The Covid-19 strategy in Lebanon needs to be decentralized in order, to cope with the small size of the population and to have a less negative impact on the lives of its citizens and the economy.
The municipalities need to be empowered to make local determinations in order to avoid complete “shutdowns” and “lock downs,” which have a profound negative impact on individuals, communities, and societies by bringing social and economic life to a near stop. Such measures also disproportionately affect disadvantaged groups, including people in poverty, migrants, internally displaced people and refugees, who most often live in overcrowded and under resourced settings, and depend on daily labor for subsistence.
The municipalities must be the main arbiter of such decisions as these impact their communities. They will also be held accountable and responsible for their choices which they will have to make with regular reviews and approval from the Ministry of Interior, based on a specific and agreed set of criteria to contain the spread of the virus.
In order to avoid such a negative downturn in the future, it is important to be able to segregate the affected communities from the safer ones, and handle the needs of any increased level of cases at the local level, where there is a better understanding of the consequences of the needed corrective actions required.
In addition, the Municipalities must be empowered by the Ministry of Health to offer daily testing facilities and have local testing stations wherever possible. They will be responsible for collecting data on the rate of the spread of Covid-19. This will be calculated using a method developed by the Harvard Global Health Institute, who have created a unified set of metrics for the coronavirus pandemic, including a shared definition of risk levels and the needed tools for communities to fight the virus.
These tools include a new classification method for risk-assessment based upon the number of new daily cases per 100,000 people. However, in the case of Lebanon, due to the small size of its overall population and the need to deal with the spread on a local level, these risk assessment ratios must be adapted to accommodate the number of new daily cases based on the size of the populations in the different areas governed by the municipalities .
As a result, the metrics need to be tailor-made for each municipality. We will give an unscientific example below (because the ratios are still unknown) and the measures offered to deal with the different stages of the outbreak which are progressive. For instance:
• A community that has only 1 new daily case per X population is classified as Green and requires no general containment although testing must continue with contact tracing and isolation to suppress outbreaks.
• A community that has 1 to 5 new daily cases per X population is considered Yellow with potential community spread. Testing must continue and social distancing must be enforced, with mask wearing becoming mandatory and social gatherings not to exceed 8 people. Outdoor eating will continue to be permitted with a limited capacity of 50% and tables of no more than 8 people. Businesses can stay open in conformity with mask regulations and social distancing measures.
• A community that has between 5 and 10 new daily cases per X population is Orange and means escalating community spread. It requires curfews with stay-at-home orders and increased testing, no social gatherings permitted, no religious services. Businesses stay open with mandatory masks and social distancing. Restaurants stay open for delivery only.
• A community which has 10 new daily cases and above per X population is considered red and indicates unchecked community spread whereby stay-at-home orders are necessary and 14 day quarantine measures with testing and lockdowns come into effect.
This strategy of customized metrics allows municipalities to gage the response level for their community and at the same time helps to keep the economy going by applying the correct response measures to the level of the crisis. It addresses the rapid spread and contains the virus in an “a la carte” fashion which permits life to go on in other parts of the country. The same criteria apply to local schools in those districts which will conform to the same color coding and their determined restrictions.
The way to deal with the Covid-19 virus which will be with us for some time, is to develop strategies that can remain fluid and are based on the rate of spread and the measures needed for its containment.
Calculating the numbers of new COVID-19 cases per day, per number of the population, is a good indicator to show the current picture of outbreaks and compare them in a consistent way. It’s a standard way to measure the risk against the total population. Also, by sticking with a standard, core metric it is possible to compare trends over time.
For local policymakers, the risk levels are also meant to signal the intensity of the effort needed to control COVID-19 and to trigger specific interventions rather than wait for the central government to give, often wrong guidance, to those operating at a local level, as has been witnessed recently by the multiple random shutdowns which have severely endangered the livelihood of hundreds of thousands of people in Lebanon.
The technology for these shared metrics and guidance is available today and the Government should make use of them and adapt them immediately to Lebanon’s needs by empowering the municipalities to take the necessary measures to contain the virus in their towns and villages.
The existing technology must be adapted to Lebanon’s needs. It is offered by Covidlocal.org, which is led by a group of disease outbreak experts and former public health officials,and CovidActNow, led by former technology executives and a group of academics who both want to see this strategy adapted more widely and used by local government.