BEIRUT: Lebanese officials are betting they can prioritize both economic and public health following the reopening of the country’s only international airport Wednesday, after a nearly four-month hiatus due to the ongoing coronavirus threat.
“You need to have a balance between health and economy. We have to see what’s better for the Lebanese,” Doctor Nada Ghosn, head of the Epidemiological Surveillance Unit at the Health Ministry, told The Daily Star
Rafik Hariri International Airport will at first operate at 10 percent capacity, bringing in around 2,000 dollar-carrying travelers per day who officials hope will buoy up the country’s economy as it collapses through the worst financial crisis in Lebanon’s history.
The airport has been closed to commercial flights since March 18, a few days after authorities imposed a state of “general mobilization” to stem the spread of coronavirus.
The swift decision to shut down the airport has been cited as one of the main factors in the country’s low coronavirus infection rates. There have so far only been 34 deaths due to coronavirus complications and 1,788 cases since the illness was first detected in the country on Feb. 21.
Because of this, public health experts believe the decision to reopen the airport is a necessary risk to help resuscitate the country’s choking economy.
“The gradual lifting of lockdown in Lebanon ... is to reopen the economy, since travel is a main driver of trade and tourism. However, the virus is here to stay and we will have to continuously abide by and implement public health measures in order to minimize the spread of COVID-19,” says Doctor Nada Melhem, Infectious Diseases and Microbiology Researcher at the American University of Beirut.
THE HEALTH MINISTRY’S NEW STRATEGY
In a bid to encourage tourism, the Health Ministry announced Tuesday that quarantine upon arrival is no longer mandatory and that it would instead be a implementing a phased PCR testing strategy.
Around 80 percent of passengers will arrive primarily from countries where “trusted” PCR tests are available prior departure. Travelers flying from countries that do not conduct PCR tests that Lebanese authorities trust will be tested upon arrival in Lebanon.
Passengers must pay for a second test 72 hours after arrival, in one of the laboratories accredited by the Health Ministry. If they test positive for coronavirus upon arrival they will be required to abide by the ministry’s instructions to self-isolate.
But as the virus has a 14-day incubation period, a negative PCR test is no guarantee that a positive result won’t emerge at a later date.
“In every strategy you use there’s a tradeoff, some people might slip through the cracks,” says head of Rafik Hariri University Hospital Firass Abiad.
“Within this strategy we won’t catch all cases but we’ll try to catch most, and allow people who want to come in for quick visits to leave their homes,” Abiad explains.
“This strategy was adopted to accommodate testing within an average of a five to six day period of time – the average incubation period – and to also accommodate visitors that might not be visiting for long periods of times,” Melhem says.
Prior to the airport’s reopening, the Health Ministry’s strategy for repatriating nationals was to enforce a two-week self-quarantine period upon arrival. However, many cases and clusters have been directly linked to returnees who had initially tested negative and failed to quarantine, subsequently infecting dozens of people in their communities.
Around 2 percent of repatriated nationals over the last few months tested positive for coronavirus, Abiad estimates. If this rate is applied to 2,000 travelers arriving per day, Abiad says this could mean up to 40 new imported coronavirus cases daily.
But the head of RHUH says he is not worried as long as the health system is not overwhelmed and has the continued capacity to treat patients. RHUH, which has taken on the majority of Lebanon’s coronavirus cases, is equipped with 175 beds to treat coronavirus patients. Eighteen patients are currently being treated in the hospital for coronavirus, Abiad says.
“Based on the data, we know the vast majority won’t need admission – 85 percent of patients will not require hospitalization, and most will be affected as they are with a common flu,” he says.
ESU AT THE READY
Ghosn says a small increase in daily coronavirus infections is manageable but “if we have 100 cases a day or more, it will be very difficult.”
Abiad in a tweet Monday warned that if the ESU, which plays a vital role in contact tracing, becomes overwhelmed, “we will see events spiraling out of control similar to some other countries.”
She says that the ESU has teams in all 26 districts of Lebanon and that when a positive case is detected, field teams are immediately dispatched to take samples, test, track and monitor those who may have come into contact with the patient.
“If you want to open the airport we have to raise awareness among the public and tell them how to properly protect themselves,” Ghosn warns.
When asked whether the decision to reopen the airport was premature, Ghosn refused to comment. “It’s a decision made by the committee and there was a big debate. I cannot comment on it.”
RISKS OF BALANCING ECONOMY AND HEALTH
AUB’s Melhem says the biggest risk with reopening the airport is “complacency in implementing preventive measures, which will result in burdening the health care system.”
“The government’s responsibility should be coupled with the individual’s responsibility to protect themselves and others by wearing a mask, social distancing, and immediately reporting any COVID-19 symptoms to their health care provider,” she explains.
Echoing Melhem’s warning, Abiad says that there is a limit to how much the government can enforce social distancing and health measures to prevent the spread of the virus.
“You can’t close restaurants, pubs, cafes and business forever. But if businesses don’t follow the simple rules of social distancing, then we will see a second surge and then go back into lockdown,” Abiad says.
These are precautions most are familiar with by now, but with virus fatigue setting in, many across the country have all but forgotten social distancing measures that were stringently followed in the first month of lockdown.
“Some people don’t think COVID exists, we have to tell them this virus exists. It can be mild but also serious. We have a duty to protect the people,” Ghosn says.