All eyes are on this service. Resuscitation, the first front line in the war against the coronavirus, now represents the key indicator of the progression of the epidemic in France. Nationally, its accommodation capacity should be increased to 14,000 beds, the government promised on Saturday.
But the number of admissions of patients continues to increase: 359 in intensive care for the only day on Sunday, announced Jérôme Salomon, the director general of Health as the epidemic wave officially falls on France.
Can we still receive patients in intensive care?
At the start of the crisis, France had 5,000 resuscitation beds. Thanks to the deprogramming of certain operations, and with the great help of transfers of patients between regions, by rail or even by air, places have been made available in areas of high tension. According to the Minister of Health Olivier Véran, 14,000 beds will be gradually available, to cope with the rapid influx of patients.
The situation in Île-de-France illustrates the acceleration well. Friday, the Regional Health Agency (ARS) had 1,300 patients in intensive care for 1,500 beds ... already filled this Sunday: according to Public Health France, the Paris region currently has 1,570 intensive care hospitalizations.
Another flagrant indicator of the arrival of this wave, the results of screening tests. “Three days ago, 50.8% of the tests came back positive. Since then, we have reached 60.5%, ”explains the management of the Robert-Ballanger hospital in Aulnay-sous-Bois (Seine-Saint-Denis).
The same wave as in the Grand-Est?
While some regions, such as New Aquitaine, are spared for the moment, others, on the contrary, are saturated, like certain establishments in Seine-Saint-Denis and north of Paris. "We are in total red," summed up this Sunday evening Professor Romain Sonneville of the medical and infectious resuscitation service at Bichat hospital in Paris. We managed to manage the weekend, to open new sheave beds, to accommodate patients, but if it deteriorates again at the end of the week, I don't know how we are going to do it. "
A situation that could become generalized? "It is not yet saturated, but we are not far from it," confirms Professor Jean-Michel Constantin, anesthesiologist-resuscitator at Pitié-Salpêtrière in Paris. All over the territory, doctors are preparing. "I'm waiting for the wave. It is going to happen, it is coming, in the South, as elsewhere, "says Dr. Christian-Michel Arnaud, an anesthesiologist-resuscitator in a private clinic in Bayonne (Pyrénées-Atlantiques).
“We organize ourselves to face up. We are forced to transform beds in the continuing care units, in the recovery room, into resuscitation beds, ”explains the doctor. A relay of private clinics "essential", according to Jean-Michel Constantin. "We need this second line". According to the Association of Resuscitators of the private sector (ARDSP) this Sunday, 170 resuscitation beds were already occupied in private establishments.
Is it true that people over 70 are no longer admitted to intensive care?
The age of patients admitted to intensive care raises a lot of questions, especially on the "sorting" of the oldest. On Saturday, Professor Karine Lacombe, alongside the Prime Minister during a press point, said that "50% of people" are "under 58 years" in intensive care. Does this mean that the older ones are turned away? Officially, no. In Bichat, an ethics committee is now in charge of this issue. "The right term is prioritization," explains Dr. Jean-François Alexandra, its president. If a patient has to go to a react, he goes there. But we know - many studies have shown - that patients aged 80 and over, patients with comorbidities cannot withstand three weeks of resuscitation. We know that the death rate for them will be 98%. It is less a question of age than of patient frailty. Systematically placing them in intensive care can be likened to relentless therapy, which is prohibited ”.
Are there enough nursing staff?
No. On the front line, caregivers are directly affected by Covid-19, exhausted by the workload or even infected with the coronavirus. To try to relay them, the ARS in Île-de-France recently launched an appeal to active or retired health workers to help healthcare establishments. Martin Hirsch, the boss of the AP-HP (Public Assistance Hospitals of Paris) asked him for "requisitions" of staff. "We must not depopulate the establishments that will receive patients perhaps later," warns Bayonne doctor Christian-Michel Arnaud, however. The government called on the health reserve, "which is enriched by 1000 people a day," assured Olivier Véran on Saturday. “This is the number one problem in shortages. Because if you do not have caregivers, to turn the respirators it is useless ”, breathes Professor Constantine.
Is there a shortage of anesthetic drugs?
"We are in great tension", cowardly, serious, Jean-Michel Constantin. “We are starting to run out of sedatives, such as curare, used to put people with severe respiratory insufficiency to sleep, and this concerns very many patients. There is also a lack of hypnotics, such as morphine, which also help you sleep, ”notes Dr. Lionel Liron, president of the ADRSP, association of resuscitators in the private sector.
Newsletter - The essentials of the news
Every morning, the news seen by Le ParisienI'm registering
Your email address is collected by Le Parisien to allow you to receive our news and commercial offers. Find out more
And if it is urgent to preserve the remaining stocks, it is because without them, it is impossible to ventilate. And therefore to save lives. “They allow patients to support the ventilator, make them sleep, or even block muscles. Without them, there is nothing we can do, ”says Jean-Michel Constantin.
To avoid rupture, a group of anesthetists-resuscitators from the AP-HP has developed a text, which "explains in detail the good principles of economy" of these "precious products", announced Professor Bruno Riou, head resuscitation service at Pitié Salpêtrière during a press briefing.
Do we have enough respirators?
No, according to Patrick Pelloux, emergency doctor. “This is the crux of the problem. Instead of making spectacular trips, the government should focus on respirators, ”he says. According to the government, which claims to have placed an order for 1,000 devices with the manufacturer Air Liquide, the demand for ventilators, which allow relays of the lungs to supply oxygen to the blood, has increased "by 2000%" since the start of the crisis .