Covid hospitals: Inside a Lebanese ICU where only 20 per cent survive


Gareth Browne
  • English
  • Arabic

The unsynchronised ventilator beeps make for an eerie soundtrack in this intensive care unit. It is a deadly melody, interrupted only by the rustling of protective suits.

A group of nurses, dressed head to toe in the safety clothing, peer through the glass at an unconscious woman.

This is not the archetypal Covid-19 patient.

At 25, Fatima – whose name has been changed – is young. She was healthy too.

Yet the virus appeared to pounce on one vulnerability – her pregnancy.

“It’s something we are seeing more of now," says Hussein Al Khazim, a 25-year-old registered nurse on the unit.

"We have several cases of pregnant women where a C section or abortion has been carried out because of Covid-19.

“Some patients have had abortions, sometimes they recover, but the effects are the same, the suffering continues, even after they are Covid-19 negative.”

An exhausted Mr Al Khazim moves to wipe his brow, before remembering to override his instincts and resist touching his face. Even the most innocent scratch might spread the virus.

"Unfortunately, she lost the baby. It was two days ago," he says.

This month, Lebanon repeatedly registered record coronavirus cases – the devastating ramifications of relaxing restrictions during the holiday period, staff at Rafik Hariri University Hospital in Beirut say.

Now the country's healthcare system is at breaking point. Hospitals are full and critical supplies of necessities such as oxygen are running low.

With the record number of cases came record deaths – 44 were reported on Friday. The number of daily deaths from the virus is now 13 times what it was in July.

In a sign of how deep in the throes of a public health calamity this country is, caretaker Health Minister Hamad Hassan was admitted to hospital with the virus on Thursday.

Dr Oussayma El Dbouni, an infectious diseases specialist at the hospital, says that although the crisis is overwhelming, it was entirely predictable.

"The normal population didn't take any precautions. These numbers are a result of what happened two weeks ago – we were expecting this," she says, referring to the loosening of restrictions over the festive period, her phone ringing incessantly as she makes her rounds.

Dr Oussayma El Dbouni, an infectious disease specialist at the Rafik Hariri University Hospital in Beirut, blames the surge in cases on the public’s failure to follow government guidelines. Tom Nicholson / The National
Dr Oussayma El Dbouni, an infectious disease specialist at the Rafik Hariri University Hospital in Beirut, blames the surge in cases on the public’s failure to follow government guidelines. Tom Nicholson / The National

"We don't have enough beds, it's always full. Patients sometimes wait in the ER for a day to get a space on the floor. We are in a very bad situation right now and where we are going, we don't know."

As the minister charged with leading the government response to the pandemic focuses on his personal battle against the virus, hundreds of patients are fighting for their lives in ICUs across the country.

Staff say that in the past year only 20 per cent of coronavirus patients admitted to this ICU have made it out alive.

One nurse, Abdullah Khatabi, says he can count the number of patients who made it off the ward in the past year on two hands.

For Fatima, and the hundreds of others admitted to ICUs across Lebanon, the odds of survival are slim.

Nurses call the ward's ventilators the "kiss of death", because even though the machines may keep patients alive long enough to fight off the virus, the side effects of long-term intubation can be crippling.

A surge in case numbers early this month prompted a flustered response from authorities.

There was panic buying in supermarkets before a lockdown was introduced on Thursday. A 24-hour curfew is in place and people are required to seek permission to leave their homes.

The empty highway at the northern entrance of Beirut days after the country went back into 24-hour lockdown to stem the spread of Covid-19. EPA
The empty highway at the northern entrance of Beirut days after the country went back into 24-hour lockdown to stem the spread of Covid-19. EPA

Hospital administrators have scrambled to increase ICU capacity with some success, but one hospital said it was isolating and treating Covid-19 patients in the car park.

Terese Ghobar, a nurse with 20 years of experience, was sent to oversee infection control on the ward after Lebanon’s first coronavirus case was detected on February 21 last year.

Nurse Terese Ghobar says the squeeze on resources is forcing hospital staff to make agonising decisions. Tom Nicholson / The National
Nurse Terese Ghobar says the squeeze on resources is forcing hospital staff to make agonising decisions. Tom Nicholson / The National

A patient travelled from Iran, the virus their invisible hand luggage.

