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July 23, 2020

COVID-19 Response in Lebanon: Current Experience and Challenges in a Low-Resource Setting

Author Affiliations
  • 1Quality, Accreditation and Risk Management Department, American University of Beirut Medical Center, Beirut, Lebanon
  • 2Faculty of Medicine, Saint George University Medical Center, Beirut, Lebanon
  • 3Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
JAMA. Published online July 23, 2020. doi:10.1001/jama.2020.12695

On February 21, 2020, the first case of coronavirus disease 2019 (COVID-19) was identified in Lebanon. This occurred amid a backdrop of political and economic turmoil that began in October 2019, when a banking crisis and a civil uprising led to a change in political leadership and pushed the country into an economic crisis. On January 31, approximately 2 weeks after cases started to emerge outside of China, the newly appointed government in Lebanon established a National Committee for COVID-19 (NCC) to oversee the COVID-19 national preparedness and response.

Lebanon had specific challenges preparing for the emerging pandemic: in addition to economic and political unrest, the country is densely populated, with 6.9 million residents—87.2% of whom live in urban areas—including 2 million displaced persons and 500 000 migrant workers, all within 10 452 km2 (approximately the size of the state of Connecticut or Kosovo). Households are largely multigenerational, averaging 5 persons per household. The health care sector is fragmented with hospitals of varying capabilities, 84% of which are private and mainly concentrated in large cities. Furthermore, 80% of the health care budget is spent on acute care in private hospitals, leaving the public health systems underresourced. In addition, Lebanon relies heavily on foreign supply chains and has no local manufacturing capability to produce essential COVID-19 supplies, including N95 masks and ventilators.

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