The former refectory of the Pointe à Pitre CHU was transformed into a resuscitation room during the second wave of COVID-19 in Guadeloupe.
-
GILLES MOREL / SIMAX / SIPA
Guadeloupe is hard hit by the second wave of the coronavirus.
With 1,000 additional cases of Covid-19 and 15 deaths over a week, the indicators, still very high, suggest a stagnation in the influx of serious patients.
The Pointe-à-Pitre University Hospital, where several Covid units have been set up and non-emergency operations deprogrammed, the reinforcements allow caregivers to meet needs and be replaced in the event of sick leave.
“The second wave in Guadeloupe, earlier and stronger than expected, clearly showed that it is not winter or autumn that brings the virus back, since we have no drop in temperatures here, but human behavior!
», Bruno Jarrige says.
The resuscitator is piloting the Covid-19 crisis in the region of France currently the hardest hit by the epidemic.
Guadeloupe has been on maximum alert for a week.
Restaurants closed, limited access to beaches, ban on gatherings of more than 10 people in public places and, for a few days now, restrictions on travel to Martinique or Saint-Martin… The restrictive measures, imposed since last weekend, have still running.
But the latest figures and reinforcements at Pointe-à-Pitre hospital point to little hope of improving the health situation ...
Towards stabilization?
According to the latest report from the Guadeloupe Regional Health Agency, Wednesday evening, the situation remains very tense.
The island has 1,000 new cases and 15 new deaths, just less than the previous week, 1,128 cases and 16 deaths.
But after weeks when all the indicators turned scarlet, this epidemiological point calms the anxiety a little.
"We believe that there is a stabilization of the situation and we hope that it will last, reassures Valérie Denux, director general of the Regional Health Agency of Guadeloupe.
Indeed, the incidence rate decreases slightly, from 300 to 278 per 100,000 inhabitants, and the positivity rate remains stable, around 22%.
The good news is that the virus's reproduction factor (R) is less than 1, to be precisely 0.92.
Indicators corroborated by returns from city medicine: "The visits to the emergency room, the Samu, consultations for Covid in the city are decreasing a little," notes Valérie Denux.
A stabilization, of course, but with still high figures.
"The problem is that 1,000 cases per 400,000 inhabitants is obviously a lot," continues the director of the ARS.
The point that worries us is the incidence rate which has increased among the elderly, whereas at the start of the second wave, it mainly concerned young people.
“Especially since Guadeloupe, with Martinique, is one of the departments with the most senior citizens, who are very vulnerable to this disease.
A trend to be confirmed
Does this mean that the drastic measures imposed since this weekend are bearing fruit?
“With only five days of hindsight, it is difficult to measure the effectiveness of the latest restrictions, she adds.
We will have to see next Wednesday whether stabilization is confirmed or whether new measures need to be put in place.
"
In the hospital, we impatiently wait for the flow of patients to dry up.
“Hospital pressure remains high, but the number of patients in intensive care has dropped a bit, from 32 to 27 patients over a week,” she continues.
At the Pointe-à-Pitre University Hospital, we confirm, but we also remain cautious.
"For the past week, the number of beds occupied by Covid patients has not increased," confirms Bruno Jarrige.
We are on a high plateau, but I hope it will end with a descent… ”
A self transformed into a Covid unit
In the meantime, the daily life of the nursing staff at the Pointe-à-Pitre University Hospital remains difficult.
It must be said that the hospital center of Guadeloupe has accumulated difficulties: a fire in November 2017 devastated part of the buildings.
Since then, the hospital has been cut by 20% of its capacity ... "Between 100 and 110 beds are occupied by Covid patients, or 25% of the entire hospital," continues the doctor.
Including more than 30 intensive care beds, or 120% of the usual sheave beds!
"
How do caregivers cope with the influx of patients?
"We opened two new intensive care units to reach 36 intensive care beds," explains Bruno Jarrige, vice-president of the CHU.
A short-term hospitalization unit has become a Covid unit.
