The impact of the Beirut blast on the COVID-19 situation in Lebanon.

AIM: On August 4, 2020, a massive explosion hit Lebanon's capital city, Beirut. The aim of this study was to explore the effect of the Beirut blast on the COVID-19 situation in the country. SUBJECT AND METHODS: Data on COVID-19 were retrieved from the Lebanese Ministry of Public Health (LMOPH), where all the COVID-19 positive cases were reported. The study was divided into two periods, considering the incubation period of the COVID-19 virus: (July 27-August 9, 2020) and (August 10-23, 2020). Information obtained included daily number of cases, tests, deaths, hospitalized patients, intensive care unit (ICU) patients, and mode of acquisition (local vs. expat). Daily positivity rates were reported per 100 tests. An independent sample t-test and a Joinpoint regression analysis were used to determine significance. A p value less than 0.05 was considered significant. RESULTS: A total of 201,010 tests were conducted during our studied period, with 8993 positive cases, constituting a total positivity rate of 4.5 per 100 tests. Case fatality rate over the studied period was 0.8%. The positivity rate of the period prior to August 10, 2020, was 2.7 per 100 tests, significantly less than that of the period following the explosion, which was 6.4 per 100 tests (p < 0.001). During our studied period, daily positivity rates were significantly increasing at a slope of 0.29 (p < 0.001). A significant increase in slope was noted on August 13, 2020 (p < 0.001). The number of hospitalized patients increased from 139 patients on July 27 to 266 on August 23, 2020, and that of ICU patients increased from 36 to 75. CONCLUSION: The port of Beirut explosion resulted in a significant increase in the daily number of positive COVID-19 cases. The aftermath of the explosion, the damage to healthcare facilities, and the overcrowding due to emergency efforts were contributing factors to that increase.

Beirut Blast: The Experiences of Acute Care Hospitals.

Mass Casualty Incidents recently increased in intensity and frequency at an unprecedented rate globally. On August 4, 2020, a massive blast hit the Port of Beirut severely damaging its healthcare sector. This study aims to provide a comprehensive understanding of the impact of the Beirut blast on acute care hospitals in the Beirut area, with a focus on understanding healthcare professionals' (HCPs) responses and encountered challenges. A qualitative research design method was adopted to evaluate the experiences of HCPs at acute hospitals located within 5 kilometers of the blast epicenter. 9 hospitals participated in the study. 11 semi-structured interviews were conducted with key informant HCPs using a designed interview guide. HCPs reported severe infrastructural damages in their corresponding hospitals, and 2 were completely non-functional post-blast. Other than physical injuries sustained by HCPs, the blast imposed substantial strains on their mental health, exacerbated by the ongoing socio-economic crises in Lebanon. Moreover, the findings revealed critical challenges which hindered hospitals' emergency responses at the level of communication, coordination, and human resources, as well as supplies. Participants urged for the need to conduct proper triage, arrange emergency operating centers, and deploy outdoor treatment tents among others, to effectively respond to future disasters. The Beirut blast overwhelmed the Lebanese healthcare system and challenged its level of emergency preparedness. This generated evidence to address the deficiencies and strengthen the existing hospitals' emergency response plans. Future efforts should include prioritizing hospitals' emergency preparedness to ensure the provision of care at increased capacity following the impact of a large-scale disaster.

Effects of a multilayered crisis on psychiatric hospitalizations in a university hospital in Lebanon; a retrospective study.

Lebanon is struggling with a multilayered crisis following the COVID-19 breakout, the economic crisis, and the Beirut port explosion. The aim of this article is to assess the effect of these crisis on the characteristics of patients hospitalized in psychiatry. This is a retrospective study conducted at the psychiatric ward of Hotel Dieu de France in Beirut between January 2017 and march 2022. The population was divided into three groups according to specific time events indicating the start of a certain crisis. Data regarding patients' demographics, psychiatric history and their present hospitalization was collected. A total of 1655 patient files were included in the study. Overall, the rate of hospitalized women increased following the Beirut port explosion, together with the rate of patients younger than 18 years old. Moreover, during the COVID-19 breakout and the start of the economic crisis, alcohol use decreased, as well as the length of stay in the hospital. In conclusion, in the event of a multilayered crisis children and adolescents, as well as women are the most at risk of being affected in terms of mental health.

The Response by International Emergency Medical Teams Following the Beirut Harbor Explosion in 2020 - Who Were They, When Did They Arrive, What Did They Do, and Were They Needed?

