Doctors change their tone. Measured speeches are now giving way to growing concern. Is coronavirus a good flu? “We were wrong, we must stop comparing them, recognizes Gilles Pialoux today. It is much more serious. This head of the infectious diseases department at Tenon hospital in Paris sees the number of patients jump over the course of the days. "Patients come from everywhere," he says. We are stressed! "
So, certainly, he does not want to create panic. Remember that over 80% have mild forms. "But the coronavirus does not play in the same court as the flu," he says. Without being afraid, you have to put people face to face with reality ”. What is it? That of a more contagious and deadly virus. We knew that, with 0.1% mortality for the flu, 2-3% for the coronavirus. "Of course, it's not Ebola," says Gilles Pialoux. But the Chinese have shown that a patient can be fine and suddenly, the second week, on the 8th or 10th day, he finds himself in intensive care. "
Therein lies the difficulty. The coronavirus is much more deceitful. Some have no symptoms while being contagious. Difficult to box against a sometimes invisible threat. Another concern, this time new, the profile of people admitted to intensive care is changing. Just two or three days ago, the men and women who came to these services for respiratory distress were mainly frail, elderly and already sick people. Now, they are no longer the only ones. "It is no longer rare to see young people aged 30 or 40, without pathology," says Gilles Pialoux. This is the reality on the ground. The circle widens. "
As proof, 86% of patients who died from the flu in France between 2011 and 2019 were over 75 years old, compared to 50% for the deaths of Covid-19 in China. Joined, Catherine (the first name has been changed), a nurse in a hospital, confirms: “We have young people, with no medical history, in very serious condition. In his televised address this Thursday evening, Emmanuel Macron said: "We must prepare for a second wave that will affect, a little later, younger people who are a priori less exposed to the disease but who will also need to be treated. How to explain it? The question remains. "Why some people draw the wrong card from the serious form, we don't know," concedes Gilles Pialoux.
The rescued patients "will be exhausted for six months"
When questioned, Jean-Michel Constantin, deputy secretary general of the French Society of Anesthesia and Resuscitation, put forward a hypothesis. "The explanation that I have is that the contamination is such that we end up also having critical forms in young people". He specifies that the virus is not mutating, but it is spreading quickly: "This explains why the number of people in intensive care is increasing at a rapid pace". In Ile-de-France, there were 6 Monday, against 100 Thursday.
Obviously, remember that not all the most serious patients hospitalized in these services die. The vast majority, 80%, is saved. Will they have pulmonary sequelae? "No, but they will be exhausted for six months," said the doctor. And they will have to go through a rehabilitation phase because of neuromuscular damage. "
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Another question occupies the minds. Will we be able to take care of all the patients who need it? Italy, for its part, does not succeed. "The influx is such that the lethality has increased to 6% in this country", continues Gilles Pialoux. France has 336 intensive care units, with an average of 8 beds. “We have room, reassures Jean-Michel Constantin. We don't take lessons. In fact, the health crisis on the Peninsula appeared two weeks before France. And if our neighbor was seized by the rapidity of the epidemic, hospitals in France, they had more time to organize and increase the reception capacity.
"The problem is that all the caregivers who come in for resuscitation are not trained to equip themselves, to put on protective clothing," says Catherine. It also takes a lot of people and time to take care of the sick, to intubate them, to place the catheters. For example, there must be several to turn them over on their stomachs so that their lungs are free and better oxygenated. This titanic work is not without risk.
"Let's be clear, we have to prepare for the worst"
Another problem is that Covid-19 patients remain on intensive care for 20 days on artificial ventilation. A very long period which does not allow other patients to occupy the beds. “This is the bad news in the bad news, admits Gilles Pialoux. Let's be clear, we have to prepare for the worst. "We are only at the beginning of the epidemic," the president admitted on Thursday. To the point that some doctors are now punching their fists on the table.
Eric Caumes asks for quick measures to avoid an Italian scenario. "You have to confine," exclaims the head of the infectious diseases department of the Pitié-Salpêtrière hospital in Paris, who gets carried away "against the amateurism of the government": "We are always running late . Let's stop chasing the epidemic. »Should we go so far as to quarantine all of France? "Probably," said the doctor. Anyway, we will get there. For sure. "
For her part, Catherine applauds the decision to close all the schools. For quarantine, the nurse seems to hesitate then cowardly: "Isn't it better to lose a lot of money and avoid thousands of deaths?" The answer is quickly found. "