In the race for anti-virus masks in France, the elderly have lost

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PARIS (Reuters) – At the end of February, when the COVID-19 pandemic was about to strike, French President Emmanuel Macron had to face a critical decision. Like most countries, France does not have enough protective masks.

A member of the medical staff, wearing a protective mask, walks with a resident of the retirement home Emile Gerard (EHPAD – Housing establishment for dependent elderly) in Livry-Gargan, near Paris, during the spread of the disease Coronavirus (COVID -19) continues in France, April 22, 2020. Photo taken April 22, 2020. REUTERS / Benoit Tessier

His response was to intervene. By decree, his government put the state in control of all stocks of masks on French territory. Officials were to distribute them to front-line health workers.

Macron’s far-reaching stage was unique among the major European states. The decree ultimately helped get protective equipment to those most at risk, such as the elderly and those with underlying chronic health conditions, people in the industry told Reuters.

But for some, including hundreds of retirement homes in France, this meant that supplies of masks from private providers could not arrive as planned. As a result, homes with low inventories have been running for around 10 days without supplies, according to a Reuters review.

COVID-19, the disease caused by the new coronavirus, has caused a global shortage of protective equipment; some world leaders are now being criticized for not doing enough to deal with the epidemic.

Experience in France shows how, faced with the deadly new virus and the scarce resources to deal with it, even governments that have acted with force can face limits and unintended consequences to their interventions.

Thirty minutes drive from the center of Paris, the Emile Gerard public retirement home spent 1,700 protective masks for the installation of 240 beds with its usual suppliers in late February and early March, said interim manager Elsa Nicoise .

These commands were not executed. Her two suppliers told Nicoise that the equipment she ordered had been requisitioned by the government, she said.

With only meager stocks in reserve, she had to ration the masks. “We distributed them sparingly,” said Nicoise. Seven residents died from the virus. At least seven staff have tested positive for COVID-19.

Emile Gerard was one of many homes affected. The requisition order cut off the supply of tens of thousands of masks to retirement homes – which house a total of about 1 million residents – just as the virus began to spread among the vulnerable and the elderly. This finding is based on interviews with four medical supply companies whose customers include more than 4,000 medical facilities, two representatives from the nursing home industry, two owners of nursing homes, and a union official.

The government has never physically requisitioned mask supplies, but producers and suppliers who wanted to avoid violating the decree have stopped shipping them to customers. Most did not resume regular deliveries until the end of March.

Reuters has found no evidence of a direct link between the requisition policy and the death of a particular resident of a nursing home. People in the French nursing home sector claim that their protective equipment is now adequate.

But Jean-Pierre Riso, head of FNADEPA, an industrial group that represents the owners of retirement homes, believes that the interruption in supplies has exposed some residents of retirement homes in France to the virus.

“The lack of protective gear in the first weeks of March has contributed to the spread of the virus in retirement homes,” said Riso.

The French presidential administration refused to answer questions about the requisition of the mask, referring to the Ministry of Health. The ministry, in a statement to Reuters, said its order was aimed at preventing speculation in the market and directing supplies where they were most needed. He said he never seized supplies or insisted that all masks be supplied exclusively to the state, and whenever he saw a shortage, he acted to remedy them.

The ministry said, however, that mask stocks were initially frozen – it did not say who had them – and that retirement homes at the start of the crisis were concerned about supplies.

As of May 9, 9,737 people have died in French nursing homes suffering from coronavirus-related diseases, according to data from the Ministry of Health. This represents just under 40% of the total number of deaths in the epidemic, as measured by the Ministry of Health.

ROOSEVELT

Macron, a 42-year-old former investment banker, became president in 2017 on a promise to unleash free market power, changed the law to allow companies to ask staff to work more hours, and attempted to remove certain retirement privileges, triggering strikes and protests.

But faced with the new disease in late February, he lifted the levers of the state, which owns and operates about half of the 7,400 nursing homes in France. All receive protective equipment through commercial companies, which also supply hospitals for public health services in France.

When the outbreak occurred, France’s ten-year-old strategic stock of personal protective equipment (PPE) gradually declined and has not been replenished.

The country was to contain one billion surgical masks and 600 million filter masks or FFP2 masks – also known as N95 masks, a design adjusted to protect the wearer from infection. But he had no FFP2 masks and the stock of surgical masks had dropped to 117 million, Health Minister Olivier Veran said on March 21.

In a tightening of global supply, it was suddenly clear that it would not be possible to import enough masks: Macron had reached a “Rooseveltian moment”, said an Elysée official in a reference to President Franklin D. Roosevelt, who ramped up. state intervention during the Great Depression of the 1930s.

