Rapidly Deployed Phone-Based COVID-19 Telemedicine Clinic in Lebanon: A Retrospective Analysis

Background: In early 2021, Lebanon's second COVID-19 wave coincided with financial collapse, health-workforce emigration, and the aftermath of the August 2020 Beirut port explosion, leaving hospitals saturated and many households unable to afford routine medical advice. Objectives: To describe the design, utilization, disposition outcomes, supervisory escalation, and direct operational cost of a free phone-based telemedicine clinic rapidly deployed through an academic-nongovernmental organization (NGO) partnership, and to identify transferable lessons for other crisis-affected, resource-constrained settings. Methods: Beirut Arab University Healthcare Center and the Federation of Businessmen for Support and Development (IRADA), a national NGO, launched a free 24-hour, 7-day-a-week phone-based telemedicine clinic staffed by 40 medical interns and residents using a standardized COVID-19 management protocol under a two-tier supervision model, with on-call family physicians reachable throughout each shift. WhatsApp voice calls were offered to provide free access, and missed calls were returned by the on-call responder. We retrospectively analyzed the de-identified records of all consultations managed during 14 weeks (February 2 to May 11, 2021); disposition categories were derived from the free-text recommendations using a rule-based classifier. Findings: The service managed 2953 consultations from all Lebanese governorates. After clinical assessment and safety-netting, 90.1% of consultations were managed outside hospitals at the point of consultation, 7.8% were referred to the emergency department, and 2.0% to primary care. The on-call family physician was consulted in 6.6% of consultations, concentrated on the highest-acuity calls (16.5% of emergency department referrals). The overnight window carried 3.7% of consultations but a higher emergency department referral proportion (12.8%). Direct operational cost was USD11,032 (USD3.74 per consultation), excluding non-monetary university contributions. Conclusions: An academic-NGO partnership, a standardized triage protocol, and tiered supervision can mobilize a trainee workforce safely, at low cost, and within days during a public health emergency.