We hear her violent fits of coughing before seeing her. Nancy Bamba, a 28-year-old woman, arrives Tuesday, April 7 at the reception of the Covid-19 consultation center, located in the Simone Veil area of ​​Nogent-sur-Marne, east of Paris.

"My attending physician sent me here because I have had worrisome symptoms for ten days. I cough and have terrible aches. In the past, I had caught malaria in Côte d'Ivoire ... But the tiredness that I feel today is much worse, it is as if I had taken all my energy away. Yesterday I had a fever of 39.4 ° C ", details the young woman visibly weakened, between two fits of cough . "As I also have a kidney problem, I'm really scared".

Nancy Bamba during her consultation at the Covid-19 center in Nogent-sur-Marne. The young woman organized to isolate herself from her own family by "requisitioning" the children's room. Her husband puts food on her doorstep every day. Mehdi Chebil

After receiving a surgical mask and cleaning her hands with hydroalcoholic gel, Nancy Bamba settles in a large, almost empty waiting room of more than 100 square meters, with chairs about two meters apart. others. Large mirrors installed on a whole section of the wall remind us that this place was home to many dance lessons before the crisis.

More than 400 people with worrying symptoms have been received here since the opening of the Covid-19 center at the end of March, after being sent by their doctor or the Samu. A municipal police officer outside the building checks that only people with an appointment enter the Covid-19 center.

After a short wait, Nancy Bamba enters a smaller room where a doctor and two nurses are waiting for her. The latter are activated immediately around the young woman to take in a few minutes her temperature, her blood pressure, and her oxygen saturation level in the blood. This last fact is crucial in the fight against Covid-19 because it can signal a respiratory risk, including in patients who do not feel discomfort in the lungs.

The nurses check the vital constants of 67-year-old Chantal, Nogentaise. Mehdi Chebil

The doctor begins with a series of questions about symptoms and possible pre-existing pathologies, before using his stethoscope to listen to the patient's breathing. A consultation quite banal, if we disregard the fact that caregivers all wear a complete protection kit - mask, gloves, glasses, charlotte, overcoat and overshoes. All instruments and the examination table are meticulously disinfected between two consultations.

Reinforcement teleconsultation

Precautions also valid in the next room, which is dedicated to teleconsultations. The brothers Pascal and Benoît Bonnet, city doctors in Nogent-sur-Marne, are alone in front of a screen, in communication with a patient whose image appears in a small window.

From a distance, the patient is subjected to the breath test, which consists of seeing how much one can count without breathing.

"This patient was able to count to 15, which is better than the last time, when she was 11. A person who is not able to count to 5 - 6 by holding her breath, it would be more worrying ", explains doctor Benoît Bonnet.

Teleconsultation is particularly useful for Covid-19 monitoring of patients that doctors have already seen. Full protective clothing is necessary because this teleconsultation room is inside the Covid-19 center. Computers were provided by the town hall of Nogent S / M Mehdi Chebil

Few doctors are in principle in favor of teleconsultation, but the emergency context, the impossibility of certain patients to move, and especially the fact of using this tool to follow their patients has overcome reluctance.

"These are means that we have experimented with empirically and it is quite reliable. You have to go quickly and be efficient in discharging the Samu and emergencies", explains doctor Benoît Bonnet.

A center to "avoid a crisis in the crisis"

The macabre daily count of victims of the coronavirus - more than 10,000 dead in France on April 7 - and the intensive work of the resuscitation services occupy the fore. Official figures show as of this date nearly 80,000 people tested positive for Covid-19.

But the reality of the epidemic is that far more people have the symptoms of this disease. In the current anxiety-provoking climate, many are afraid to go to see their doctor or to call the Samu, for fear of being "not sick enough" to mobilize emergency services in full overheating. Worse still, elderly people prefer not to call despite worrying symptoms because they are convinced - wrongly according to doctors - that there is no therapeutic path for them.

It was to deal with this crisis situation that local doctors, organized through the local professional healthcare community, launched the project for a Covid-19 ambulatory consultation center. The mayor of Nogent-sur-Marne, Jacques JP Martin, immediately responded to their call by providing them with the Simone Veil space, a vast brand new room, with a ramp for wheelchairs, which normally houses the House of associations.

