Concerns for low-resource countries, with under-prepared intensive care units, facing the COVID-19 pandemic

Elhadi, Muhammed; Msherghi, Ahmed; Alkeelani, Mohammed; Alsuyihili, Ali; Khaled, Ala; Buzreg, Anis; Boughididah, Tariq; Abukhashem, Mohamed; Alhashimi, Ayiman; Khel, Samer; Gaffaz, Rawanda; Ben Saleim, Najah; Bahroun, Sumayyah; Elharb, Abdelmunam; Eisay, Mohamed; Alnafati, Nafati; Almiqlash, Bushray; Biala, Marwa; Alghanai, Esra

BACKGROUND: Low-resource countries with fragile healthcare systems lack trained healthcare professionals and specialized resources for COVID-19 patient hospitalization, including mechanical ventilators. Additional socio-economic complications such as civil war and financial crisis in Libya and other low-resource countries further complicate healthcare delivery. METHODS: A cross-sectional survey evaluating hospital and intensive care unit's capacity and readiness was performed from 16 leading Libyan hospitals in March 2020. In addition, a survey was conducted among 400 doctors who worked in these hospitals to evaluate the status of personal protective equipment. RESULTS: Out of 16 hospitals, the highest hospital capacity was 1000 in-patient beds, while the lowest was 25 beds with a median of 200 (IQR 52-417, range 25 – 1000) hospital beds. However, a median of only eight (IQR 6-14, range 3 – 37) available functioning ICU beds were reported in these hospitals. Only 9 (IQR 4.5-14, range 2 – 20) mechanical ventilators were reported and none of the hospitals had a reverse transcription-polymerase chain reaction machine for COVID-19 testing. Moreover, they relied on one of two central laboratories located in major cities. Our PPE survey revealed that 56.7% hospitals lacked PPE and 53% of healthcare workers reported that they did not receive proper PPE training. In addition, 70% reported that they were buying the PPE themselves as hospitals did not provide them. CONCLUSIONS: This study provides an alarming overview of the unpreparedness of Libyan hospitals for detecting and treating patients with COVID-19 and limiting the spread of the pandemic.