World Covid-19: four questions to understand the saturation of hospitals

22:55  27 october  2020
22:55  27 october  2020 Source:   lemonde.fr

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The influx of patients with SARS-CoV-2 is straining the French hospital system, as in the spring. With what consequences?

While the health threat linked to the new coronavirus seemed to dissipate in the summer, it became very concrete again in the fall. Less than six months after deconfinement, French hospitals are now facing a new influx of patients with Covid-19. This "second wave" is already raising fears of a risk of saturation of intensive care services, specializing in the management of serious cases. Four-question update on the situation at the hospital.

at the "sheave" service of the Bichat hospital, a second wave of Covid-19 far too real 1. How much does the second wave affect hospitals?

At the beginning of August, just over 5,000 people were hospitalized in connection with Covid-19. That number has tripled in ten weeks, topping 16,000 as of October 25. This already represents more than half of the number of patients who had been treated at the height of the epidemic peak in spring (just over 32,000 on April 14).

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It is especially patients admitted to the intensive care unit, suffering from severe forms of Covid-19, who are worrying. In the heart of summer, there were fewer than 100 new weekly intensive care admissions, compared to 1,904 in the week of October 20 to 26, according to Public Health France (SPF).

Since September, the departments concerned have been rapidly filling up despite the progress made in the management of the disease in recent months. Around 2,600 patients were hospitalized in intensive care as of October 25, a number which is still far from the April peak (around 7,000 patients at the worst of the crisis), but which is already causing problems in many departments concerned.

2. What is the reception capacity in intensive care? Could we increase it?

Normally, there are around 5,000 places in intensive care throughout France. But the SARS-CoV-2 coronavirus is not spreading evenly in the territories, which is why some hospitals have been overwhelmed for weeks.

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At the rate at which the virus is spreading, the risk of seeing the specialized services saturated from November is real. A little more than half of the available beds are in fact already occupied, while the number of patients present in “shifts” has doubled approximately every three weeks since the beginning of September.

Solutions can still be envisaged to urgently reinforce the reception capacities of hospitals. This had been the case in the spring to make up to 7,000 resuscitation beds available for patients. Can we go further? As of the end of June, the Minister of Health announced the possibility of "arming at least 12,000 intensive care beds" in the event of a second wave in the fall. But on October 15, Olivier Véran tempered his remarks, explaining that the "objective is not to have a number of sheaves expandable to infinity".

This figure of 12,000 beds was a theoretical calculation, adding up the simultaneous capacities of all regions, with a reinforcement of 24,000 nurses and 10,500 additional nursing assistants: human resources which are far from being available this fall.

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The reinforcements deployed during the first wave were based in particular on transfers between regions, which cannot be repeated while the virus is circulating everywhere in France. Likewise, ad hoc recruitments seem more complex than in the spring. "It's very different from March, where everyone wanted to help, many caregivers are fed up, they are exhausted, the first wave broke them, we see the weariness", recently confided to the World Stéphane Gaudry, at the Avicenne hospital, in Bobigny, noting that the calls for applications receive very few responses.

the untenable promise of 12,000 intensive care beds 3. Why is this influx of patients so worrying?

What caregivers wish to avoid in the first place, in the event of the continued progression of the epidemic, would be having to triage patients, that is to say not being able, due to lack of space, to admit to intensive care those who - with Covid-19 or other serious illnesses - should be in normal times. For these patients, the consequences are serious and directly damaging.

The effects of the influx of Covid patients go far beyond, in a kind of domino game. In the spring, the health crisis monopolized a large number of resources to the detriment of other pathologies: cancer, heart or neurological diseases, diabetes, etc. Most of the surgical procedures deemed non-urgent were canceled and follow-up appointments were canceled. This collateral damage is difficult to measure, but its effects were felt after containment. The postponement of care procedures can be accompanied by a worsening of the patient's condition.

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Faced with the increase in patients with Covid-19 in October, deprogramming has already started. The Grand Est launched the "white plan" on October 26, allowing requisitions of staff and hospital blocks, while massive deprogramming was ordered in public and private hospitals in Ile-de-France and Auvergne-Rhône -Alps.

Ile-de-France hospitals forced to "deprogram" their activity outside of Covid-19 4. Is this an unusual situation as winter approaches?

Every year, tensions appear in the French hospital system, faced with seasonal winter infections, due in particular to the lack of intensive care beds. For example, in the fall of 2019, in the midst of a bronchiolitis epidemic, the lack of space in pediatric intensive care had already led to transfers of young patients from Ile-de-France to other regions.

The fight against SARS-CoV-2 alone represents a considerable burden for hospital services. To have a point of comparison, the “classic” seasonal flu generates on average each year between 1,000 and 2,500 admissions to intensive care units, according to SPF. However, since the start of 2020, the Covid-19 has caused around 30,000 intensive care admissions. In addition, a very clear peak in mortality was recorded in March and April. The National Institute of Statistics and Economic Studies estimates that there were 27,300 "excess" deaths in the period from March 10 to May 8 compared to the average for previous years.

While it is nothing new that hospitals are overcrowded at the end of the year, the epidemic caused by the coronavirus could, for lack of sufficient response, overwhelm them to much larger proportions.

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