Hospitals were already under pressure in Beirut. The novel coronavirus was resurgent, and the economy crashing. The government had declared another round of shutdowns.

Then an explosion at a warehouse at the port ripped through the city, leaving more than 135 people dead and many wounded, with tolls expected to rise, and as many as 300,000 displaced.

Within seconds, devastation reigned, overwhelming any instinct for covid-19 infection control. In the immediate aftermath of the explosion, coronavirus measures such as social distancing and mask-wearing were superseded by the death and devastation.

It is still too soon to know what impact the explosion will have on Lebanon’s coronavirus outbreak. Though testing, contact tracing and the hospitalization of severely ill patients continue, according to the World Health Organization, health workers and aid agencies are sounding the alarm.

Emergency aid flights from Italy and Russia arrived in Beirut carrying medical personnel and supplies, less than two days after massive explosions on Aug. 4. (Reuters)

The coronavirus in Lebanon is “on the rise” and “will be more difficult to contain after what has happened,” Firass Abiad, the general manager of Beirut’s Rafik Hariri University Hospital, the main Lebanese government hospital charged with managing the epidemic, tweeted Thursday. “The tolerance of people to lockdown is at a minimum. Promised aid is badly needed. Our hope lies in the resilience of the community, a resilience that was well evident in the past days.”

Crisis mode

In the aftermath of Tuesday’s blast — which appear to have been caused by the ignition of 2,750 tons of ammonium nitrate — shocked residents went into crisis mode. People loaded strangers into their cars and raced for hospitals. They set up impromptu triage centers in the streets to patch up the wounds of passersby. Three hospitals severely damaged by the blast rushed to evacuate and transfer patients. Medical centers that were still functioning quickly filled beyond capacity. Available doctors and emergency workers poured into the area to help. Lebanon’s Red Cross issued pleas for blood donations. The dead, it said, should go straight to the morgue.

Residents of Beirut awoke to devastation after two massive, deadly explosions shook the city in the early evening of Aug. 4. (The Washington Post)

Those who still wore masks did so in part to keep out the dust and stench. A toxic cloud of nitrous oxide loomed, health officials warned.

Marco Baldan, a surgeon in Beirut with the International Committee of the Red Cross, told The Washington Post by phone that within two hours of the explosion hospitals in Beirut ran out of medical supplies that were meant to last for days.

“We could not respect the necessary measures to maintain control of the pandemic,” Baldan said. “So this may favor a spread that we will see in the coming days.”

By Wednesday, Beirut’s mayor estimated that a quarter-million people had been displaced. Some estimates ran higher. Lebanon’s parliament pledged to house people in empty schools. Many Beirut residents have already fled the shattered capital to stay with family and friends elsewhere in the country. On social media, people are exchanging the latest on who has an open room or space for the displaced.

These dispersal and solidarity come with added coronavirus risk. Crowds, and proximity in hospitals and homes, public health experts warned, are situations in which the virus thrives.

On Thursday, French President Emmanuel Macron visited Lebanon, the first foreign leader to do so since the explosion. During a walk through devastated streets, scores of sad, angry and traumatized Lebanese thronged around him to vent their frustrations. There was no attempt at maintaining distance.

Coronavirus concerns

Lebanon recorded more than 5,000 confirmed coronavirus infections and 65 related deaths. On Tuesday and Wednesday, officials confirmed 355 new cases, the WHO’s country representative in Lebanon, Iman Shankiti, told The Post. Before the blast Tuesday, Lebanon also reported three deaths over the past day, including the country’s first nurse to die of the virus.

In the early days of the pandemic, the nation of nearly 7 million kept the coronavirus mostly at bay amid a strict lockdown. But numbers began to climb after restrictions were lifted in May. On July 27, the government ordered another shutdown, to last two weeks. Health officials moved fast to expand testing, and they were averaging 6,000 a day, according to Shankiti.

Hours before the explosion, Abiad tweeted that Rafik Hariri University Hospital had 19 critical-care patients and a capacity for just 23. Fifty-five of its 80 regular beds also were filled with confirmed or suspected coronavirus patients.

Now mass casualties and stricken hospitals need to be factored in, too.

“St. Georges Hospital, on the forefront against Covid19, in testing and management, was damaged and all patients had to be evacuated,” Abiad tweeted.

Lebanon has several other Ministry of Health-designated hospitals for covid-19 patients outside of Beirut, Shankiti said. Inside the capital, a few hospitals are still receiving covid-19 patients, though only the most critical ones. Efforts are underway to move patients with serious injuries, infected with covid-19 or not, to hospitals outside of Lebanon.

As of Thursday, across Lebanon there were 40 covid-19 patients in intensive care units and 125 patients in regular beds in government run hospitals, Shankiti said.

“They are continuing with the surveillance, with contact tracing, with testing,” she said. “But I don’t know until when they can continue with that if the number of critical cases increases.”

Before Tuesday, the Beirut port was the main entry point for much of the country’s medical supplies which, like much else in Lebanon, were imported from abroad. Shankiti said an estimated 10 to 17 containers of medical supplies at the port were destroyed during the explosion.

In the short term, Shankiti said the safety of medical workers who rushed to help — some of whom had been laid off in recent months amid the economic upheaval — was the top priority.