As coronavirus fills French ICUs again, doctors ask what went wrong

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In a single night shift this week, three new COVID-19[feminine[feminine the patients were rushed to the small intensive care unit of Dr Karim Debbat in the city of Arles, southern France. It now has more patients infected with the virus than in the first wave of the pandemic and is scrambling to create new intensive care beds elsewhere in the hospital to accommodate the sick.

COVID-19 patients now occupy 40% of intensive care beds Paris region, and more than a quarter of ICUs nationwide as weeks of growing infections among young people spread to vulnerable populations.

Medical staff are caring for a patient with COVID-19 at the New Civil Hospital in Strasbourg, in eastern France (Photo: September 2020) (AP)

Despite being one of the richest nations in the world – and one of the hardest hit when the pandemic first hit the world – France has not added significant capacity in intensive care or the staff needed to manage the extra beds, according to figures from the national health agency and doctors at several hospitals.

As in many countries facing a resurgence of infections, critics say French leaders failed to learn the lessons of the first wave.

“It’s very tense, we are out of seats,” Debbat told The Associated Press. Joseph Imbert Hospital in Arles is converting recovery rooms to ICUs, delaying elective surgeries and directing more and more of its staff to COVID-19 patients requiring high maintenance.

Asked about additional doctors to help with the new cases, he simply replied, “We don’t have them. This is the problem. “

When workers at Parisian public hospitals this week confronted French President Emmanuel Macron to demand more government investment, he said: “It is no longer a question of resources, it is a question of organization.”

He defended his government’s management of the crisis, and noted 8.5 billion euros ($ 13.9 billion) of investment promised in July for the hospital system. Protesting doctors said funds were too little and too slow to come, after years of cuts that left France with half the number of ICU beds in 2020 it had in 2010.

Medical staff take care of a patient suffering from COVID-19 at the Nouvel Hôpital Civil in Strasbourg, in eastern France (Photo: September 2020)
Medical staff take care of a patient with COVID-19 at the New Civil Hospital in Strasbourg, eastern France (Photo: September 2020) (AP)

The occupancy rates of intensive care units are considered to be an important indicator of the saturation of the hospital system and of the efficiency of health authorities in protecting populations at risk. And the figures for France do not look good.

It reported more than 18,000 new cases of the virus daily on Thursday, and COVID patients now occupy 1,427 intensive care beds across the country – a figure that has doubled in less than a month. France’s total intensive care capacity stands at 6,000 people, roughly the same as in March, according to national health agency figures provided to the AP.

By comparison, Germany entered the pandemic with around five times as many intensive care beds as France. To date, the number of confirmed deaths linked to the virus in Germany is 9,584 compared to 32,521 people in France.

Getting the right capacity for intensive care is a challenge. Spain was taken aback in the spring and increased its permanent intensive care capacity by around 1,000 beds. Britain has expanded intensive care capacity by building emergency field hospitals. They have been put on the back burner because they were hardly used, but the government says they can be reused if needed.

A nurse is seen in a COVID-19 area of ​​the New Civil Hospital in Strasbourg, in eastern France (Photo: September 2020)
A nurse is seen in a COVID-19 area of ​​the New Civil Hospital in Strasbourg, in eastern France (Photo: September 2020) (AP)

France added additional makeshift beds in the spring and transported patients by plane and high-speed train from hot spots to less saturated areas. The health agency said French hospitals could potentially double their intensive care capacity if needed this fall.

Compared with March and April, doctors say that French intensive care services are better armed this time around, both with protective gear and more knowledge about how this coronavirus works. Doctors are now placing fewer patients on breathing machines and hospitals are learning to revamp their operations to focus on COVID-19.

The number of patients infected with the virus in intensive care quickly doubled last month at Strasbourg’s new civilian hospital, but the atmosphere is surprisingly calm. An AP reporter observed teams of doctors coordinate closely to manage the trajectory and treatment of each patient according to strict protocols to which they are now accustomed.

But this additional practice does not mean that dealing with resurgent cases of ICU viruses is easy. Along with additional breathing apparatus and other equipment, adding temporary intensive care beds is also time consuming and labor intensive – as is treating the COVID-19 patients they contain.

“The work is harder and takes longer” than for most other patients, said Pierre-Yves, head of the intensive care unit at the Laveran military training hospital in Marseille. He was not allowed to be identified by his last name due to military policy.

Seven or more of its 47 employees are needed every time they slowly and carefully turn a patient from back to stomach or vice versa. Entering and exiting the room now involves a long and painstaking dance of changing the entire body equipment and disinfecting anything they have touched.

Dr Debbat in Arles said it takes several months to train intensive care staff, so he’s counting on the same staff levels as in the spring, and he’s worried they might run out.

“I’m like a coach and I only have one team, with no reserve players,” he said.

He is also worried about patients uninfected with the virus, who were already put on hold earlier this year. And he is worried about the coming flu season, which sends around 2,000 patients to ICUs in France each year.

The head of the SOS Medecins emergency medical service, Serge Smadja, does not think that France will again be faced with the situation it experienced in the spring, when more than 7,000 patients infected with the virus were in intensive care at most. height of the crisis, and some 10,000 infected people died in nursing homes without ever going to hospital. But he said that the French public and its leaders were wrong to think that “the virus was behind us”.

“There are not enough beds… and above all there is a lack of staff,” he says. And with his service seeing a steady increase in cases and the pandemic continuing, he warned, “What’s missing is an end date. “

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