Doctors at the new Strasbourg civilian hospital, October 22, 2020. -

Jean-Francois Badias / AP / SIPA

The growing influx of Covid-19 patients in intensive care units is forcing hospitals to postpone more and more surgical and medical activities, under the control of regional health agencies (ARS) who ask them to "arm" more and more critical care beds.

The hospital may have been treating "whatever the cost" for several months, there are still no magic beds.

To accommodate thousands of additional intensive care patients, operations and consultations must be “deprogrammed” on a massive scale.

A "white plan" to strengthen the workforce

A set of communicating vessels which allows each public or private establishment - after triggering its "white plan" - to collect qualified personnel in order to strengthen its critical care services (resuscitation, intensive care and continuous monitoring, depending on the level of gravity).

Until last week, the doctrine varied from one region to another, with ARS asking for the uniform activation of “white plans”, others only in certain territories, even referring the decision to hospitals and clinics.

The goal is to free up beds for places in intensive care

Olivier Véran finally asked at the end of October all the directors of establishments to "start without waiting (...) the first levels of deprogramming", or to move to "higher levels" in the regions "most in tension" by "deprogramming all activities (…) that can be ”- except for cancer, transplants,“ urgent care ”and psychiatry.

The Minister of Health thus wanted "to reach the maximum capacities as quickly as possible" in resuscitation beds.

Their number, already raised from 5,100 to 5,800 after the first epidemic wave, rose to 6,400 in early November and was expected to reach 7,500 this week, according to the government.

More than half (4,321) was occupied on Friday by coronavirus patients and at least 6,000 are expected in mid-November in the best case, according to projections by the Institut Pasteur.

A peak at 7,148 people in intensive care in April

To treat these patients without neglecting the others, Emmanuel Macron announced that resuscitation capacities would be increased to 10,000 beds, as in the first wave - which peaked at 7,148 patients with Covid-19 in intensive care on April 8.

In Auvergne-Rhône-Alpes, the epicenter of the second wave, they have already almost doubled, from 550 to “around 1,000 equipped beds” according to the ARS, which set the target at 1,200 in the coming weeks.

As early as October, even before the minister's instructions, she had called on all establishments in the region to "deprogram all non-urgent surgical activities without loss of proven short-term opportunity".

25% to 60% of postponed activities in hospitals

Questioned Friday, the administration was however "not able to say what is the deprogramming rate" in the region, even if "to [his] knowledge, all the establishments contribute" to the effort.

Same thing in Occitania, passed from 478 to 640 beds “armed” in intensive care, but where the ARS “does not have stabilized figures” on deprogramming on Friday.

The Toulouse University Hospital was for its part “around 25 to 30%” of activities postponed, according to its general manager Marc Penaud, who estimated during a press point that this rate was “not high”, in any case "Much less than in some large university hospitals".

At Marseille Hospitals (AP-HM), this proportion was in fact around two-thirds on Thursday, with only 30 operating theaters still open out of 90. Ditto in Toulon, where 60% of operations will be postponed from Monday .

All regions are concerned

The Provence-Alpes-Côte d'Azur region has already gone from 450 to 760 resuscitation beds and the ARS started the fight on Friday, with "a deprogramming of non-urgent medico-surgical activities" to increase to 850 beds.

In Ile-de-France, "the regional average of deprogramming (was) of 35%" Wednesday, according to the ARS, which targeted 1,775 beds at the end of the week against about 1,200 in normal times.

In Normandy also “30% of activities have been deprogrammed”, going from 238 to 335 beds, while in Hauts-de-France, resuscitation capacities have been increased from 460 to 700 beds and must still rise to 800 beds. .

Even in Nouvelle-Aquitaine, which has been rather spared until now, "the hospital situation requires the initiation of deprogramming", explained the ARS this week, while ensuring that these decisions "will be targeted, proportionate and adapted".

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