A “race against the clock” against the coronavirus is underway in Ile-de-France. With the acceleration of the Covid-19 epidemic in the region, "we are entering a phase of great concern", recognizes the director general of the regional health agency Aurélien Rousseau. In an interview with the Parisian-Today in France, he presents the system put in place to deal with the increase in serious cases and underlines the decisive impact of confinement.
The milestone of a thousand intensive care hospitalizations has been crossed in Ile-de-France. How many beds remain available?
AURÉLIEN ROUSSEAU. Tuesday evening, we had an acceleration in the curve of the number of patients, with 150 more resuscitations in a single day: figures that make you dizzy. The scale of the challenges is completely new. It's a tough battle. I hope we will win it. We are doing everything for, but we are entering a phase of great concern. Today, we are able to treat 1,300 to 1,500 Covid patients in intensive care. We expect 800 more beds than our initial capacity of 1,200 beds. We know that we have a few days of capacity ahead of us. We mobilize the private and the public to win a few hundred additional beds. Our hope is that from the beginning of next week the curve of the number of cases will slow down. It is a race against the clock: mobilization is maximum, because concern is maximum.
Is the progression comparable to that experienced in Italy?
No, we cannot project the typology of patients, for example. In Italy, the elderly were the first affected, then the young. Here, from the start, there have been young and old. The lengths of stays in intensive care are not the same either. But what is constant is the progression which first appears linear then, suddenly, exponential. And it's very hard to predict when it will slow down: the most decisive element is the impact of confinement. Simulations show us just how much: if a contaminated person sees 0.8 other people per day instead of 1.2, that reduces the number of beds in intensive care by 1000.
The question is not limited to resuscitation beds…
No, this impacts the entire offer, with a domino effect to accommodate patients in post-intensive care, follow-up care for those who were in medical beds ... From upstream to downstream, everyone is mobilized.
Did the call for volunteers launched by ARS on Friday bear fruit?
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Today, 1,200 requests for reinforcements have been made and nearly 1,000 requests are being filled: 6,200 volunteers have registered, 1,800 nurses, 1,000 caregivers, 1,000 doctors, 300 stretcher bearers, 180 paramedics ... The system works, but we have to go further on, our need for human resources is long-term, we know that we will have sick caregivers. Human resources are the heart of our battle: we can push the walls, but we cannot replace the intelligence or the know-how of a caregiver.
Which professionals do you particularly need?
Those who will intervene in resuscitation, these are rare skills. Those who come forward will be accompanied in training, other reinforcements will come from the medical beds to the intensive care beds. You have to keep in mind that people are not going to be called upon for their core competence. Surgeons have agreed to take up nursing duties.
How to meet the need for equipment, drugs?
The nerve of this battle is also the respirators. To receive 2000 patients in intensive care, corresponding staff, 2000 respirators and medicines are required. We are on new volumes. We will appeal to national solidarity in terms of drugs. We hope that once the peak is reached, we will be in support of other regions in difficulty.
Are private hospitals playing the game enough? We hear that there are empty beds that are not available…
Yes, I consider that private hospitals and Espic (private non-profit, Editor's note) play the game, even if some people thought that too few patients were sent to them at first. Today, their capacities are widely used, but they will have to go even further in mobilizing their means to contribute to the collective effort, by personnel or equipment such as respirators. We will move personnel or equipment where it will be the fastest.
Are “load shedding” from Ile de France on other regions envisaged?
It would be a measure of last resort. I am not saying that we will not do it, but my priority is to go to the end of capacity in Ile-de-France, we have the first CHU in Europe… The goal is not to weigh pressure on other regions, which will also have to receive other patients.
How do you follow the progress of the epidemic in the Ehpad, accommodation establishments for dependent elderly people?
We have been following her extremely closely for several weeks with the decisions taken, such as the prohibition of visits, the separation of flows, with areas of isolation when a Covid case is confirmed. We gave strong instructions yesterday in this direction. At the Ehpad Rotschild, an ARS team went on site to help set up an action plan, hygiene measures and psychological support. When we saw the situation deteriorate this weekend, we delivered a lot of masks in an emergency. I told all the directors of the Ehpad that if they had any need to finance improvements, the ARS would take care of them. We are in the process of setting up a medical device to support coordinating doctors, in particular, who will deal with increasingly heavy cases, with palliative care issues, we cannot leave the caregivers or the staff Ehpad heads-up with a progressing epidemic. We must be able to be in support, on the spot, in support of medical advice.
Are foreign or provincial reinforcements planned?
Not at this stage. We are experiencing, after our comrades in the Grand-Est, a major shock, with even greater volumes, and we know that the other regions will also be affected, but we hope with as much delay as possible. There is no question of siphoning the doctors or transferring our patients. We may need occasional reinforcements, but they must be able to return to their region when it is affected.
What lessons have been learned from the Grand Est?
We have daily discussions with our colleagues in the Grand Est, and doctors have been sent there to get feedback. Concretely, this prompted us to set up small training modules for back-up volunteers, in the form of tutorials prepared by hospitals. To set up also a cell of help and psychological support for the carers and the staff of Ehpad, for a few days. The experience of the Grand Est allows us to check whether we should intensify vigilance on a particular aspect.
Can you tell if there will be masks for everyone tomorrow?
No, not everyone will have a mask in the country. The resource in masks being limited, as in everyone, it is necessary to assign them in priority to those who take care of the Covid patients, in hospitals, nursing homes, city doctors, for home helpers. For the rest of the population, we have barrier gestures and containment, the effectiveness of which is widely proven.
Wasn't the departure of Ile-de-France residents in the provinces a benefit for hospitals in Ile-de-France?
It is very difficult to assess. I cannot say that it is a benefit and if the virus spreads elsewhere, it cannot be the source of any relief. My fear is that these departures have contributed to spreading the virus more quickly elsewhere. And let's not forget that the capacity to take charge rests on the fact that not all regions are affected at the same time.
Is the creation of town medicine hotlines planned to accommodate people who fear being contaminated?
Yes, there will be around sixty centers dedicated to Covid which allow for a flow of care so that patients do not frequent the usual and sick offices on a daily basis. We have calibrated this with the Regional Union of Health Professionals and Health Insurance to fix the terms of remuneration. But all of this must be coordinated to ensure that health professionals are in the best possible situation to provide these consultations.