And we had transformed a self into a Covid service during the first wave.
It had not been in use at the time, but it was operational when everything accelerated in August.
"
To limit the damage, caregivers redouble their patience and pedagogy to explain the importance of barrier gestures and hand hygiene.
“We feel a population that doubts, who do not necessarily wear the mask, breathes Leïla, intern in the infectious diseases department, now dedicated to the coronavirus.
It is complicated for families to understand that it is necessary to visit their loved ones less, not to bring them, meals for example.
Unfortunately, we have a lot of elderly patients infected after a visit from their grandchildren… ”
The reinforcements needed to support caregivers
"For five weeks, all the outputs of intensive care have been replaced direct," continues Leïla.
In a month and a half, the hospital's intensive care unit took care of 120 patients compared to about fifty during the two and a half months of the first wave.
So much so that on September 21, the CHU launched an appeal for help, overwhelmed by the influx of serious patients.
Last weekend, 37 soldiers arrived on the island as reinforcements for a period of one month.
And they are now piloting a Covid unit.
"For the moment, the sizing is adapted, but we will see over the days if we need more reinforcements, and for what duration", nuance Bruno Jarrige.
A mixed military reinforcement team was sent Saturday September 26 and Sunday September 27 to Guadeloupe to support the department in managing the crisis linked to the # COVID19 pandemic.
About thirty caregivers come to support the teams at the Pointe-à-Pitre CHU.
- GILLES MOREL / SIPA
To be able to manage the second wave, the CHU had to deprogram non-urgent surgical operations by triggering the white plan on August 23.
“This redeployment is done to the detriment of our usual patient base,” regrets Bruno Jarrige.
“Thanks to the reinforcements - military, but also retired doctors and agents from a clinic - we managed this week to reprogram part of adult surgery, at least that of cancer.
Next week, I hope we will be able to do more.
"
Caregivers arrested for Covid or exhaustion
Provided that the caregivers, on the bridge for five weeks, hold out.
Because between the workload which has exploded, canceled holidays, shortened vacations, the staff of the CHU begins to be overcome by fatigue and discouragement.
“Already, in normal times, we suffer from a deficit of doctors.
So with the Covid, which requires a lot of attention and causes long hospitalizations, we are clearly understaffed, notes Leïla, the intern stationed at the CHU.
We had to recall interns who were in metropolitan France or who work in town in Guadeloupe.
"But general practitioners' offices, also overwhelmed by Covid consultations, cannot function for too long without the essential support of interns ...
Another support is the health reserve, ie around forty doctors, who rotate every two weeks.
“This allows us to share the workload,” continues Bruno Jarrige.
And above all to compensate for sick leaves, because the real problem is the absenteeism of the nursing teams.
Some have Covid, held in solitary confinement for seven days, others suffer from the consequences of fatigue.
"
Dengue fever, flu and lack of testing
Especially since it is not only the Covid that is raging on the island.
An epidemic of dengue, a disease transmitted by mosquitoes, has been declared since mid-August.
“Mosquitoes do not avoid caregivers!” Leïla quipped.
Between dengue and Covid-19, last week we had 76 agents arrested - stretcher bearers, nurses, doctors… ”
Fewer caregivers for more patients?
If the Covid seems a major challenge, dengue "remains a minor problem, nuance Bruno Jarrige.
The serotype that prevails in Guadeloupe is much less aggressive than that found in Martinique.
So this epidemic generates few hospitalizations.
»And do not saturate the resuscitation.
But Valérie Denux also warns of the possible damage of a future flu epidemic: "Even in the tropics, we have increased hospitalizations because of the flu, especially for frail people".
Second difficulty: the lack of capacity to carry out the tests.
“We are the region most affected by the Covid and the least able to carry out PCRs, regrets Bruno Jarrige.
Our CHU has half the number of machines to analyze samples than that of Martinique.
Certainly, private laboratories have machines, but they are congested by screening, to the detriment of the diagnosis [on symptomatic people].
"
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