COVID-19 Pandemic in Lebanon: One Year Later, What Have We Learnt?

ABSTRACT Lebanon is witnessing an unprecedented crisis with the rapid spread of coronavirus disease 2019 (COVID-19), financial meltdown, economic collapse, and the Beirut Port explosion. The first wave began in February 2020, following which the country experienced several episodes and peaks while alternating between lockdowns and phased liftings. One year of the pandemic revealed that effective mitigation could not be separated from the collapse of the ongoing economic, political, and health sectors. Scaling up vaccination, preparedness, and response capacities is essential to control community transmission. The World Health Organization (WHO), National Council for Scientific Research—Lebanon (CNRS-L), nongovernmental organizations (NGOs), and humanitarian responses proved to be the safety net for the country during the current pandemic.

with a dramatic increase in the number of people testing positive for the virus ( Fig. 1 and 2).

FIRST LOCKDOWN
During the first phase of the lockdown, the numbers of test centers and PCR tests performed were limited. The positivity rate reported during this period was correlated with the number of tests performed which in general was very limited. The average reported daily cases was 16 in the period extending from 15 March to 17 April 2020 ( Fig. 2A). Mass random testing was initiated in April within selected targeted areas. The number of detected COVID-19-positive tests was low, culminating in easing of the lockdown measures the first week of May (Fig. 1).

EASING LOCKDOWN AND BEIRUT PORT EXPLOSION
Measures were eased, and the Beirut International airport was reopened on 1 July 2020. Relaxing the measures led to a surge in the daily number of reported cases, with the positivity rate remaining below 5% ( Fig. 2A). On 4 August 2020, a massive blast shook the heart of Beirut and was ranked the third-largest explosion of modern time, killing more than 220, injuring 6,500, and displacing 300,000 people (8). Major hospitals in Beirut, Lebanon, were severely damaged. The COVID-19 hospital wards were demolished. The remaining functional hospitals were overwhelmed treating patients injured in the blast; the country started facing the third COVID-19 wave (Fig. 2B). As of 14 September 2020, the numbers were still increasing, surpassing 1,000 cases/day (the equivalent of 159.4 cases/ million), with the positivity rate reaching as high as 13.9% during the first 2 weeks of November. An immediate lockdown was imposed and extended until 30 November 2020 with no significant changes in the volume of testing and positivity rates (Fig. 2B).

UK VARIANT
In December 2020, during the holiday season, measures were eased again. Restaurants were reopened, and all lockdown restrictions were removed with a  (Fig. 3, 4, and 5), calling for a strict and full lockdown as of 15 January 2021. One month into the January lockdown, the average positivity rate remained above 20%. Despite an alarming rise in the number of reported cases, a gradual lift and easing of the lockdown measures in February were implemented. This coincided with the launching of the first vaccination campaign.

INSIGHTS
With an increase in the daily cases, COVID-19-related deaths, and ICU bed occupancy, the pandemic is far from being on a tight rein. The effectiveness of the COVID-19 mitigation strategies could not be separated from the ongoing economic, political, and health sector collapse. Increasing waves of positive cases followed the Beirut Port explosion, the reopening of the Beirut airport, and easing after each lockdown, leading over time to higher records in the total number of COVID-19-positive cases (9).
Genomic surveillance of SARS-CoV-2 is critical in monitoring and tracking the circulating viral lineages (10). Implementing an effective and rapid genomic surveillance of SARS-CoV-2 is challenging due to the scarcity of functional sequencing facilities, lack of support and funding, high costs and delivery delays, and lack of skilled personnel.
Looking through the first year of the pandemic in Lebanon helped in uncovering the gaps and lessons learned. Testing and molecular surveillance should be part of any plan to lift or impose confinement. Additionally, scaling up vaccination, preparedness, and response capacities in Lebanon is essential to mitigate viral spread, with the WHO, CNRS-L, NGOs, and humanitarian responses being a safety net to provide the muchneeded support during the current pandemic. Finally, there is an urgent need to plan, strategize, and strengthen the health care system.

ACKNOWLEDGMENTS
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.