Tatiana Tohmeh

The COVID-19 pandemic continues to expand globally, with case numbers rising in many areas of the world, including the Eastern Mediterranean Region. Lebanon experienced its largest wave of COVID-19 infections from January to April 2021. Limited genomic surveillance was undertaken, with just 26 SARS-CoV-2 genomes available for this period, nine of which were from travellers from Lebanon detected by other countries. Additional genome sequencing is thus needed to allow surveillance of variants in circulation. In total, 905 SARS-CoV-2 genomes were sequenced using the ARTIC protocol. The genomes were derived from SARS-CoV-2-positive samples, selected retrospectively from the sentinel COVID-19 surveillance network, to capture diversity of location, sampling time, sex, nationality and age. Although 16 PANGO lineages were circulating in Lebanon in January 2021, by February there were just four, with the Alpha variant accounting for 97 % of samples. In the following 2 months, all samples contained the Alpha variant. However, this had changed dramatically by June and July 2021, when all samples belonged to the Delta variant. This study documents a ten-fold increase in the number of SARS-CoV-2 genomes available from Lebanon. The Alpha variant, first detected in the UK, rapidly swept through Lebanon, causing the country's largest wave to date, which peaked in January 2021. The Alpha variant was introduced to Lebanon multiple times despite travel restrictions, but the source of these introductions remains uncertain. The Delta variant was detected in Gambia in travellers from Lebanon in mid-May, suggesting community transmission in Lebanon several weeks before this variant was detected in the country. Prospective sequencing in June/July 2021 showed that the Delta variant had completely replaced the Alpha variant in under 6 weeks.

Background On the 11th March, the WHO has declared COVID-19 pandemic. Officially, the virus was introduced in Lebanon on the 21st February 2020. Since then, the national curve has drawn several waves. From July to September 2021, Lebanon has experienced the first delta wave. As part of the investigation, contact tracing was enhanced to limit virus transmission. The objective is to describe close tracing approach and profile of close contacts identified during the first delta wave. Methods COVID-19 surveillance is integrated within the national communicable diseases surveillance. The case definitions are adopted from WHO guides. Laboratories report positive cases on daily basis to the Ministry of Public Health, on DHIS2 platform directly or indirectly via excel files importation. Once reported, case investigation is initiated. It includes contact tracing with: 1) identification of close contacts, 2) advice on quarantine and self-monitoring, 3) contact testing. Referral to field testing is made available free of charge for close contacts. Collected data is updated on DHIS2 platform. Later, data is cleaned and analyzed to generate the daily report including description of close contacts. The report is shared with decision makers, professionals, media and public. Results From week 2021W27 to week 2021W40, 85490 cases were reported. Case investigation rate reached 78.8% of the cases were investigated within 24 hours. 66.5% of investigated cases shared lists of contacts, with 3.6 as average number of contacts per case. We identified a total of 161805 close contacts, 95% were from family members, 71% were not vaccinated and 10 % had prior COVID-19 infection. As for contact testing, 65% had RT-PCR test upon investigation, with 32% positive result. Furthermore, 19205 were referred and tested via field testing, with 25% positivity rate. Of all identified contacts, the reported positive tests reached 56,904 representing 35.2% of all contacts. Conclusion During community transmission and mitigation strategy, contact tracing contributes to increase awareness to the contacts and importance to abide to quarantine measures and thus to slow down the virus circulation. Current close contacts are characterized with new profile of prior infection, vaccination history and testing behavior. There is need to adapt the quarantine measures to close contacts based on their profile, and to ensure easy access to free testing.

Background The COVID-19 pandemic continues to expand globally, with case numbers rising in many areas of the world, including the Eastern Mediterranean Region. Lebanon experienced its largest wave of COVID-19 infections from January to April 2021. Limited genomic surveillance was undertaken, with just twenty six SARS-CoV-2 genomes available for this period, nine of which were from travellers from Lebanon detected by other countries. Additional genome sequencing is thus needed to allow surveillance of variants in circulation. Methods Nine hundred and five SARS-CoV-2 genomes were sequenced using the ARTIC protocol. The genomes were derived from SARS-CoV-2-positive samples, selected retrospectively from the sentinel COVID-19 surveillance network, to capture diversity of location, sampling time, gender, nationality and age. Results Although sixteen PANGO lineages were circulating in Lebanon in January 2021, by February there were just four, with the Alpha variant accounting for 97% of samples. In the following two months, all samples contained the Alpha variant. However, this had changed dramatically by June and July, when all samples belonged to the Delta variant. Discussion This study provides a ten-fold increase in the number of SARS-CoV-2 genomes available from Lebanon. The Alpha variant, first detected in the UK, rapidly swept through Lebanon, causing the country’s largest wave to date, which peaked in January 2021. The Alpha variant was introduced to Lebanon multiple times despite travel restrictions, but the source of these introductions remains uncertain. The Delta variant was detected in Gambia in travellers from Lebanon in mid-May, suggesting community transmission in Lebanon several weeks before this variant was detected in the country. Prospective sequencing in June/July 2021 showed that the Delta variant had completely replaced the Alpha variant in under six weeks.