In intensive care, doctors worry about having to "sort" patients (Illustration) -

FRED SCHEIBER / SIPA

  • Nearly 1,500 patients are currently in intensive care in Ile-de-France, against 2,800 during the first wave.

  • In several forums, doctors from the Assistance publique-Hôpitaux de Paris are worried about having to sort patients.

  • Hospitals in the Ile-de-France can no longer count on reinforcements from all over France.

Until Thursday, Professor Djillali Annane, head of the intensive care unit at Raymond-Poincaré hospital in Garches, in Hauts-de-Seine, refused five patients with a severe form of Covid-19 daily.

And as soon as a bed became available, it was reassigned "within the hour".

But since Friday, the phone has not ringed.

No admission request in three days.

“It's really very surprising, admits the practitioner.

I am unable to tell you if a recession is starting, if we are in the eye of the storm or if it is simply a problem of referral of patients.

But the result is there: in his department, there are now four critical care beds and three vacant critical care out of 25 in total.

At the regional level, however, the health situation is extremely worrying: nearly 1,500 “Covid +” patients are in intensive care in Ile-de-France.

This is certainly almost half as much as last year (2,800 in April 2020), but the peak has not yet been reached and concerns are growing.

This weekend, 41 medical directors of the Public Assistance-Hospitals of Paris (AP-HP) signed a column in the

Sunday Journal

to ask for a tightening of containment.

"We will be forced to sort the patients in order to save as many lives as possible", warn the signatories.

“The current situation tends towards a prioritization, otherwise called 'sorting', which consists, when there is only one resuscitation bed available but that two patients can benefit from it, to decide which one will be admitted (and will perhaps survive ) and which will not be admitted (and will die quite probably) ”, add nine other doctors of the AP-HP in a forum in

Le Monde on

Monday.

Respirators ... but not enough staff

If such warnings had been given last year, they had never been so strong when the figures were however more worrying.

"The situation is very different: during the first wave our main fear was the lack of equipment, especially respirators, today it is the staff that is lacking", notes Frédéric Valletoux, president of the Hospital Federation of France.

Last spring, caregivers flocked from all over France to Ile-de-France and the Grand-Est, the two epicenters of the epidemic, to lend a hand to their overwhelmed colleagues.

At the time, France was "cut" in two, the North and the East were crumbling under cases, the South and the West were relatively spared.

Today, if the West remains less affected, the situation is nevertheless worrying.

Especially since unlike the first wave, deprogramming only affects critical areas.

“Last spring, we found ourselves, in some regions, with slow-moving hospitals waiting for patients,” recalls Frédéric Valletoux.

“Classic” activity is now buoyant, especially as not all hospitals have made up for the delays accumulated during this first wave.

In the red zones, on the other hand, all internal resources are mobilized to "equip" new beds.

In Ile-de-France, 40% of interventions have been deprogrammed and the objective is to reach 80% within a few days.

Prioritization, a daily practice

What about patient transfers?

Two weeks ago, the government announced the transfer of several hundred patients to less affected regions.

Last March, they had made it possible to relieve the Ile-de-France hospitals on the “edge of the abyss”, in the words of the then director of the Ile-de-France Regional Health Agency, Aurélien Rousseau.

Today, however, the device is struggling to find candidates for departure: only a hundred patients from Ile-de-France could be transferred this month, families often opposing such a transfer.

Our file on the coronavirus

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Are we therefore moving inexorably towards a “sorting” of patients?

Father Djillali Annane, who did not sign either of these two forums, regrets this term and prefers to speak of “prioritization”.

"Balancing the benefits and the risks of a stay in intensive care, where the treatments are very heavy, is part of our training," he insists.

We are not improvising, each year we have periods of great tension during which we have to assess, patient by patient, the situation.

»Age, comorbidities, loss of autonomy… are all factors that come into play.

On the other hand, this fervent defender of the “Zero Covid” strategy who has been arguing for a much harsher confinement for many weeks recognizes that an uncontrolled influx of patients will result in excess mortality.

“The quality of the care will always guide our choices, but mathematically, if the influx is too large, it will have consequences.

"

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