Did we try everything before reconfining?

Weeks of heavy weather and hardship await us. “ Government spokesman Gabriel Attal spoke of a toughening of measures centered on Île-de-France and Hauts-de-France, Wednesday March 17, while the various levers to ease the pressure on hospitals no longer seem sufficient. Presented as the ultimate way out of saturation, patient transfers are only carried out in small quantities. In question, a lower reception capacity in the provinces, because “All the resuscitation services, throughout the national territory, are almost at saturation”, said Zaynab Riet, general delegate of the Hospital Federation of France (FHF), Wednesday 17.

The English variant, which causes more severe forms, is also an obstacle. “When we look at the number of patients who are stable enough to be transported, we have barely more than 10%”, underlined Martin Hirsch, director general of the Assistance publique-Hôpitaux de Paris (AP-HP), on RTL. Of this population, “There is a family refusal rate which is a little higher than in the spring”, because unlike the first wave, “They often wish to keep their loved ones close to them”.

Two trains should have left Île-de-France this week with up to 80 patients on board in serious condition, but they will remain at the platform for the moment. In all, only ten patients have therefore been transferred out of the region in the past three days. In all, 185 patients have been transferred from one region to another across the country since January 26, according to the general directorate of health.

The deprogramming of operations (40% in Île-de-France) can hardly be pushed further, “Except to further accentuate the consequences in terms of public health”, after Zaynab Riet. “They risk considerably degrading the general state of health of the population”, also alerts Gérard Raymond, president of France Assos Santé. The repercussions of postponements could be severe: “The number of kidney transplants decreased by 30% between 2019 and 2020, and it was not possible to make up for the neurosurgical procedures not performed last year”, Zaynab Riet said.

“Nearly 93,000 cancer diagnoses could not be established, completes Axel Kahn, president of the League against cancer, the leading cause of death in France. Each month late is equivalent to a 10% loss of chance to survive. “

Human resources, above all, are lacking. According to Frédéric Valletoux, president of the FHF, “The problem is not so much to open more intensive care beds as to find enough personnel to supervise them”. Unlike the first wave, the transfer of staff between hospitals is no longer really possible. “Today, all hospitals need their professionals because activity outside of Covid, this time, has not stopped, explains Agnès Ricard-Hibon, head of Samu Val-d’Oise and member of the French Society of Emergency Medicine. Every caregiver is already needed where he is. “

As for the health reserve, it cannot meet demand (read the benchmarks). And the caregivers tire. “We’ve been at the front for a year, and this in all regions, emphasizes Agnès Ricard-Hibon. The caregivers are worn out, anxious about the deterioration of the situation, and do not necessarily want to be sent to another region, far from their families. “

Professionals from the private sector are also less available, as explained by Thierry Chiche, director of Elsan, which brings together around a hundred private clinics and hospitals in the region. During the first wave, 600 caregivers of the group had lent a helping hand to private and public establishments in the most affected regions. But a year later, the reinforcements were less. “There is a lack of personnel everywhere, he laments. Despite the precautions, they are regularly infected or contact cases, not to mention all those who are mobilized by the vaccination campaign. “

In this tense context, the fear of not being able to treat everyone begins to reappear, assures Agnès Ricard-Hibon. “Our great anguish is to have a patient who needs resuscitation, who has chances of survival, but to whom we will not be able to provide all the necessary care. “ The representatives of the FHF are convinced of this: “The maximum limitation of social interactions will, unfortunately, be the only way to ensure this difficult balance between deprogramming as little as possible and arming intensive care beds with the appropriate personnel. “


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