Illustration of a hospital department where patients are tested for Covid-19.

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AFP

  • While the resuscitation services in public hospitals are already under strain and November promises to be particularly difficult, there is still good news.

  • Private and public seem to work together better to deal with this second wave.

  • Because to go from 5,800 to 10,000 intensive care beds without deprogramming all operations, it will be necessary to rely on solidarity, reorganization and significant responsiveness of caregivers in the public and private sectors.

The death and hospitalization indicators have been going crazy for a week.

To the point that public hospitals in general, and intensive care units in particular, fear that they will not be able to cope with an exponential influx for a long time, without avoiding a dramatic sorting out between patients.

What the President of the Republic made clear in his televised address Wednesday evening.

"The second wave will undoubtedly be more deadly than the first", warned Emmanuel Macron, announcing a new confinement of at least a month.

If this new ordeal promises to be arduous and long for public caregivers, they can, this time, count on their colleagues in the private sector.

One of the rare glimmers of hope ...

The private sector little used at the start of the first wave ...

According to figures from last Wednesday from the Federation of Private Clinics and Hospitals of France (FHP), 2,185 Covid patients are currently being taken care of by the private sector, including 285 in intensive care.

This is more than last March.

Because during the first wave, at least at the beginning, the dialogue did not always work well.

“The government's doctrine in February was clear: only public hospitals were able to take care of Covid patients,” recalls Lamine Gharbi, president of the FHP.

In practice, when a patient arrived at our home for a Covid, knowing that we had no tests, we were instructed to "pack" him and send him to the University Hospital Center (CHU).

We served as a letterbox!

In March, when some hospitals found themselves saturated in the Grand-Est, they did not have the reflex to appeal to the private sector.

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Confirmation from Montauban, where Claude Porcher directs the Pont de Chaume clinic (Elsan).

A private establishment with 350 beds, more than 500 employees, a hundred doctors and receives 78,000 patients per year.

“Our experience feedback on the organization of the first wave is that we were ready to welcome patients and in all, we received less than 15!

Some of which were transferred by plane from the Grand-Est, while private establishments in Ile-de-France remained empty… I hope that lessons have been learned from the first wave.

"

... but mobilized for this second wave

This is the case, if we are to believe Lamine Gharbi, who notes an improvement in cooperation between public and private.

Some hospitals send patients to clinics… and vice versa.

All without the patient spending a penny.

“The lessons have been learned: the public and the private sector have learned to know each other better and to work together”, assures Lamine Gharbi.

"This time, the order of the ARS was clear: all hospitals keep patients in their region", confirms Julien Amour, intensive care anesthesiologist

at the Jacques Cartier private hospital (Ramsay Santé).

Even if this dialogue fluctuates according to the regions and the regional health agencies… In Montauban, a scarlet town on the map of France in terms of indicators, Claude Porcher assures us that this cooperation works… and that it is essential.

“Currently, I have 21 Covid patients, including 7 in sheaves.

We arranged for the hospital to open new beds on Monday and my clinic to 6 resuscitation beds, plus 15 medicine beds to receive Covid patients.

Thanks to this coordination, we divide the actions to be carried out.

For her, cooperation existed during the first wave, but it has been amplified.

“Faced with the influx of patients, we have set up a weekly video commission to graduate the deprogramming and the opening of sheaves with the Montauban hospital.

It is our coordination that is the strength of the response in our territory.

And the director to take for example the imminent arrival of two nurses from a clinic specializing in ophthalmology in Agen of the Elsan group.

But there are still a few small hiccups.

This week, Covid patients from Gard were sent to Brittany ... forgetting once again to contact nearby clinics.

An exception, wants to believe Lamine Gharbi.

Several changes compared to the first wave

Counting on private sheave and medicine beds is therefore an asset, while this second wave of Covid-19 differs from the first in several aspects.

The caregivers are exhausted by the first wave, some have resigned (20% of paramedics in Ile-de-France ...), others are sick with Covid-19 or other diseases.

"What sets this new wave apart is first of all the desire to limit as much as possible the impact of deprogramming on the care of other patients," underlines Lamine Gharbi.

This is a public health issue, even if it considerably limits the human and material resources that can be mobilized.

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“We went to level 4 on Thursday, which means almost total deprogramming of operations.

We are trying, in consultation with the ARS and therefore the Montauban hospital, to manage not only Covid patients but also our urgent patients, in particular with cancer, illustrates Claude Porcher.

The human resources problem, we all have it!

Julien Amour confirms that this time the doctrine has changed.

The medical resuscitation of his clinic is solely dedicated to Covid and has gone from 15 to 22 beds.

On the other hand, he tries to keep his surgical resuscitation open to other patients.

“There were a lot of deaths of heart attack patients, infections of the heart, stomach, sometimes young during the first wave.

We try not to reproduce this drift, but it's not easy… ”

A homogeneous contagion

On the other hand, the current wave is hitting the national territory more globally, while three regions were mainly concerned in the spring.

This very severe and homogeneous second wave therefore limits the possibility of transferring patients from one region to another.

In addition, the lack of caregivers may be more glaring this time, because the epidemic is affecting medical deserts, while Ile-de-France like Grand-Est were rather well endowed.

Will this mutual aid be enough?

Emmanuel Macron announced Wednesday evening that France was able to go from 5,800 intensive care beds to 10,000.

"I was a bit of a husband that the president did not mention the private sector," recognizes Lamine Gharbi.

But I'm not worried, we already provide more than 20% of Covid patients in intensive care, we can go up to 30%, "he reassures.

Julien Amour is much more dubious.

“In our clinic, we are already at 70% of medical intensive care.

However, today, we return two Covid patients per day to the emergency room.

Resuscitation and continuing care services in Ile-de-France, public and private, are 82% full on average.

This confinement seems to me quite late ... "

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