HALT SUPPLIES

At a meeting in late February, health ministry officials told representatives of major mask manufacturers – four French manufacturers and several foreign companies – that the state would requisition masks, said Franck Sarfati, director of sales for CAHPP, a company that provides supplies and services to over 4,000 medical establishments.

From then on, producers were reluctant to source, said Sarfati. Under a government decree of March 3, all regular deliveries stopped and the big producers had to send masks to the main hospitals in each region. From there, they were to be assigned to the health workers who needed them.

But according to Sarfati, a second commercial supplier and four executives from the nursing home industry, there was a bottleneck: centralized state supplies went as planned to major hospitals, but were not not transferred to nursing homes.

With fresh supplies blocked, Emile Gerard’s home ended up with a stock of 800 surgical masks and 765 FFP2 masks, Nicoise said. A local school donated 700 more masks. It was not enough. At the rate the house is now using masks, she said, FFP2 masks would last several weeks, but surgical masks would only last a few days.

Anissa Amini, a home worker and union representative, said that staff caring for a resident sometimes did so without a FFP2 mask – because officials had not provided it – and later discovered that the person had COVID-19.

“This is how it spreads,” she said. Nicoise declined to comment on this, saying she needed to know the details of a given case. She stated that the home quickly implemented all of the security measures and recommendations made by the government. Emile Gerard’s suppliers did not immediately respond to the comment.

“PANIC ON THE BRIDGE”

Retirement homes across France were unable to source new products during this period, suppliers and nursing homes said.

Robert Kohler, director of La Roseliere nursing home in Kunheim, eastern France, realized on the evening of March 19 that he had only three days left of supplies. After two days of phone calls to ask for help, some companies donated masks at home.

Mask supplier Le Réseau Cocci said that there were interruptions in delivery to the 160 nursing and retirement homes and three hospitals it supplies. “We have received a large number of calls from hospitals and have been unable to answer them,” said his boss, Ronald Monfrini.

Another supplier, Voussert, had orders for about 200,000 masks in its books for customers, including dozens of nursing homes, medical offices and clinics, said president Laurent Camin. With the requisition order, deliveries were halted, affecting 1,000 customers, he said. There was no breakdown of the number of these nursing homes.

“It was panic on the bridge,” said Florence Arnaiz-Maumé, chief representative of Synerpa, a lobby group for private retirement homes, describing the atmosphere of the first 10 days of March among the 1,800 homes of nursing members of its organization. She said that since then supplies had been restored and that the requisition had helped.

“NOT A PRIORITY”

In Emile Gerard’s house, the first supplies of state-supplied masks arrived on March 22, but the virus had already spread. Some residents would not survive the pandemic. They included Denise Pham Van, the 99-year-old widow of a WWII veteran.

Denise, who suffered from dementia, was doing well at the start of the epidemic, said her daughter, Monique Pham Van. As it progressed, it deteriorated. Visits have been banned due to the virus, but on a Skype call, Monique Pham Van said her mother looked skinny and didn’t speak.

Within a week, Denise was on a drip and receiving oxygen. She had no fever and coughing – two of the symptoms of COVID-19 – and the house made an exception to the visitation ban, allowing her daughter to be at her bedside.

On April 13, Monique, wearing a mask, held her mother’s hand and spoke to her as her breathing became more and more shallow. Her mother died just before 2 a.m. the next day.

Two days after that, Denise’s family learned that they were among those infected with COVID-19.

“I think the contamination is partly due to this absence, this lack of equipment,” said Monique Pham Van. In the race to supply health workers in France with protective equipment, retirement homes, she said “was not a priority”.

Health workers wear protective masks when they work at the La Roselière retirement home (EHPAD) in Kunheim, near Colmar, during the epidemic of coronavirus disease (COVID-19) in France, April 21 2020. Photo taken on April 21, 2020. / Photo taken on November 26, 2018 / REUTERS / Christian Hartmann

Director Nicoise said it was difficult to make this connection, given that many scientists still do not understand the virus. “It is too early to draw conclusions,” she said. “We are still really aware. The time for analysis will come later. “

According to documents consulted by Reuters and Fabien Arakelian, the lawyer representing the families, at least 11 families of residents of nursing homes have filed legal complaints identifying a lack of masks and other protective equipment among the alleged shortcomings of the treatment during the epidemic. He said he was preparing 10 more complaints.

Families have not specified who is the target of their complaints; their lawyer said this approach could trigger an investigation to determine who was to blame.

Additional reporting by Michel Rose, Johanne Decorse, Lucien Libert, Richard Lough and Marine Pennetier; Under the supervision of Sara Ledwith and Jason Szep

Our standards:Principles of the Thomson Reuters Trust.

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