Why this remote town in Lebanon has become a coronavirus hot spot

Beirut, Lebanon – When Nicolas Tawk saw cases of coronavirus multiplying in Beirut last month, he left the city for his native Bsharre, some two hours’ drive away.

The town of about 5,500 residents is nestled on the edge of a deep chasm in the rugged green mountains of north Lebanon, 1,500 metres above sea level.

Bsharre is famed for its ancient cedar forest, of which only a sliver remains due to deforestation, and its picturesque red-roofed houses that become covered with snow in the winter months.

It was a perfect getaway for the freelance photographer. “My mind is at ease up there – alone with the camera and nature,” Tawk told Al Jazeera. “I see no one and no one sees me.”

But over the past two weeks, almost 10 percent of Lebanon’s total coronavirus cases have been recorded there – some 60 out of 663. Roughly 1 percent of the town’s inhabitants have been infected. A two-week total lockdown came into effect on April 10 and soldiers now patrol the streets.

“We were surprised by the scale,” Bsharre Mayor Freddy Keyrouz told Al Jazeera.

He said authorities were unable to trace the source of the town’s outbreak, though he suspected that some of those who came to the town from urban areas as the country went into lockdown in mid-March may have brought it with them.

Dr Antoine Geagea, the CEO of Bsharreh Government Hospital, said that close ties between residents and family members – many of whom live by the dozen in the same building – facilitated the virus’s rapid spread.

In an attempt to identify and contain the outbreak in the town, the hospital implemented widespread testing for the virus among residents, and has carried out some 600 tests.

“We have implemented the German protocol – massive testing, random testing, following every case. With this system, we are not in danger,” Geagea told Al Jazeera.

He said the policy of widespread testing in Bsharreh could serve as a lesson for the rest of Lebanon, where testing rates are relatively lower. Some 18,115 tests have been carried out across the population of more than six million, according to the information ministry.

“If you did the amount of testing we are doing across Lebanon, you would find the real numbers are certainly higher,” Geagea told Al Jazeera.

Hidden numbers

Lebanon recorded its first case of coronavirus on February 21 and numbers steadily increased until a national lockdown was announced on March 15, supplemented by an overnight curfew 11 days later. Of the 663 cases recorded so far, there have been 21 deaths and 85 recoveries according to the information ministry.

But experts say the official numbers do not reveal the real scale of the outbreak. Only about 500 tests have been carried out each day, amounting to roughly 2,500 tests per million people.

Those nations that have won international plaudits for their response to containing the global pandemic, such as Germany and South Korea, have tested at a rate of about 10,000 tests per million and 20,000 tests per million respectively.

But limited resources in Lebanon have made that difficult. The country’s healthcare system was already struggling under the weight of years of austerity, coupled with the worst dual economic and financial crisis in the country’s history that came to a head late last year.

Moreover, the government owes years of dues totalling hundreds of millions of dollars to many private hospitals, which have, in turn, cut services and failed to pay staff. Sleiman Haroun, the head of the syndicate of private hospital owners, said earlier this week that 15 hospitals would soon close if the state failed to pay them. The cabinet on Thursday allocated the equivalent of some $150m to pay private hospitals money owed, although the hospitals claimed last year they were owed more than one billion dollars.

In an attempt to increase its financial capabilities, the government has sought the help of the World Bank, the United Nations, and individual countries, including China. But the nationwide lockdown is seen as the government’s only real way of preventing even a relatively small surge in cases that could quickly overwhelm hospitals.

Bsharre’s outsized standing

The large-scale testing in Bsharre is an exception, made possible by the small town’s outsized standing in Lebanon and abroad.

It is a stronghold of the Lebanese Forces party, a large Christian group whose leader, Samir Geagea, along with his wife Sethrida Geagea, are both natives.

Lebanon’s establishment parties – each of which claims to represent one of the country’s religious communities – have traditionally secured support by providing services that are usually the prerogative of the state. This crisis is no different.

According to Dr Geagea, area MPs and former LF-affiliated ministers, including former Health Minister Ghassan Hasbani, have made donations of money and equipment to Bsharre Government Hospital.

He said that donations have also poured in from Australia, where the Lebanese Forces has many loyal supporters, part of a large Lebanese diaspora community that spans the world.

These resources have enabled Bsharre to test more than 10 percent of the town’s population. Geagea said they discovered that 25 percent of those infected showed no symptoms.

“Its a very big number. These are the people who spread it without knowing.” Those cases, he said, showed precisely why large-scale testing is vital to controlling the pandemic in Lebanon. “If this is a race, we are trying to run in front of the virus and catch it.”