Libya Health Sector: Coronavirus disease 2019 (COVID-19) preparedness and response plan for Libya

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(WHO, IOM, UNHCR, UNICEF, UNFPA, UN Habitat, IMC, HI, TDH, MSF-Holland, MSFFrance, Emergenza Sorrissi-Naduk, IRC, PUI)

Tripoli, Libya 26 March 2020

Libya - current situation and risk of COVID-19

As of 25 March 2020, 1 confirmed case of COVID-19 is reported in Libya. Until present, a total of 61 cases were tested for COVID-19 with 73 people on quarantine.

WHO has defined four transmission scenarios for COVID-19:

  1. Countries with no cases (No cases);

  2. Countries with 1 or more cases, imported or locally detected (Sporadic cases);

  3. Countries experiencing cases clusters in time, geographic location and/or common exposure (Clusters of cases);

  4. Countries experiencing larger outbreaks of local transmission (Community transmission).
    Currently, Libya falls under the second scenario. This is a call for Libya to stop transmission and:

• Enhance emergency response mechanisms
• Educate and actively communicate with the public through risk communication and community engagement
• Enhance active case finding, contact tracing and monitoring; quarantine of contacts and isolation of cases
• Implement COVID-19 surveillance using existing respiratory disease surveillance systems and hospital-based surveillance
• Train staff in IPC and clinical management specifically for COVID-19
• Prepare for surge in health care facility needs, including respiratory support and PPE
• Test all individuals meeting the suspect case definition
• Considerations in the investigation of cases and clusters of COVID-19
• Clinical management of severe acute respiratory infections when novel coronavirus is suspected
• SARI/ILI surveillance for COVID-19 and reporting
• Screen and triage patients at all points of access to the health system • Care for all suspected and confirmed patients according to disease severity and acute care needs
• Ready hospitals for surge • Ready communities for surge, including by setting up community facilities for isolation of mild/moderate cases
• Test suspect COVID-19 cases according to diagnostic strategy
• Isolation/cohorting in: health facilities, if resources allow; community facilities (i.e. stadiums, gymnasiums, hotels) with access to rapid health advice (i.e. adjacent COVID-19 designated health post, telemedicine); self-isolation at home according to WHO guidance. For moderate cases with risk factors, and all severe/critical cases: Hospitalization (in-patient treatment), with appropriate isolation and cohorting.

Libya is at high risk of having imported cases from neighboring countries with ongoing transmission and the spread of Corona Virus Disease (COVID-19) due to low capacity given its growing levels of insecurity, political fragmentation, weak health system and high numbers of migrants, refugees and internal displacement of people (IDPs). The two Libyan governments are not well prepared to implement effective preparedness and response measure to mitigate the risk of the COVID-19 , and support of WHO and other health partners is needed to fill the gaps in capacity both at a national and subnational level to support the national health authorities.
The risk of imported cases in Libya and further local transmission in the community has become very high for the following reasons:

• Libya is at high risk for COVID-19 given its political instability (fragmented state: two Ministries of Health), insecurity, weak health system. The preparedness and response capacity of the interim MoH in east Libya is reportedly very limited. Preparedness and response activities in south Libya are basically non-existent.

• The absence of governance (and resulting absence of law and order) will hamper efforts to contain and isolate geographic areas where there may be clusters of the disease. There has been a surge of cases in neighbouring countries, including those that share borders with Libya.

• The cross-border control points are not effective in the east of the country and absolutely absent in the south. The imposed shutdown of border crossing points is not being respected with thousands of people (6,000) sneaking into the country from all directions by road with no capabilities to test them all at PoEs, quarantine procedures, etc.

• There is large and frequent population movement between Libya and other affected countries.

• Early detection of the disease in Libya will be difficult. Fewer than half the country’s functioning hospitals report regularly to EWARN.

• There is limited national capacity of contact tracing and case management due to the fragile health system with limited availability of medical equipment and health facilities, especially in rural and hard-to-reach areas.

• The needs of vulnerable groups – including the elderly, immuno-compromised, pregnant women (especially with respiratory illnesses) is at further increased risk of adverse outcomes.

• Vulnerable populations reside across the country, such as IDPs, migrants and refugees who may be more susceptible to disease due to limited access to health care and deteriorated living conditions. A need to find solutions to cover “formal” and “informal” detention centres and prisons. Also, armed conflicts across the country increase the vulnerability among the population to any infectious disease.

• Rumours and misperceptions about the disease are widespread. Both communities and health care workers have vociferously opposed proposals to use isolation units for COVID-19 patients, going as far as threatening to burn down hospitals if these are patients admitted. In the face of this hostility, private facilities with isolation units have refused to admit COVID-19 patients. Similarly various armed groups in control of different geographical locations have refused to allow hospitals in those areas to be assigned for COVID-19 preparedness and response.

• Delays in recognizing an imminent threat and its pandemic nature to mobilize required resources and attention among the high level authorities both in the east and west of the country (LNA and GNA accordingly).

• There are very limited funds for preparedness and response activities despite the announcements for support of earlier developed national preparedness and response plan for 10.5 million LYD and statement by the PM office to allocate 500 million LYD for COVID-19 response. In addition, it was estimated that 8 million USD would be required to establish and equip hospitals with isolation wards and ICU.

• Preparedness and response activities are left within the domain of municipality authorities (100) with little knowledge, expertise, competence, skills and funding to manage these actions.

• Until now, no clarity of assignment of hospitals with isolation wards and ICU capabilities in the west; two or three hospitals identified in the east (Quiefia hospital (8 ICU beds), Al Hawari (not ready) and Sirt (4 ICU beds available out of 12 announced) and none in the south. On 21 March it was informed that Tripoli University Hospital was assigned with this function (additional information is being collected). Of note, 2017 information indicated that 75 hospitals had ICU capacity with 482 ICU bed capacity.
Table 1 2017 data on availability of ICU departments and ICU beds in hospitals (see Annex 6)

• Number of rapid response teams managed by NCDC is very low (6) for 3 regions to the country.

• Overall lack of personal protective equipment across the country.

• Limited number of PCR test kits required for COVID-19 testing. An estimated minimum of 200 for the next 2 months.

• Refusals of health workers to engage in treatment and follow up of COVID-19 patients.

• Continuous delays in salary payments for health workers minimizing any motivation.

• Absence of fast track procedures to clear and release imported humanitarian assistance related health supplies.

• There are indications of negative impact of COVID-19 on other services such as immunization, suspension of prenatal check-ups, NCD treatment services (e.g. dialysis, physical therapy) and emergency care.

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