“At least we were not asked to give up our vacation, while exhaustion wins the teams.
".
It is with this little touch of irony that certain doctors welcome the new directives which have just been transmitted to them.
On Friday March 12, the Directorate General for Health (DGS) and the Directorate General for the Provision of Care (DGOS) sent an internal memo to the regional health agencies and hospitals, entitled "Organization of the healthcare offer in forecast of a new epidemic wave ”.
With the desire to anticipate any risk of a possible epidemic outbreak.
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This circular was indeed transmitted in a very particular period.
If the figures of the epidemic do not reveal at this stage of the beginning of the third wave, on the contrary, the fact remains that the spread of the variants in the country is causing concern.
Revealed by Le Journal du dimanche, the document, which Le Parisien also obtained, lists a series of measures to be implemented by Thursday, February 18.
This, in principle, guarantees the most effective possible care of Covid-19 patients in the event that the number of patients to be taken care of should increase substantially.
But which in reality does not act as a revolution, according to the professionals we interviewed.
Crisis cells and reinforcements
These measures must be implemented in all territories, specifies the circular.
First and foremost, it is for health establishments to be ready to mobilize as many beds as possible in intensive care units, by activating or maintaining “internal mobilization plans”.
With, as a final step, the possibility for hospitals to initiate the White Plan, already used during the two previous waves.
“For the ARS, it is about strengthening the Regional Health Support and Steering Unit (CRAPS), reactivating the
bed management unit
and identifying a regional coordination Samu”, specifies the ARS Ile-de. - France, specifying not to have waited for ministerial requests to prepare.
“These measures had already been in place for a few weeks and we had asked the health establishments to activate their crisis unit and to bring them together to anticipate the measures to be taken, in the event of a possible third wave.
"
Another point mentioned in the circular: the sensitive issue of deprogramming.
Institutions are therefore invited to prepare deprogramming “graduated and adapted” to needs.
It is therefore up to the ARS to set up "research and monitoring units for available resuscitation beds".
The fact remains that, here again, ARS Ile-de-France, to name just one, tells us that it has "already reactivated its HR reinforcement unit to identify the needs of establishments".
"You don't need a flyer for that"
As for deprogramming, they are already a reality in the region, and to date around 10%.
To promote outings, caregivers should ensure that they favor outpatient care as well as home treatment.
“It's a bit of a non-event, tempers Benjamin Davido, infectious disease specialist at Garches hospital (Hauts-de-Seine).
The situations vary according to the hospitals, but the resuscitation services already oscillate between 60 and 80% of Covid occupation, there are strategic choices that must be made and that are made, you do not need a circular for that.
Some services have already made the choice to switch to 100% covid in intensive care ”.
And when the confidential note intends to recall the necessary territorial solidarity via the EVASAN (medical evacuation) strategy, the ARS Île-de-France once again allows itself to recall that the region "has received some Covid patients from other regions in tension ".
The note specifies, however, that patient transfers may also concern non-Covid patients whose state of health requires intensive care.
Even patients, "Covid or non-Covid, coming under a conventional hospitalization service".
The ministerial service note imposes a strict rule in the management of caregivers who are contaminated by a variant of Covid-19.
A sign of the authorities' vigilance on this point, the services of the DGS call for scrupulously following the recommendations of the High Council of Public Health, established on January 14.
Namely a 7-day eviction for caregivers infected with the British variant, and ten days for the South African and Brazilian variants.
"This rule must not suffer from any derogation and removes this possibility opened in its opinion of May 23, 2020", writes the Directorate General of Health.
The return of overtime increased by 50%
“This is actually the only novelty of this document,” comments emergency physician Patrick Pelloux.
Until now, in fact, caregivers contaminated by Covid-19 could continue to practice in the strictest respect of health precautions.
From now on, only contact cases can continue to exercise, unless they become symptomatic.
"All professionals, caregivers and non-carers, within a health establishment or a social or medico-social establishment (ESMS) are therefore now potentially concerned by an eviction measure, as a confirmed case of Covid -19 or contact person at risk of a confirmed case ”, specifies the DGS.
Benjamin Davido still wonders about the implementation of this measure.
“I have the impression that we are setting out a rule without providing a solution.
If you lose half of a serve, how do you compensate?
There is indeed recourse to the interim but it costs twice as much, it does not happen with the snap of a finger, with the risk that it will end up weighing on the quality of care.
".
To prevent the services from suffering from absenteeism, the circular announces, according to our information, the return of the overtime increase of 50% and the renewal of the exceptional allowance for paid leave not taken for service reasons.
A decree on the subject is being drafted.
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If the General Directorate of Health also invites the mobilization of the health reserve, it must be remembered that it is not able to meet all needs.
Last November, Le Parisien took stock of the state of the forces involved.
The troops were running out of steam, with a drop in the response rate to alerts.
But also a lack of profiles adapted to the real needs of health establishments.
Among doctors, for example, the reserve had last November only 614 emergency physicians and 68 resuscitators officially available out of the 46,000 registered.
Professionals who were in reality all already solicited, by other means.
So many reasons that lead Benjamin Davido to think that the circular is primarily intended for private establishments.
“Maybe that's a way to ask them to stay on high alert, including during the holidays.
For the AP-HP and other public establishments, I see it above all as a form of recall.
"