As the virus re-populates French intensive care units, doctors ask what went wrong

As the virus re-populates French intensive care units, doctors ask what went wrong

PARIS (AFP) – Over the course of one night shift this week, three new COVID-19 patients were transferred to Dr Karim Dabat’s small intensive care ward in the southern French city of Arles. His service now includes more virus patients than it was during the first wave of the pandemic, and he is striving to create new ICU beds elsewhere in the hospital to accommodate patients.

Similar scenes are shown all over France. COVID-19 patients now occupy 40% of intensive care beds in the Paris region, and nearly a quarter are in intensive care units across the country, with increasing infections spreading among young people for several weeks to vulnerable populations.

Despite being one of the richest countries in the world – and one of the hardest hit when the pandemic first swept across the globe – France has not added much capacity to the intensive care unit or staff needed to manage the extra beds, according to figures from the National Health Agency and doctors in multiple hospitals. As in many countries facing a new infection, critics say France’s leaders have not learned their lessons from the first wave.

“The situation is very tense,” Dr. Dabat told the Associated Press. “We don’t have any more places.” His hospital is converting recovery rooms into intensive care units, delaying non-urgent surgery and directing more and more of its staff to high-maintenance COVID patients. When asked about more doctors to help with the new cases, he simply said, “We don’t have them. That’s the problem.”

When workers in public hospitals in Paris protested against French President Emmanuel Macron this week to demand more government investment, he said, “It is no longer a matter of resources, it is a question of regulation.”

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He defended his government’s handling of the crisis, noting that 8.5 billion euros of investments promised in July to the hospital system. Protesting medics said funds were too little and too slow to arrive, after years of cost cuts that left France with half the number of ICU beds in 2020 it had in 2010.

ICU occupancy rates are an important indicator of how saturated the hospital system is and how effective health authorities are in protecting the population at risk.

France’s numbers are not looking good.

It reported more than 18,000 daily new cases on Thursday, and virus patients are now occupying 1,427 ICU beds across the country – a number that has doubled in less than a month. France has a total ICU capacity of 6,000, roughly the same as it was in March, according to National Health Agency figures provided to the AP.

For comparison, Germany entered the epidemic with nearly five times the number of intensive care beds as France, which has a well-developed healthcare system and a slightly smaller population. So far, the number of confirmed deaths related to the virus in Germany has reached 9,584, compared to 32,521 in France.

Getting the correct ICU capacity is a challenge. Spain deflated in the spring, expanding the capacity of its permanent ICU by nearly 1,000 beds. Britain has expanded the capacity of its intensive care unit by building emergency field hospitals. The so-called Nightingale Hospitals were disabled because they were barely used. However, the British government says it can be used again if needed.

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France added additional temporary beds in the spring – including some that the military built in its first field hospital in peacetime ever – and the health agency said French hospitals could eventually double ICU capacity if needed this fall.

Compared to March and April, doctors say French intensive care wards are better armed this time, with both protective gear and more knowledge about how the Coronavirus works. Paramedics are putting fewer patients on ventilators now, and hospitals are training how to rearrange their operations to focus on COVID-19.

The number of virus patients in the intensive care unit doubled rapidly last month at the new civil hospital in Strasbourg, but the weather was surprisingly calm. An Associated Press reporter watched teams of doctors coordinate closely to manage each patient’s path and treatment according to the strict protocols they are now used to.

But this additional practice does not mean that managing viral recurrences in intensive care units is easy. In addition to extra ventilators and other equipment, adding temporary ICU beds also takes time and labor – as does treating COVID-19 patients in it.

“The work is more difficult, and it takes longer” than most other patients, said Pierre Yves, head of the intensive care unit at La Veran Military Hospital in Marseille. He was not authorized to mention his last name due to the military policy.

Seven or more of his 47 employees are needed every time they slowly and carefully rotate the patient from back to stomach or vice versa. Entering and leaving the wing now includes a long, careful dance to completely change body tools and cleanse everything it touches.

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Dr Depatt in Arles said training ICU staff takes several months, so he’s based on the same staff levels as in the spring, and he’s worried they’ll run out.

“I am like a coach and I only have one team without reserve players,” he said.

He is also concerned about patients not infected with the virus, who were already placed in the back earlier this year. He is concerned about the upcoming flu season, which sends around 2,000 patients to intensive care units in France every year.

The head of SOS Medecins, Serge Smadja, does not believe that France will once again face the situation it witnessed in the spring, when more than 7,000 patients with the virus were in intensive care at the height of the crisis, and about 10,000 infected. He died in nursing homes without reaching hospitals. But he said the French public and its leaders were wrong to believe that “the virus was behind us”.

He said, “There is not enough beds … and there is a particular shortage of staff.” And he warned that his service is witnessing a steady rise in cases and the continuing spread of the epidemic, “what is missing is an end date.”


Jean-Francois Badias of Strasbourg, France contributed to this story.


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