Ms Ghobar says the squeeze on resources, particularly ICU beds, is forcing hospital staff to make agonising decisions.

“It’s the most difficult part. Who do I put on the ventilator? If I have one respirator, who do I put on it? The young man? Or the sick man? Every day we are making those decisions,” she says.

The ward is made up of 10 bays, closed off by sliding glass doors. The bays surround a central hall, where there is nothing but essential equipment.

Yet the hall is a stifling pot of exhaustion and frustration.

The masks and suits are suffocating, blocking not just the virus, but even the most basic form of human interaction. Reassuring smiles are hidden, supportive hugs strictly forbidden.

Much of the staff, some of them still inexperienced, have been working for the past year without much rest.

Their proximity to the virus meant huge personal sacrifices were made.

They have forgone seeing their families for months. Social lives are a distant memory.

“My father is bedridden, my mother is sick. I’m afraid to visit them,” says Ms Ghobar.

Frustration is also building with the Lebanese public, who medics say do not appear to take the virus seriously.

Indeed, the Internal Security Forces recorded 13,167 breaches of safety measures on Wednesday, on the eve of stricter rules – all despite warnings of the unfolding crisis.

"The lockdown is late. I want to pray to the Lebanese people. I don't feel the lockdown is the solution to reduce it," says Ms Ghobar.

"Stay in the house. From all our hearts. Please help us. We're so tired. Psychologically, physically, we're very tired.

“The psychological approach of people is more important than the government.”

As for those who might be tempted to break the stringent lockdown, Mr Al Khazim has one message.

“I wish they would spend one shift, or half a shift, in intensive care – then they can see the damage of their actions,” he said.

“Covid-19 doesn’t discriminate, as they say, it cannot differentiate between the young, the elderly or children”.

But despite the frustration and emotions, there are slivers of hope.

A woman wakes up after 10 days on a ventilator.

Delirious from the anaesthetic, she musters a smile, and waves to a line of nurses through the glass of her bay.

She is expected to be released from the ICU today. She is one of the 20 per cent.

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Long read

Mageed Yahia, director of WFP in UAE: Coronavirus knows no borders, and neither should the response

PREMIER LEAGUE RESULTS

Bournemouth 1 Manchester City 2
Watford 0 Brighton and Hove Albion 0
Newcastle United 3 West Ham United 0
Huddersfield Town 0 Southampton 0
Crystal Palace 0 Swansea City 2
Manchester United 2 Leicester City 0
West Bromwich Albion 1 Stoke City 1
Chelsea 2 Everton 0
Tottenham Hotspur 1 Burnley 1
Liverpool 4 Arsenal 0

Global state-owned investor ranking by size

1.

United States

2.

China

3.

UAE

4.

Japan

5

Norway

6.

Canada

7.

Singapore

8.

Australia

9.

Saudi Arabia

10.

South Korea

Tearful appearance

Chancellor Rachel Reeves set markets on edge as she appeared visibly distraught in parliament on Wednesday. 

Legislative setbacks for the government have blown a new hole in the budgetary calculations at a time when the deficit is stubbornly large and the economy is struggling to grow. 

She appeared with Keir Starmer on Thursday and the pair embraced, but he had failed to give her his backing as she cried a day earlier.

A spokesman said her upset demeanour was due to a personal matter.

ABU DHABI ORDER OF PLAY

Starting at 10am:

Daria Kasatkina v Qiang Wang

Veronika Kudermetova v Annet Kontaveit (10)

Maria Sakkari (9) v Anastasia Potapova

Anastasia Pavlyuchenkova v Ons Jabeur (15)

Donna Vekic (16) v Bernarda Pera 

Ekaterina Alexandrova v Zarina Diyas

Sanju

Produced: Vidhu Vinod Chopra, Rajkumar Hirani

Director: Rajkumar Hirani

Cast: Ranbir Kapoor, Vicky Kaushal, Paresh Rawal, Anushka Sharma, Manish’s Koirala, Dia Mirza, Sonam Kapoor, Jim Sarbh, Boman Irani

