Doctors in the Paris region have warned that rising coronavirus infections could soon overwhelm intensive care units and force them to decide who to treat. Jowharreports from an emergency room in the capital’s hard-hit northern suburbs, where staff are confident they will survive the storm.
“Morning, do you have an extra bed for us?” drops the ambulance driver as he rolls a stretcher into the hospital lobby without pausing for answers.
Olivier Feutry is used to driving back and forth between congested hospitals in the Paris region and knows exactly where the most important spare beds are.
“Sure, we’ve hidden one for you,” said the head of the intensive care unit at the Estrée Clinic, a private hospital in the suburb of Stains, north of the French capital.
A few minutes later, Feutry’s patient is lying on a bed with a breathing machine that gently pumps oxygen into her diseased lungs and the ambulance driver is soon about to pick up another patient.
A Covid-19 patient is moved from an ambulance stretcher to a free bed in the clinic’s intensive care unit. © Mehdi Chebil
With more than 1,500 patients currently on ICU units throughout the Paris region, the third wave of coronavirus pandemic is proving even more brutal than the first. Nationally, the occupancy rate is close to 90%, which means that health workers have few alternatives to take their patients elsewhere.
The increasing pressure on hospitals has caused several doctors to sound the alarm and warns that they may soon have to choose which patients they have the resources to treat.
In a sober warning issued on Sunday, a group of 41 doctors at the ICU said that failure to order a strict lockout of the public would soon “force health workers to decide which patient would live and which would die”.
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The situation is particularly serious in the Seine-Saint-Denis area around Stains, the poorest ward in France, where the daily infection rate is more than twice the national average.
“The conversation about choosing between patients is meant to scare the public,” Feutry said, before driving away in his ambulance. “Of course we are in the middle of a health crisis. But while some senior doctors are talking to the press, their understaffed team is working on their butts. ”
Ambulance driver Olivier Feutry (left) and an emergency physician Ziane are ready to pick up another patient for transfer. © Mehdi Chebil
At the Estrée Clinic, anesthesiologist Irène Kriegel is convinced that hospitals will cope with the storm without having to choose which patients to treat. But her fear is that non-covid patients will pay the price as more and more resources are devoted to fighting the pandemic.
“As a result, other patients do not receive the same level of care,” she says. “We can see a sharp increase in serious cancer cases in the coming months due to delayed diagnoses.”
After resisting stricter curbs to limit the spread of Covid-19, President Emmanuel Macron has been forced to change thanks this week, announcing a temporary closure of schools and extended partial lock-in measures to all French regions.
Macron also promised to increase the number of ICU beds across the country from around 7,000 today to 10,000 – a daunting challenge that staff at the Estrée Clinic are well aware of.
Doctors Irène Kriegel (left) and Widad Abdi are discussing the resuscitation service of the Estrée clinic. The question of planning and effects occupies an important part of their exchanges. © Mehdi Chebil
When Jowharvisited for the first time in April 2020, the clinic had hurried to set up a temporary ICU unit by bringing in health workers and equipment from other facilities. When the second wave occurred last fall, patients received improved treatment thanks to upgraded machines and staff experience. The clinic then increased the number of ICU beds from 10 to 15 in time for the third wave.
However, finding the human resources to keep pace with the change has proved challenging, says Widad Abdi, an emergency physician, noting that the hospital now has “more beds and better equipment, but with fewer staff”.
Unlike last year, when cases were more localized, it is now very difficult to transfer doctors from one region to another, as all parts of the country are affected by the pandemic. The absence of a strict lock-in also means that other hospital wards must be open as patients continue to enter.
Another difference is the average age of Covid-19 patients in intensive care, which has dropped to about 60. This in turn affects the type of treatment doctors choose, whether intubation or a less invasive form of ventilation.
“Our only criteria is the patient’s chance of survival,” says Abdi. “We know that intubation causes abrasions that can be fatal to elderly patients. So we do not intubate an 85-year-old who may not survive the process. On the other hand, we become more aggressive towards younger patients who have a strong chance of recovering. ”
A patient breathes using an oxygen mask, a non-invasive form of ventilation. © Mehdi Chebil
While the first wave was quickly killed among the weak and elderly, the greater resilience of younger patients means they are more likely to occupy ICU beds far. According to Abdi, the trend will only increase when the third wave spreads to an increasingly younger public.
“Chronic fatigue, working late at night or partying a little too much … factors that weaken the immune system make us more likely to develop serious infections,” she says, warning that young people are also at risk.
Therefore, many doctors require a strict locking to stop the third wave of infection in its tracks, warning of a catastrophic congestion of cases.
“The alarmist conversation is really about trying to limit the increase in infection,” says Romain Spiteri, the nurse at the Estrée clinic. “We get the impression that the government will use the option of strict locking in much the same way that doctors resort to intubation – at the last minute.”
This article has been translated from the original into French.