- President Emmanuel Macron announced a range of drastic measures to try to further slow the spread of the coronavirus in France.
- If it seems unlikely to be able to block Covid-19, the strategy of the government and health authorities is to limit the circulation of the coronavirus as much as possible.
- This is to give the health system time to organize itself.
Closure of schools, crèches and universities from Monday, March 16, maintenance of municipal elections with the assurance that all necessary protective measures are provided, and seniors requested to stay at home: during his televised address Thursday evening, President Emmanuel Macron announced a component of measures intended to slow the spread of the coronavirus on the territory. Meanwhile, hospitals are organizing to cope with a possible massive influx of patients, while ensuring continuity of care for patients suffering from conditions other than Covid-19. Ditto on the side of city doctors. For his part, the Minister of Health Olivier Véran launched the "maximum white plan". But will these measures suffice? Is the French healthcare system ready to manage the coronavirus crisis if the number of infected patients explodes? Or are we moving towards an Italian scenario?
Measures to curb the spread of the coronavirus
"Minimize the risks of exposure of the most vulnerable to the coronavirus, prevent children - who have few, if any, symptoms of Covid-19 - from spreading it, promote travel limitation and telework: the measures announced by the president are logical, comments Dr. François Braun, president of Samu - Urgences France and head of the emergency department of the CHR of Metz-Mercy. France is in a good strategy to mitigate the spread of the virus. And for now, it's effective, since the coronavirus is progressing more slowly here in some neighboring countries. ”
Here, the aim of the government and the health authorities is not to put the country under control or to stop, "it is a question of avoiding reaching the peak of the epidemic too quickly, and of transforming this steep progression curve - as is the case in Italy - in a hill-shaped curve, with a more smoothed distribution of cases over time, insists Dr François Braun. Otherwise, we would have a massive influx of serious patients and it would saturate the health system. ” For the doctor, “the French strategy of diagnosis as early as possible, thanks to the medical regulation of the Samu, made it possible until now to avoid a saturation of the emergency and resuscitation services. We have adapted to the situation: while a few weeks ago, I would have told you that it was impossible to achieve it, we answer three to four times more calls than normal. This close monitoring of the contamination chains has certainly not blocked the virus, but has slowed it down, to allow the health system to prepare for the events. ”
Give hospitals time to organize
Because the goal is to give hospitals time to organize. Thus, the government has launched the "maximum white plan", ordering hospitals and clinics to cancel any non-emergency surgery to accommodate the maximum number of patients with coronavirus, and they will have for that "all the necessary financial means". "I asked the regional health agencies to immediately cancel any scheduled activity in all hospitals in the country," said Minister of Health Olivier Véran on Friday. The day before, a letter sent to all the directors of these agencies instructed them to proceed to the "immediate deprogramming of non-urgent surgical operations with post-operative resuscitation", that is to say under general anesthesia.
The minister had mentioned this scenario at the end of last week, but "we had been preparing this operation (…) for several weeks" already, said the director of the ARS Ile-de-France Aurélien Rousseau. For Olivier Véran, today we need to "free up resources, technical platforms (and) competent staff" by anticipating, "everywhere, including where the virus is not yet circulating, so that (…) we are not taken by the throat ". Enough to increase "the number of beds in conventional hospitalization, for people who do not need to go to intensive care," responded Professor Karine Lacombe, head of the infectious diseases department at the Parisian hospital Saint- Antoine. "Very sick people represent less than 5% of people who are infected" with the coronavirus, but the epidemic "will probably affect 50, 60, 70% of the French population," she estimated. "If it is over a very short period of time, for example a month and a half to two months, it will make a lot of people to take care of in the care system," she warned.
An Italian scenario?
While France currently has 2,876 cases of contamination and 61 deaths, according to the latest assessment communicated by the authorities on Thursday, a complex phase is coming, with the probability of a massive and rapid influx of patients to the hospital. A case which raises the question of the logistical and human means to deal with it. A few days ago, Italian doctors expressed their utter dismay at a lack of means forcing them to have to choose from contaminated patients in great respiratory distress which to place on artificial respirators, jeopardizing the chances of survival of those not receiving not this treatment.
And we, are we moving in France towards an Italian disaster scenario? "For the time being, this seems to me to be excluded," reassures Dr. François Braun. The measurements of the white plan allow us to anticipate, and our resuscitation equipment is numerous. Especially since services other than resuscitation have respirators, like the Samu, which also has stocks of small transport respirators. All this should make it possible to provide care for patients with Covid-19, but also for all others whose state of health requires it. ” In addition to the material resources, the staff were also mobilized. Olivier Véran thus beat the reminder of the troops: "Medical interns, young retirees, health reserve ... We are going to need everyone," he said. And "transgenerational solidarity has already been put in place even outside the mobilization of the health reserve," moves Dr. Braun. Medical students and retired doctors did not wait to offer their help. However, if the epidemic were to accelerate, phase 3 of the coronavirus management plan would be triggered. ”
General practitioners "already ready"
In this case, the health system would be readjusted according to the situation, "with treatment by liberal medicine of minor cases", notes Dr. Braun. Because in this Covid-19 epidemic, general practitioners have also been at the front since the start. “We are 50,000 general practitioners in France, with a significant territorial network: we have been mobilized since the first day and are ready to continue the mobilization, assures Dr Jacques Battistoni, general practitioner and president of the MG France union. For the time being, the number of cases of coronavirus, even if it is increasing, remains fairly contained. And we have the capacity to scale up significantly, ”he says.
The general practitioner also highlights “our experience with seasonal flu epidemics: we know how to manage a massive and rapid influx of patients and we have a strong capacity for adaptation. For the specific management of the coronavirus, simple measures make it possible to receive all the patients. First, in line with what is planned in the hospital, we can postpone non-urgent consultations and thus devote the time saved to patients with coronavirus. Then, it is important for us to set up two separate patient flows: the first for those who have no fever or cough and those who have different acute problems; and the second for patients infected with the coronavirus. If there are multiple doctors in one office, they can distribute the patients this way. If we are alone, we can receive the first in the morning and the second in the afternoon, which is what I'm going to do. ”
But being ready means being equipped. "We have very few masks," says Dr. Battistoni. This is why masks with a high level of protection, called FFP2, will be sent to doctors who are not practicing in hospital to cope with the intensification of the epidemic caused by the coronavirus, the minister said on Friday. of Health.
While schools are closed until further notice and many areas are idling, Dr. Braun acknowledges that “the situation with the coronavirus is changing from hour to hour. I would be unable to tell you what the situation will be in a fortnight. But for now, I am confident, everyone in the health sector is prepared ”.
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