Rating: 3.5 stars

The%20specs
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Company%20profile
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UAE currency: the story behind the money in your pockets
How to come clean about financial infidelity
  • Be honest and transparent: It is always better to own up than be found out. Tell your partner everything they want to know. Show remorse. Inform them of the extent of the situation so they know what they are dealing with.
  • Work on yourself: Be honest with yourself and your partner and figure out why you did it. Don’t be ashamed to ask for professional help. 
  • Give it time: Like any breach of trust, it requires time to rebuild. So be consistent, communicate often and be patient with your partner and yourself.
  • Discuss your financial situation regularly: Ensure your spouse is involved in financial matters and decisions. Your ability to consistently follow through with what you say you are going to do when it comes to money can make all the difference in your partner’s willingness to trust you again.
  • Work on a plan to resolve the problem together: If there is a lot of debt, for example, create a budget and financial plan together and ensure your partner is fully informed, involved and supported. 

Carol Glynn, founder of Conscious Finance Coaching

Pharaoh's curse

British aristocrat Lord Carnarvon, who funded the expedition to find the Tutankhamun tomb, died in a Cairo hotel four months after the crypt was opened.
He had been in poor health for many years after a car crash, and a mosquito bite made worse by a shaving cut led to blood poisoning and pneumonia.
Reports at the time said Lord Carnarvon suffered from “pain as the inflammation affected the nasal passages and eyes”.
Decades later, scientists contended he had died of aspergillosis after inhaling spores of the fungus aspergillus in the tomb, which can lie dormant for months. The fact several others who entered were also found dead withiin a short time led to the myth of the curse.

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Disability on screen

Empire — neuromuscular disease myasthenia gravis; bipolar disorder; post-traumatic stress disorder (PTSD)

Rosewood and Transparent — heart issues

24: Legacy — PTSD;

Superstore and NCIS: New Orleans — wheelchair-bound

Taken and This Is Us — cancer

Trial & Error — cognitive disorder prosopagnosia (facial blindness and dyslexia)

Grey’s Anatomy — prosthetic leg

Scorpion — obsessive compulsive disorder and anxiety

Switched at Birth — deafness

One Mississippi, Wentworth and Transparent — double mastectomy

Dragons — double amputee

UAE currency: the story behind the money in your pockets
In The Heights

Directed by: Jon M. Chu

Stars: Anthony Ramos, Lin-Manual Miranda

Rating: ****

The%20Killer
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How Islam's view of posthumous transplant surgery changed

Transplants from the deceased have been carried out in hospitals across the globe for decades, but in some countries in the Middle East, including the UAE, the practise was banned until relatively recently.

Opinion has been divided as to whether organ donations from a deceased person is permissible in Islam.

The body is viewed as sacred, during and after death, thus prohibiting cremation and tattoos.

One school of thought viewed the removal of organs after death as equally impermissible.

That view has largely changed, and among scholars and indeed many in society, to be seen as permissible to save another life.

SPEC%20SHEET%3A%20SAMSUNG%20GALAXY%20S24%20ULTRA
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The low down on MPS

What is myofascial pain syndrome?

Myofascial pain syndrome refers to pain and inflammation in the body’s soft tissue. MPS is a chronic condition that affects the fascia (­connective tissue that covers the muscles, which develops knots, also known as trigger points).

What are trigger points?

Trigger points are irritable knots in the soft ­tissue that covers muscle tissue. Through injury or overuse, muscle fibres contract as a reactive and protective measure, creating tension in the form of hard and, palpable nodules. Overuse and ­sustained posture are the main culprits in developing ­trigger points.

What is myofascial or trigger-point release?

Releasing these nodules requires a hands-on technique that involves applying gentle ­sustained pressure to release muscular shortness and tightness. This eliminates restrictions in ­connective tissue in orderto restore motion and alleviate pain. ­Therapy balls have proven effective at causing enough commotion in the tissue, prompting the release of these hard knots.

