Lebanon and COVID19: Where we stand and where we’re going.

This thread was written by Khalil Baddour (@KBadd) on February 29, 2020.

The virus no longer belongs to one country or another. It is global. We must react accordingly.

Remember that Hopkins study @realDonaldTrump referred to a few days ago. It’s called the Global Health Security Index (GHSI).

The USA does indeed rank 1st on that index. Lebanon? Joint 73rd out of 195.

The GHSI asks 140 questions to assess a country’s preparedness to respond to a biological outbreak like #COVID19. The questions are organized across 6 categories: Prevention; Detection & Reporting; Rapid Response; Health System; Compliance with International Norms; and Risk Environment.

The GHSI provides a score for each question and category – eventually grouped into one overall score out of 100. Lebanon’s overall score is 43.1. We rank 8/17 in Western Asia and 5/21 in the @WHOEMRO behind KSA, UAE, Kuwait, and Morocco.

Not bad when you consider the international average of 40.2 – but not so good either. If we get a little more granular, we can notice that Lebanon fails drastically at Prevention (27.3/100) and Health (23.8/100), based on GHSI criteria.

The low Prevention score is in part due to the fact that we do not have legislation or systems that take in consideration biosafety and biosecurity measures, including consolidating inventory of dangerous pathogens, training personnel, and having a national biosafety agency.

The Health score, on the other hand, is affected by lack of formal communication channels between public health officials and healthcare workers during a PHE (Public Health Emergency), lack of a publicly available plan and strategy to address shortage of PPE – Personal Protective Equipment – (masks, gloves, gowns, etc.). Still in Health – look at this – GHSI ranked Lebanon 139th/195 in Healthcare Access, in part due to lack of universal healthcare coverage and diminished access in under-served regions and among our extensive refugee population.

Epidemics do not take pity over countries with poor infrastructure. Years of neglect might come back to haunt us.

But it’s in other categories that Lebanon’s weaknesses really show. Under Risk, we rank 184th and 124th in Political/security risk and Infrastructure, respectively.

Epidemics do not take pity over countries with poor infrastructure. Years of neglect might come back to haunt us.

@RANDCorporation has a similar index called the Infectious Disease Vulnerability Index (IDVI) with 7 categories and an overall score ranging from 0 to 1. (You can read the most recent report in a PDF format here).

Lebanon ranks 86/195 with an IDVI score of 0.546. Ranking especially low in the Political-Domestic Domain (0.360) and high in the Demographic domain (0.796), ie population density, mobility, level of education and literacy. See below for the breakdown of each domain.

Where do these indices fail? Well, GHSI dates to July 2019 and IDVI is as old as 2016! You don’t need me to remind you what has happened since then. Even July of last year is no longer representative of the country’s preparedness to respond to the #COVID19 epidemic.

GHSI currently ranks Lebanon 97th in Socio-economic resilience. With informal capital controls, imminent default, the aftermath of country-wide protests, and people slipping below the poverty line by the day, I would be surprised if this ranking wouldn’t be in fact lower.

Where does this put us, then? Firmly in the middle, I believe.

@mophleb recently confirmed the 4th case of 3COVID19 and 1st case of person-to-person transmission on Lebanese soil.

We do not have the time, economic or political will to contain this virus. There is utility in airport screenings and quarantining people from certain countries. But now is the time to bolster the national response strategy and be prepared to mitigate this epidemic on home turf.

There is a high likelihood of seeing more cases in Lebanon. However, the concern is in mildly symptomatic or asymptomatic individuals that may fly under the radar and shed the virus. This will hasten the spread to vulnerable populations.

I was happy to see that recommendations are being put forward to increase the availability of the diagnostic kit to private laboratories and train healthcare workers in responding uniformly to respiratory illnesses.

The virus no longer belongs to one country or another. It is global. We must react accordingly. This is why we must raise our index of suspicion and screen any and all patients that present to a hospital with suggestive symptoms – regardless of travel history.

Funds may not permit this to its fullest extent but with a proposed Private-Public partnership this just might work.

The socio-economic and healthcare repercussions of the alternative “complacent” choice alone should be an incentive.

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