmas. People “went to events and dinners. . . as we are in the normal [life]Mr. Kettaneh said, adding that the current coronavirus outbreak was “their fault”.
Yet on Monday, Beirutis in the streets around Saint George spilled over in the January sun, lining up outside bakeries. During the weekend, the snow on the famous cedars of Lebanon proved to be irresistible; traffic was reported on roads leading to hill stations.
This news “made my blood curdle,” said Dr Juvelekian, who cannot remember the last time he took a day off. He begged people to stay home, “I can’t keep doing this. . . we are exhausted.