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As the virus fills French intensive care units again, doctors ask what went wrong

PARIS (AP) – During a single night shift this week, three new COVID-19 patients were rushed to Dr. Karim Debbat’s small intensive care unit in the southern French city of Arles. Its service now has more virus patients than during the first wave of the pandemic, and is rushing to create new intensive care beds elsewhere in the hospital to accommodate the sick.

Similar scenes are taking place all over France. COVID-19 patients now occupy 40% of ICU beds in the Paris region and nearly a quarter in ICUs nationwide, as several weeks of escalating infections among young people spread to vulnerable populations.

Despite being one of the richest nations in the world ̵

1; and one of the hardest hit when the pandemic first hit the world – France hasn’t added significant intensive care capacity or the staff needed to handle extra beds, according to data from the national health agency and doctors from several hospitals. As in many countries facing recurring infections, critics say French leaders haven’t learned their lesson from the first wave.

“It’s very tense, we have no more places,” said Dr. Debbat to the Associated Press. His hospital is converting recovery rooms into intensive care units, delaying non-urgent surgery and increasingly directing its staff towards high-maintenance COVID patients. When asked about extra doctors to help with the new cases, he simply said, “We don’t have them. That’s the problem.”

When workers at the Paris public hospital protested this week, they confronted French President Emmanuel Macron to ask for more government investment, he said: “It’s no longer a question of resources, it’s a question of organization.”

He defended his government’s handling of the crisis and noted € 8.5 billion in investments promised in July for the hospital system. Protesting doctors said funds are too few and too slow to arrive, after years of cost cuts that have left France with half the number of ICU beds in 2020 it had in 2010.

Intensive care unit employment rates are seen as an important indicator of how saturated the hospital system is and how effective health authorities have been in protecting populations at risk.

And France’s numbers don’t look good.

It reported more than 18,000 new cases daily on Thursday, and virus patients now occupy 1,427 ICU beds nationwide, a figure that has doubled in less than a month. France’s overall intensive care capacity is 6,000, roughly the same as in March, according to national health agency data provided to the PA.

For comparison, Germany entered the pandemic with about five times as many ICU beds as France, which has an equally well-developed healthcare system and a slightly smaller population. To date, the confirmed death toll related to the virus in Germany is 9,584 compared to 32,521 in France.

Getting the right critical care capacity is a challenge. Spain ran short in the spring and expanded its permanent intensive care capacity by around 1,000 beds. Britain expanded critical care capacity by building emergency field hospitals. As they were barely used, the so-called Nightingale hospitals were taken out of service. However, the UK government says they can be reused if needed.

France added more makeshift beds in the spring – including some built by the military in the country’s first peacetime field hospital – and the health agency said French hospitals could possibly double critical care capacity if needed this fall. .

Compared to March and April, doctors say that this time the French ICUs are better armed, both with protective equipment and with more knowledge on how this coronavirus works. Doctors are now putting fewer patients on breathing machines, and hospitals are experts on how to reorganize their operations to focus on COVID-19.

The number of virus patients in intensive care has rapidly doubled last month in Strasbourg’s New Civilian Hospital, but the atmosphere is surprisingly calm. An AP reporter watched teams of doctors coordinate closely to manage each patient’s trajectory and treatment according to rigorous protocols they are accustomed to.

But this extra practice doesn’t mean handling recurring virus cases in intensive care units is easy. In addition to extra breathing machines and other equipment, adding temporary beds in the ICU also takes time and work, as does treating COVID-19 patients within them.

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

Seven or more of its 47 collaborators are needed every time they slowly and carefully rotate a patient from back to stomach or vice versa. Getting in and out of the ward now involves a long and careful dance to change the equipment of the whole body and disinfect everything they touched.

Dr Debbat in Arles said ICU staff training takes several months, so he relies on the same staffing levels as in spring and fears they may run out.

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

He also cares about virus-free patients, who had already been sidelined earlier this year. And he’s worried about the upcoming flu season, which sends around 2,000 patients to intensive care in France each year.

The head of the SOS Medecins emergency medical service, Serge Smadja, does not think France will face the situation again it saw in the spring, when more than 7,000 virus patients were in intensive care at the height of the crisis and nearly 10,000 infected people died. in nursing homes without ever reaching hospitals. But he said French public opinion and its leaders were wrong in thinking “the virus was behind us”.

“There aren’t enough beds … and there is mostly a lack of staff,” he said. And with his service that has seen a steady increase in cases and the pandemic continuing, he warned: “what is missing is an end date.”


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


Follow AP’s pandemic coverage at http://apnews.com/VirusOutbreak and https://apnews.com/UnderstandingtheOutbreak

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