EU's%2020-point%20migration%20plan
%3Cp%3E1.%20Send%20EU%20border%20guards%20to%20Balkans%3C%2Fp%3E%0A%3Cp%3E2.%20%E2%82%AC40%20million%20for%20training%20and%20surveillance%3C%2Fp%3E%0A%3Cp%3E3.%20Review%20EU%20border%20protection%3C%2Fp%3E%0A%3Cp%3E4.%20Reward%20countries%20that%20fund%20Balkans%C2%A0%3C%2Fp%3E%0A%3Cp%3E5.%20Help%20Balkans%20improve%20asylum%20system%3C%2Fp%3E%0A%3Cp%3E6.%20Improve%20migrant%20reception%20facilities%C2%A0%3C%2Fp%3E%0A%3Cp%3E7.%20Close%20gaps%20in%20EU%20registration%20system%3C%2Fp%3E%0A%3Cp%3E8.%20Run%20pilots%20of%20faster%20asylum%20system%3C%2Fp%3E%0A%3Cp%3E9.%20Improve%20relocation%20of%20migrants%20within%20EU%3C%2Fp%3E%0A%3Cp%3E10.%20Bolster%20migration%20unit%20in%20Greece%3C%2Fp%3E%0A%3Cp%3E11.%20Tackle%20smuggling%20at%20Serbia%2FHungary%20border%3C%2Fp%3E%0A%3Cp%3E12.%20Implement%20%E2%82%AC30%20million%20anti-smuggling%20plan%3C%2Fp%3E%0A%3Cp%3E13.%20Sanctions%20on%20transport%20linked%20to%20smuggling%3C%2Fp%3E%0A%3Cp%3E14.%20Expand%20pilot%20deportation%20scheme%20in%20Bosnia%C2%A0%3C%2Fp%3E%0A%3Cp%3E15.%20Training%20for%20Balkans%20to%20deport%20migrants%3C%2Fp%3E%0A%3Cp%3E16.%20Joint%20task%20forces%20with%20Balkans%20and%20countries%20of%20origin%3C%2Fp%3E%0A%3Cp%3E17.%20Close%20loopholes%20in%20Balkan%20visa%20policy%C2%A0%3C%2Fp%3E%0A%3Cp%3E18.%20Monitor%20migration%20laws%20passed%20in%20Balkans%C2%A0%3C%2Fp%3E%0A%3Cp%3E19.%20Use%20visa-free%20travel%20as%20leverage%20over%20Balkans%C2%A0%3C%2Fp%3E%0A%3Cp%3E20.%20Joint%20EU%20messages%20to%20Balkans%20and%20countries%20of%20origin%3C%2Fp%3E%0A
MATCH INFO

Manchester United 1 (Rashford 36')

Liverpool 1 (Lallana 84')

Man of the match: Marcus Rashford (Manchester United)

RESULT

Huddersfield Town 2 Manchester United 1
Huddersfield: Mooy (28'), Depoitre (33')
Manchester United: Rashford (78')

 

Man of the Match: Aaron Mooy (Huddersfield Town)

Key facilities
  • Olympic-size swimming pool with a split bulkhead for multi-use configurations, including water polo and 50m/25m training lanes
  • Premier League-standard football pitch
  • 400m Olympic running track
  • NBA-spec basketball court with auditorium
  • 600-seat auditorium
  • Spaces for historical and cultural exploration
  • An elevated football field that doubles as a helipad
  • Specialist robotics and science laboratories
  • AR and VR-enabled learning centres
  • Disruption Lab and Research Centre for developing entrepreneurial skills
What is an ETF?

An exchange traded fund is a type of investment fund that can be traded quickly and easily, just like stocks and shares. They come with no upfront costs aside from your brokerage's dealing charges and annual fees, which are far lower than on traditional mutual investment funds. Charges are as low as 0.03 per cent on one of the very cheapest (and most popular), Vanguard S&P 500 ETF, with the maximum around 0.75 per cent.

There is no fund manager deciding which stocks and other assets to invest in, instead they passively track their chosen index, country, region or commodity, regardless of whether it goes up or down.

The first ETF was launched as recently as 1993, but the sector boasted $5.78 billion in assets under management at the end of September as inflows hit record highs, according to the latest figures from ETFGI, a leading independent research and consultancy firm.

There are thousands to choose from, with the five largest providers BlackRock’s iShares, Vanguard, State Street Global Advisers, Deutsche Bank X-trackers and Invesco PowerShares.

While the best-known track major indices such as MSCI World, the S&P 500 and FTSE 100, you can also invest in specific countries or regions, large, medium or small companies, government bonds, gold, crude oil, cocoa, water, carbon, cattle, corn futures, currency shifts or even a stock market crash.