Illustration of a caregiver in intensive care at the Pellegrin hospital in Bordeaux.
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UGO AMEZ / SIPA
The president announced a curfew on Wednesday evening from 9 p.m. to 6 a.m. in Ile-de-France and in eight French metropolises,
from Saturday
,
to fight the second wave of coronavirus.
A measure with serious consequences for citizens and for the economy, but which should help relieve hospitals in tension.
And which has proven itself in Guyana, underlined Emmanuel Macron.
20 Minutes
wanted to know more
with caregivers.
So it will be métro-boulot-dodo.
By avoiding the hosto box.
From Saturday 9 p.m., and for a month, all the inhabitants of Ile-de-France and eight metropolises where the signals have turned red on the Covid-19 side will have to stay at home every evening, until 6 a.m.
One way to avoid congestion in hospitals.
"The virus is everywhere in France," said Emmanuel Macron on Wednesday evening on TF1 and France 2, specifying that the caregivers were "very tired" and that there were "no beds in reserve".
Avoid overloading intensive care units
An inescapable decision for Bruno Megarbane, head of the medical and toxicological resuscitation service at Lariboisière hospital (Assistance Publique-Hôpitaux de Paris).
“Despite the barrier gestures, the masks outdoors, the closures of bars, the progression of contaminations continues, regrets the resuscitator.
A stricter measure was needed.
“In fact, for the past three weeks, we have seen the number of admissions to emergency rooms and sheaves increasing.
"We have 1,600 resuscitation beds occupied out of the 5,000 in France," continues the resuscitator.
And in Ile-de-France, we are at 45% occupancy rate by Covid patients.
The modulations suggest that we will be at 100% by mid-November.
However, each winter, we have 100% of our beds taken by seasonal viruses.
So we would have to double our capacities, which is impossible.
"
And the resuscitator reminded that winter is the season when chronic patients decompensate the most and where hospitalizations for flu and other pneumonia are numerous.
To face this second wave of the coronavirus, we have the advantage of a better knowledge of the disease.
But three black spots remain on the board.
On the one hand, an exhausted nursing staff, the president himself recognized during his speech on Wednesday.
A party also scrolls this Thursday to ask for more resources.
In response, Jean Castex announced that the general salary increase of 93 euros net for paramedics will finally be paid "before the end of the year" rather than in March 2021 as initially planned.
Second problem: the flu epidemic.
"In March, it was over while there, everything will overlap, and there may even be patients who suffer from both diseases", warns Bruno Megarbane.
Not to mention all the other serious patients.
"The more Covid patients we have in intensive care, the less we can do scheduled surgery, take care of cancers, in particular, do all the rest of medicine which is important," recalls Pierre Parneix, public health doctor at the Bordeaux University Hospital. .
Last pitfall, transfers.
Carried out in March and April for Covid patients, they will be very complicated to set up, because unfortunately, the epidemic is affecting the whole territory this time.
In addition, usually in winter, “when all the beds are full in Ile-de-France, patients are sent to other services in the region.
», Explains Bruno Megarbane.
It will be difficult this year.
"This anticipatory measure should act in two weeks on the contaminations, and it will be necessary to wait another fortnight to see hospital admissions drop," continues the doctor.
And two more weeks to see less saturation of the sheaves.
Because more serious cases generally stay three weeks in intensive care.
"The six weeks of curfew envisaged by Emmanuel Macron therefore do not seem unreasonable ...
Reduce contamination in the private sphere
Why have imposed the end of nighttime social life and only "encouraged" teleworking?
It would be a way of targeting the private sphere, which is difficult to monitor… "Most of the contamination occurs inside family reunions," assures Bruno Megarbane.
We realize this in our services, because people who arrive in sheaves are generally retired, have not gone to the bar or restaurant, so they could only have been infected by the family.
However, if we are to believe the figures of Public Health France, nearly half of the clusters are located in companies and schools.
“But family clusters are neither identified nor traced,” he analyzes.
For Pierre Perneix, an expert from the Mission who has just submitted a progress report on the management of Covid-19, only the future will be able to tell if this solution is the right one.
“What is aimed at is to reduce private parties, which are factors of transmission currently identified.
»Provided that citizens do not transform the evening at the bar into a pajama party…
The Guyanese example, a proof of effectiveness?
The president relied on the Guyanese example to praise the effectiveness of a curfew.
Indeed, since March, this French region has experienced several versions of the curfew.
Started at 9 p.m., it was brought forward from 5 p.m. when the epidemic was circulating a lot ... A study published on October 12 and carried out by Inserm, the Pasteur Institute and the CNRS seems to prove that the extended curfew has borne fruit.
"We find that the combination of these interventions reduced the basic reproduction number of SARS-CoV-2 from 1.7 to 1.1, which was enough to avoid the saturation of hospitals," summarizes the study.
But experts point to a set of measures, because the curfew was not the only restriction in Guyana: the region experienced total containment from mid-March to May 11 and the closure of borders after that date.
“It is a territory that cannot be compared to France, nuance Pierre Perneix.
Because there is a difference in weather, density, demography… ”Remember that this overseas department is located in the southern hemisphere and that half of the population is under 25 years old.
It is therefore difficult to conclude that this measure will be as effective in a city like Paris ...
A lack of beds?
These dead cities that we are about to find in the evening are the result of decades of savings in the hospital, believe some caregivers.
“We feel that the president understood the seriousness of the crisis, but does not take the measure of the hospital crisis.
And we must paralyze the country because hospitals lack beds ", was annoyed Patrick Pelloux, president of the Association of emergency physicians of France (Amuf), interviewed by AFP.
A shortcut for Bruno Megarbane.
“
Covid 19 is a serious disease, the solution is not only to increase capacity, we must also avoid catching it.
We must act on two levels: reduce contamination to have a lower number of serious forms and give hospitals the means to manage the second wave.
"
How? 'Or' What ?
The resuscitator hopes the beds will reopen, or at least their stabilization.
“Ségur only solved the problem, certainly important but short-term, the easiest to solve: increasing wages.
In March-April, we said to ourselves that no one would think of reducing the number of beds in sheaves and in June, I heard the same litany about savings.
The directors were always in the idea that there would be no rebound.
Now that the second wave is here, I hope we will change our strategy.
"For his part, Pierre Pernaix, public health doctor, has few illusions:" tomorrow we will not go to 10,000 beds of sheaves in a sustainable manner, 80% of which are empty, because that would not be profitable.
The question is rather: how to maintain a sanitary reserve capable of reacting in the event of a crisis?
"
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