As the virus fills the French ICU afresh, doctors ask what went wrong

PARIS (AP) – During an overnight single-shift this week, three new COVID-19 patients were drilled in the southern French city of Arles. Karim was taken to the small intensive care ward of Debbat. His service now has more virus patients than the first wave of the epidemic, and is scrambling to build new ICU beds elsewhere in the hospital to accommodate sick people.

Similar scenes are going on all over France. COVID-19 patients now occupy 40% of the ICU beds in the Paris area, and around a quarter of ICUs across the country, as the young population has spread over several weeks from vulnerable infections to growing infections.

Despite being one of the richest countries in the world according to National Health Agency data and doctors – and when the epidemic in the world first washed away, France did not add significant ICU capacity or the staff needed to manage the extra beds. Many hospitals. Like many countries facing a resurgent transition, critics say that French leaders have not learned their lesson from the first wave.

Dr. “It’s very stressful, we have no other place,” Debbat told The Associated Press. His hospital is converting recovery rooms into ICUs, delaying non-urgent surgeries and instructing its staff to have more and more COVID patients. When asked about additional medics to help with new cases, he simply said, “We don’t have them.” this is the problem.”

When employees of the Parisian government hospital who staged the protest this week demanded more government investment from French President Emmanuel Macron, he said: “It is no longer a question of resources, it is a question of organization.”

He defended his government’s handling of the crisis, and noted 8.5 billion euros in promised investment in July for the hospital system. Protesting intermediaries said the funds were too small and too low in the coming years, leaving France with half the number of ICU beds in 2020 that it had in 2010.

The ICU occupancy rate is considered an important indicator of how saturated the hospital system is and how effective health officials are in protecting against risk-averse risks.

And France’s numbers are not looking good.

It reported more than 18,000 new daily cases on Thursday, and virus patients now occupy 1,427 ICU beds nationwide – which has more than doubled in less than a month. According to data from the National Health Agency provided to the AP, France has an overall ICU capacity of 6,000, roughly the same as in March.

For comparison, Germany entered the epidemic nearly five times as many intensive care beds as France, with an equally well-developed health care system and a slightly smaller population. To date, the number of confirmed deaths related to the virus in Germany is 9,584, compared to 32,521 in France.

Empowering ICU capability is a challenge. Spain was caught less in the spring, and has expanded its permanent ICU capacity by about 1,000 beds. Britain expanded ICU capacity by building emergency area hospitals. Because they were barely used, so-called nightingale hospitals have been mothballed. However, the British government says that they can be used again if needed.

France added additional bedsheet beds in the spring – including some built by the military in the country’s first-area field hospital – and the health agency said French hospitals could eventually double ICU capacity if needed this fall .

Compared to March and April, doctors say that French intensive care wards are better armed around this time, with both protective equipment and more information on how this coronavirus works. Medics now placed fewer patients on breathing machines, and practiced in hospitals on how to re-organize their operations to focus on COVID-19.

The number of virus patients in the ICU at the New Civilian Hospital in Strasbourg doubled last month, but the atmosphere is surprisingly calm. An AP reporter observed teams of medics closely coordinating the trajectory and treatment of each patient according to strict protocols to which they are now accustomed.

But that additional practice does not mean managing resurgent virus cases in the ICU is easy. In addition to additional breathing machines and other equipment, adding temporary ICU beds also takes time and labor – as COVID-19 treats patients in them.

“It is harder, and takes longer, than most other patients,” said Pierre-Yves, head of the intensive care ward at Leveron Military Training Hospital in Marseille. He was not authorized to be identified by his last name due to military policy.

Seven or more of its 47 employees are required to slowly and carefully rotate a patient from back to abdomen or vice versa each time. Entering and leaving the ward now involves a long, meticulous dance to change a full body gear and disinfect everything they touched.

Dr. in Arles. Debbat said that training ICU staff takes several months, so he is relying on personnel levels in the spring as well, and he worries that they may burn out.

“I am like a coach and I have only one team which does not have any reserve players,” he said.

He also worries about non-virus patients who were already put on the burner earlier this year. And he worries about the upcoming flu season, sending about 2,000 patients to the ICU in France every year.

SOS Medicine, the head of the emergency medical service, Serge Smadaja, does not think France will again face the situation she saw in the spring, when more than 7,000 virus patients were in intensive care at the peak of the crisis, and about 10,000 infected people. He died without ever being made in hospitals in a nursing home. But he said that it was wrong for the French public and its leaders to think that “the virus was behind us.”

“There are not enough beds … and especially a shortage of personnel,” he said. And seeing a steady rise in affairs with his service and an epidemic worn on him, he warned, “What is lacking in the end date.”


Jean-François Badias contributed to this story in Strasbourg, France.


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