Caretaker Health Minister Hamad Hassan greeted Qatari officials delivering two emergency field hospitals to Lebanon yesterday. (Dalati & Nohra)
BEIRUT — As Lebanon enters a new two-week lockdown on Saturday, officials are scrambling to ramp up the number of hospital beds for COVID-19 patients.
“We’ve reached a point of critical danger as public and private hospitals no longer have the capacity to accept severe [coronavirus] cases,” caretaker Prime Minister Hassan Diab said as he made the announcement of the lockdown on Tuesday.
As of Wednesday, 300 people were in intensive care receiving treatment for severe coronavirus complications, according to the Health Ministry. That would mean about 82 percent of the 364 available ICU beds were full, using the World Health Organization’s most recent bed count on Tuesday night.
“The lockdown is an important non-pharmacological intervention,” Abdul Rahman Bizri, a doctor and member of the national scientific committee for COVID-19, told L’Orient Today. “It should reduce the burden of pressure and decrease the flow of cases to hospitals.”
This should give hospitals the time to add beds to their coronavirus-dedicated units, or open up COVID-19 wards if they do not already have them.
Since Sept. 4, when the WHO first started adding bed capacity to its daily coronavirus reports, ICU beds have more than doubled, from 165 to 364.
Private and public hospitals across the country have opened up coronavirus units, with caretaker Health Minister Hamad Hassan regularly touring and inaugurating new facilities.
However, it is difficult to pinpoint exactly where the COVID-19 beds in Lebanon are and how many beds each hospital has, as the relevant data is not publicly available.
The dashboard operated by the Health Ministry is no longer publicly accessible and requires login credentials. The dashboard run by the Disaster Risk Management body, which mapped out all hospitals and their bed capacity, displayed the same information for weeks and now simply shows an error message.
Neither the Syndicate of Private Hospitals nor the Health Ministry could provide L’Orient Today with an updated list of which hospitals are accepting COVID-19 patients and how many beds each hospital has. Multiple Health Ministry employees said they were not permitted to give this information to the media.
While the WHO publishes a daily report that includes daily occupancy of ICU and regular beds, the organization does not have its own breakdown of individual hospital capacity, but simply receives numbers from the Health Ministry.
For Sara Chang, a public health consultant who has been tracking COVID-19 in Lebanon, the lack of clarity surrounding bed capacity is one of the greatest challenges when assessing the country’s response to the virus.
“As the country enters another full lockdown … it will be nearly impossible to judge the success of those efforts [to increase beds] if there is little or no transparency about capacity to begin with,” she said.
Public hospitals on the front line
What we do know, however, is that since the first case of coronavirus was reported in Lebanon on Feb. 21, the focus of efforts to combat the disease in health care settings has been in the public sector, in line with the Health Ministry’s COVID-19 operational plan.
Around two-thirds of coronavirus beds are in the public sector, according to MP Assem Araji (Future/Zahle), the head of Parliament’s Public Health, Labor and Social Affairs Committee, despite public hospitals only containing around 15 percent of all hospital beds in the country.
The ongoing addition of new beds and equipping of COVID-19 units has been funded in a large part by loans and donations from the international community, said Reda Al-Moussawi, a media advisor to the health minister.
$40 million of a $120 million World Bank loan originally destined to strengthen Lebanon’s health care system was reallocated in March to help public hospitals deal with the coronavirus. As of the beginning of October, $13 million has been used to purchase personal protective equipment, ventilators and other essential medical supplies, according to the World Bank’s Lebanon office.
The UN’s refugee agency has also supported public hospitals’ expansion of bed capacity, while donations from Kuwait, Bahrain, China and other countries have also helped the ministry gear up.
Two Qatari airplanes landed in Beirut Wednesday carrying two field hospitals, each with a 500-bed capacity, that will be set up in Tripoli and Sur.
But not all the money came from abroad.
In a press conference on Oct. 30, Hassan listed local contributions given to public hospitals to support the fight against the coronavirus. They received LL25 billion from the state budget and budget reserves, LL1.5 billion from a public donation fund, LL3 billion from the Higher Relief Council and $6 million from the Association of Banks in Lebanon.
Public hospitals are now working on further expanding their capacity, with around 60 coronavirus ICU beds set to be added within two weeks, according to the health minister.
Private hospitals in a financial bind
As new cases of coronavirus cases continue to rise and increasing numbers of people require hospital treatment, calls have increased for the private sector to also expand its COVID-19 capacity.
The ministerial committee on COVID-19 held a meeting on Nov. 2 in which all private hospitals were instructed to open up coronavirus units and dedicate 10 percent of ordinary beds and 20 percent of ICU beds for COVID-19 patients within two weeks.
This would translate to 1,000 ordinary beds and 200 ICU beds, according to Sleiman Haroun, the head of the Syndicate of Private Hospitals, in addition to the existing 300 ordinary and 100 ICU beds in private facilities.
However, he said, financial pressures on hospitals mean they will be unlikely to meet that goal.
Private hospitals are owed more than LL2 trillion ($1.3 billion at the official rate of LL1,507.5 but now worth $270 million at a market rate of LL7,400) by the Health Ministry, the National Social Security Fund and other public insurers.
On Monday, the health minister said in a press conference that he had contacted the central bank to make sure hospitals receive what is owed to them for the first six months of 2020, but this would only be a small part of the LL2 trillion in dues, which date back as far as 2012, according to Haroun.
“This would help hospitals pay some overdue invoices, but it won’t go far,” said MP Fadi Alameh (Amal/Baabda), who is also the vice president of the hospitals’ syndicate.
Setting up an ICU isolation room for a coronavirus patient costs between $35,000 and $50,000, according to Alameh, with expensive equipment such as ventilators and negative pressure units that need to be imported from abroad.
Global demand for such equipment is high, slowing down delivery to Lebanon, said Salma Assi, the head of the Medical Devices and Equipment Importers Syndicate.
A recent policy introduced by Banque du Liban that requires importers of essential goods, including medical suppliers and pharmaceutical drugs, to provide cash lira to access dollars at the official exchange rate has made imports even more complicated, Assi added.
The central bank’s policy is making it even harder for hospitals to equip themselves, as medical suppliers within Lebanon are now demanding that they pay their bills in cash, up front — a major challenge when hospitals are struggling financially and do not have access to hard currency.
“Due to the corruption of the political oligarchy and the policy of the central bank, hospitals are having real difficulties in replenishing supplies,” Bizri said.
Hospitals also have to pay for infrastructural work to divide their facilities into two in order to keep coronavirus patients and non-coronavirus patients separate.
The ministerial coronavirus committee recommended that the Health Ministry downgrade the classification of any hospitals that do not prepare coronavirus units, which could impact their financial reimbursements, and ask insurers not to cover treatment at these hospitals.
Alameh is skeptical that the ministry would actually take such measures. Even if they did, he said, it wouldn’t have a significant effect, as “hospitals are not being reimbursed anymore anyway.”
Either way, Haroun doubted that all of the some 100 private hospitals that haven’t yet opened units will be able to do so, adding that he was concerned hospitals may skirt safety requirements if they come under pressure.
However, many public health officials, including the health minister, have said that hospitals do not have the luxury of choice.
“We know the private hospitals are facing huge financial challenges,” Araji said. “But we’re in a global pandemic, they have to [prepare COVID-19 units].”
Petra Khoury, an adviser to the caretaker premier, agreed. “After eight months, it’s unjustifiable that some private hospitals have still not opened up to coronavirus patients. This is against the principles of medicine.”