INTRODUCTION: On August 4, 2020, a massive explosion struck the Beirut Harbor in Lebanon. Approximately 220 people were killed and around 7,000 were injured, of which 12% were hospitalized. Despite being weakened by economic crisis and increasing numbers of coronavirus disease 2019 (COVID-19) cases, the national health care system responded promptly. Within a day, international health care assistance in the form of International Emergency Medical Teams (I-EMTs) started arriving. Previous studies have found that I-EMTs have arrived late and have not been adapted to the context and dominating health care needs. The aim of this study was to document the organization, type, activity, and timing of I-EMTs deployed to Beirut and to discuss their relevance in relation to medical needs. METHODS: Data on all deployed I-EMTs were retrieved from all available sources, including internet searches, I-EMT contacts, and from the World Health Organization (WHO) EMT coordination cell (EMT CC) in Lebanon. The WHO EMT classification was used to categorize deployed teams. Information on characteristics, timing, and activities was retrieved and systematically assessed. RESULTS: Nine I-EMTs were deployed to Beirut following the explosion. Five were equivalent to EMT Type 2 (field hospitals), out of which three were military. The first EMT Type 2 arrived within 24 hours, while the last EMT set up one month after the explosion. Four civilian I-EMTs provided non-clinical support as EMT Specialized Care Teams. A majority of the I-EMTs were focused on trauma care. Three of the four I-EMT Specialized Care Teams were rapidly re-tasked to support COVID-19 care in public hospitals. CONCLUSION: A majority of the deployed I-EMT Type 2 were military and focused on trauma care rather than the normal burden of disease including COVID-19. Re-tasking of EMTs requires flexible EMTs. To be better adapted, the I-EMT response should be guided by a systematic assessment of both health care capacities in the affected country as well as the varying health effects of hazards before deployment.

Challenges of coronavirus disease 2019 (COVID-19) in Lebanon in the midst of the economic collapse.

Lebanon, one of the smallest countries in the Middle East, has held for decades a reputation for being the premier medical hub for patients from the Arab world as well as neighboring countries and for offering world-class treatment and advanced medical services. However, this once world-renowned healthcare sector is now facing a risk of imminent collapse as overlapping crises have struck the country since October 2019. In this article, we describe the concomitant political, economic, and financial challenges that Lebanon is facing, which have strained the national healthcare system and have undermined its ability to respond to the coronavirus disease 2019 (COVID-19) pandemic. We present an overview of the political instability, the Lebanese revolution with countrywide protests, as well as the devaluation of the Lebanese currency representing one of the worst economic meltdowns since the 19th century. We describe the unprecedented energy crisis the country is facing and the disastrous consequences of the Beirut port explosion of August 2020. We review the efforts and measures taken by different stakeholders to contain the COVID-19 pandemic amid the multifaceted challenges and the large exodus of healthcare personnel.

National trauma and substance use disorders: A slippery slope in Lebanon.

Lebanon, a small middle-income nation in western Asia, has been crippled by decades of political turmoil and armed conflict. A "quadruple crisis" hit the country over the past years, starting with the protracted humanitarian Syrian refugee crisis, followed by a severe socioeconomic collapse, the global COVID-19 pandemic, and lastly the Beirut port catastrophic blast. With the exposure to repetitive traumatic events and associated organic brain injury, the Lebanese population has become at a higher risk of addiction, among other psychiatric comorbidities. With the scarce statistics about the topic and limited addiction services in the country, collaborative local efforts and international help are urgently needed to fight the upcoming substance use epidemic. Raising awareness, providing adequate training, and securing resources for the management of both addiction and trauma are of utmost importance.

The psychological experiences of Lebanese ground zero front-line nurses during the most recent COVID-19 outbreak post Beirut blast: A qualitative study.

BACKGROUND: For the past 2 months the number of COVID-19 cases in Lebanon has been on the rise, while frontline nurses after the Beirut Blast of August 4th have been practicing through limited resources and a challenging context. AIM: This paper aims at exploring the psychological experiences of Lebanese frontline nurses serving at ground zero hospital during the current COVID-19 outbreak. SETTING: This study was carried out in three main ground-zero hospitals in Beirut which are receiving COVID-19 cases. METHOD: This study have employed a phenomenological exploratory qualitative research design, where virtual interviews were conducted with 18 frontline nurses during the second week of January 2021. RESULTS: Thematic analysis of the data expressed by the frontline nurses working in the approached ground-zero hospitals gave rise to five themes, namely 'helplessness and impending doom', 'increased mortality rates and depressive mood', 'fear of death and obsessive thinking', 'flashbacks, panic, and incompetence', and 'public recklessness, governmental responsibility, and anger'. CONCLUSION: The frontline nurses working at ground zero hospitals in Beirut are facing significant psychological challenges that should be mediated by the government and health policymakers in order to safeguard the quality of care and avoid higher mortality rates.