For the past four days, Professor Djillali Annane, head of the resuscitation service at Raymond Poincaré hospital, in Garches, in the Hauts-de-Seine, has been forced to refuse a dozen patients with Covid-19 daily. The 26 “sheave” beds - eleven more than normal - are taken. "And as soon as a bed becomes available because we have to deplore a death [there have been six in the service on the thirty patients treated], there is hardly time to change the sheets that it is already reassigned ”, laments the head of service. This Friday morning, a 37-year-old patient, without major health concerns, succumbed to this new coronavirus. "This is the worst health disaster of the modern era, insists the practitioner. In Ile-de-France, the situation is out of control, we are overwhelmed. "
For the time being, refused patients are admitted to other hospitals in the Ile-de-France region, but the saturation threshold should be reached over the weekend. Clearly: Thursday evening, of the 1,500 intensive care beds available in the region, 1,297 were occupied. However, the epidemic peak is still not reached and since Tuesday, the situation seems to have worsened, the serious cases increasing at full speed. "The number of hospitalizations in intensive care, constantly increasing, is particularly worrying," says one within the regional health agency (ARS) Ile-de-France. If the organization hopes to reach 2,000 resuscitation beds in Paris and its suburbs (compared to 1,200 in normal times) in the coming days, notably by mobilizing the private sector, the health situation is becoming more and more like that of the Grand- East. "We will be, from this weekend, in a situation of extreme tension, we see that the waterline is close", recognizes Frédéric Valletoux, the president of the French hospital federation.
“Load shedding” in other regions or even countries?
To deal with this situation and wait for the first effects of confinement to “flatten” this famous curve, the president of the federation pleads for a “load shedding” - “I don't like this term, but we have to say things like this that they are ”- in regions which, for the time being, still have beds available, mainly the West of France. "We have to make use of national, even European solidarity, this is the only way out of it," insists Frédéric Valletoux. These regions are a week, sometimes fifteen days behind Ile-de-France. When they are in turn in an epidemic situation, these transferred patients will be on the verge of resuscitation because the average hospital stay for the Covid is around two weeks. If the ARS claims to study this possibility, for the moment, no transfer is scheduled. "To date, there is still capacity in Ile-de-France, we must continue to take care of patients and not weigh on other regions, which too will be faced with mass hospitalizations", specifies the organism.
In Garches, ten additional beds have been well equipped with respirators to cope with the massive influx of patients. But remain hopelessly empty. 24 nurses and as many nursing assistants are missing to open them. “It has been months, years, that people say that there is a shortage of staff, that the hospital is suffering. It is our daily life, but in a health crisis like this, it is a disaster ", insists Pr Djillali Annane who affirms that other hospitals in the region are in the same situation. Beds but people for s To meet this urgent need for caregivers, the ARS relies on goodwill. Nearly 8,600 people have already registered on the dedicated platform, including 2,600 nurses, 2,100 caregivers and 1,500 doctors. part has already been deployed but some hospitals, like Raymond Poincaré, are still waiting. "These reinforcements, we do not need them in 10 days but now, if we want to cope," annoys the head of service.
Towards a sorting of patients?
There remains one question: could this health crisis push practitioners to set up patient sorting? The ARS Ile-de-France published last week a document for doctors "on the decision or not of admission of patients in intensive care units or critical care in the context of the Covid-19 epidemic ". In the Grand-Est, testimonies from caregivers report a saturation such that certain patients considered to be too fragile have been excluded from intensive care in favor of younger people. “In intensive care, we are used to discussing the risk-benefit at each admission because the treatments are very heavy, relativizes Professor Djillali Annane. Covid or not, you have to wonder whether the patient will support this care. The difference is that we will ask ourselves the question much more often. "
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