From our special correspondent
In Bordeaux, the crisis unit has never been put to sleep. Twice a week since last March, the main department heads concerned by Covid-19 and the management of the university hospital have met to identify the number of beds occupied by Covid patients. But also to be the spokesperson for what their teams are going through. An essential feedback as caregivers warn about their difficulties since the start of the crisis, and they are mobilizing, once again, this Thursday, October 15 (read the benchmarks).
Here, the caregivers have experienced a particularly trying back to school. The second wave was early in Bordeaux, with a very significant influx of patients from mid-September. As evidenced by the peak of hospitalizations at that time on the curves projected in the preamble of the meeting, on the white wall of the large room which serves as a crisis post. That morning, there are about fifteen around the tables arranged in a U and as many to intervene by videoconference. The white coats of the doctors contrast with the dark outfits of the members of the management.
For a little more than two weeks, the main indicators of the evolution of the epidemic have been stable: number of hospitalizations, positive RT-PCR tests and calls to the Samu. “The decline, then the stabilization of the curve that we are seeing today, clearly shows that the restrictive measures which were taken in Bordeaux and Gironde in September were effective”, says Professor Denis Malvy, head of the medical unit for tropical diseases and travelers.
If the situation worsened, on the other hand, the infectious and tropical diseases department of Professor Didier Neau would have little room for maneuver to welcome new patients. It is currently full, but not because of the Covid. “Of the 50 beds, only five are occupied by Covid patients against 20 in mid-September”, he specifies, his department welcoming “intermediate cases”: patients who do not need respiratory assistance but suffer from other associated pathologies, such as diabetes or renal failure.
After him, the round table continues, led by the Director General of Bordeaux University Hospital, Yann Bubien. A situation is emerging that is generally under control, in particular in terms of “shifts”, the epicenter of the crisis. “With us, patients arrive in small quantities. We have no difficulty in taking charge of them for the moment ”, confirms Professor Didier Gruson, head of the intensive medicine-intensive care unit. On that day, he welcomed 13 Covid patients out of a capacity of 180 beds. Average age: 66 years old. In geriatrics, where a Covid unit has been created, the situation is more tense. The 13 beds are all occupied and “There is a queue of patients”, testifies Professor Nathalie Salles: “They are all very old and very sick. One patient dies every two days. ” The manager also notes, without being able to explain it yet, that some patients enter the service with “A negative PCR test and become feverish after two or three days.”
The explanation, in any case, does not come from the caregivers, the tests carried out on them all coming back negative. “Today, between 5 and 6 new cases of Covid are recorded per day among the staff of the Bordeaux University Hospital, against 15 to 20 during the peak in September”, remembers Catherine Verdun-Esquer, occupational physician. Positive caregivers are automatically terminated, asymptomatic contact cases are not. “Unlike the general population, they are not put in solitary confinement for a week, details the head of the health, work, environment department, who presented her flu vaccination strategy for the staff that day. Caregivers are already used to respecting barrier gestures and have protective equipment available. They should self-monitor and have lunch on their own, if possible. “
This difference in treatment can also be explained by the death toll in personnel that the isolation of contact cases could cause on teams already suffering. “Our operations are not deprogrammed because of the Covid, but absenteeism linked to staff exhaustion forces us to close beds, says Professor Christophe Laurent, head of the hepatobiliary surgery and liver transplantation service. Even if, for the moment, we are able to maintain an emergency activity: we have done liver transplants, lung transplants… ”“ The absenteeism rate is very low at the Bordeaux University Hospital, around 7% “, notes Yann Bubien. For now, epidemic pressure is not “Sufficient” to ask for backup. But the whole stake of this crisis unit is also to anticipate the measures to be taken if the influx of patients becomes too important again. “The adaptation will be gradual in order to be able to continue to take charge of other patients”, resumes the manager.
Several levels will thus make it possible to ramp up “sheave” services. The continuous surveillance beds will first be equipped to take care of the most serious patients, then the recovery rooms will be requisitioned. “This will allow us to ventilate 300 patients instead of 180 today”, indicates the head of the intensive care-intensive care unit.
Reaching this maximum capacity of resuscitation beds would mean this time that operations could no longer be maintained and that nursing staff would have to be reassigned to the detriment of other services. The Bordeaux University Hospital, relatively spared during the first wave, had been able to welcome patients from other regions. But today, the virus is circulating throughout the country. “Our caregivers are already tired, alert Catherine Verdun-Esquer. What I fear is that this time, in the absence of confinement, there will be no more possibility of mutual aid. “