The large waiting room at the Covid-19 center in Nogent-sur-Marne. Alexandre and Chantal are a couple who live together but, worried about symptoms compatible with the Covid-19, they try to keep their distance from each other. Mehdi Chebil

Several dozen similar initiatives, supported by local authorities and the Regional Health Agency, have emerged in the Paris region. The watchword is the same everywhere: mobilization, solidarity, and doing your part in the fight against the epidemic.

"The goal is to unclog emergencies by sorting out in our center the patients who need care in the hospital and those who have weaker symptoms. This is called separating the "hot" and "cold" flows and this is essential in the current crisis ", explains doctor Frédéric Thibault, project coordinator of the Covid-19 center in Nogent-sur-Marne.

With an absolute requirement: the safety of caregivers and patients. Which was not won in advance in the current shortage situation.

"When you are used to doing surgery with robots that cost a fortune, you can't imagine having to fight one day for hydroalcoholic gel!" Exclaims doctor Thibault, pointing to a "cubi "of 20 liters of artisanal gel supplied by a local pharmacist.

Doctor Frédéric Thibault, coordinator of the Covid-19 consultation center in Nogent-sur-Marne. Mehdi Chebil

"Starting from scratch, having to solve problems very quickly, today gives me the impression of being on a mission," added the doctor, who has worked in the past on humanitarian projects in Afghanistan, at Bangladesh, or even on the Syrian-Jordanian border.

Local solidarity and the D system have indeed played to the full. The protective overcoats, charlottes and overshoes were thus provided by school canteens in Nogent-sur-Marne. The anti-projection visors were sent by Shields, a network of volunteers equipped with 3D printers. The heavy examination tables were loaned by a physiotherapist.

As for masks, the center initially received 200 FFP2 masks for caregivers from ARS - enough to last five days - and 4,000 surgical masks. As everywhere, the hunt for FFP2 masks is in full swing and everyone is active to collect donations from their personal networks. Companies, individuals in business relationship with China, widows of doctors who find the kits issued in anticipation of H1N1 in 2009 ... All plans are good to take.

The mobilized nurses also have a key role, by disinfecting the instruments and the examination table after each patient. Mehdi Chebil

"Fortunately, I had kept the equipment I used when I was an emergency doctor," said Dr. Anne-Marie Bénéteau-Bechara, one of the initiators of the center, whose office is located in Nogent-sur-Marne. "I was able to bring my ECG device, which is used to monitor the electrical activity of the heart, the saturometer to check the oxygen level in the blood, and armbands of several sizes to take the blood pressure," added the doctor.

The frustration of not having a cure

To the coping of each other is added a strict organization. The caregivers' vacations are limited to three hours to ensure that their concentration is always maximum, the patients are always few in the large waiting room, and their journey in the premises is signposted so that they do not not cross in the corridors.

The Covid-19 consultation center operates thanks to a huge surge of solidarity. Élisabeth Bossetti is one of the volunteers who receive the phone calls and manage the reception of the center. Mehdi Chebil

It is precisely at the exit door of the consultation room that we find Nancy Bamba. The doctor told her that her exam did not show a lung infection and the young woman is sent home with a prescription for paracetamol.

"I was told that I did have Covid-19 symptoms and I was offered a teleconsultation in three days to reassess my situation. I was already taking Doliprane and I was not offered a screening test or other solutions, "says the patient, a little disappointed.

The doctors at the Covid-19 center are regularly confronted with this request for tests, but they can only perform them in very specific cases: for nursing staff, pregnant women and people with breathing difficulties or certain chronic diseases.

These strict rules, which apply throughout France, are reinforced by the distrust of doctors at the center with regard to the nasopharyngeal test, by sampling from the nose. According to them, this test gives a high proportion of false negatives. A result which can have dramatic consequences: a patient believing himself not to be sick with Covid-19 risks lowering his guard when he is actually contagious.

Doctor Pascaline Mourey examines Christian Edimo, a 47-year-old man who presents with several symptoms of Covid-19 Mehdi Chebil

"We explain to patients that there is no effective treatment for the new coronavirus all day long, it's very frustrating for us", explains doctor Pascaline Mourey, general practitioner in Bry-sur-Marne, after a consultation at the Covid-19 center. "When a patient is less well, we try to determine when to send him to the hospital, knowing that we should not do it too early in this period of health crisis"

Out of around 50 patients seen every day, around five or six people are transferred from the Covid-19 center to the hospital. A sorting job that gives a breath of fresh air to the Samu and the emergencies during this period of overheating.

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