In the intensive care unit of Ibn Rochd hospital in Casablanca, the red line that winds on the ground draws a border between life and death. Day and night, an army of caregivers covered from head to toe cross it to join intubated patients or patients on artificial respirators behind glass doors that isolate them from the outside world.
Most of them are in a deep sleep. A 70-year-old man, who has emerged from a induced coma but is still in respiratory distress, looks pleadingly. “Those who survive are transferred to regional hospitals, where Covid-19 patients in less serious condition are admitted, while waiting to get better and return home. The others do not survive ”, sighs Lahoucine Barrou, the head of department.
Of the more than 300,000 cases of Covid-19 recorded by Morocco, 18% are in the Casablanca-Settat region, despite the containment measures put in place in September to stem the epidemic. If the country was relatively spared during the first wave, the figures have continued to climb since the start of the school year, reaching records of contamination with more than 5,000 new cases daily – even if the case fatality rate remains below 1 , 7%.
“We are preparing for the worst”
“We are in the middle of the second wave, we are preparing for the worst, trust M. Barrou. For now, we manage to have room in intensive care, but tomorrow we will be overwhelmed. ” Already weakened by a pathology such as diabetes, renal failure or Alzheimer’s disease, all patients arrive in critical condition. “I call them the victims of Covid-19 because they did not look for it: it fell on them”, regrets the resuscitator.
At 90, the dean of the intensive care unit had not stepped outside since the start of the epidemic. She was however contaminated. “Obviously, people continue to visit the elderly, totally unconscious! And we also have very young patients ”, indignant Mr. Barrou, pointing to a single room. There, behind the red line, lies, unconscious, a 32-year-old man with trisomy 21. His father, also infected, died the day before but he does not know it yet. “Now who’s going to take care of him?” “, breaths the doctor.
Attached to the university hospital (CHU) of Casablanca, the Ibn Rochd hospital, the largest in the kingdom with its 45 hectares, has 65 intensive care beds. Since the health crisis, four intensive care units comprising 70 additional beds have been created and equipped to accommodate coronavirus patients. Each week, about fifty patients are admitted there. “We moved a whole surgical department to create intensive care. We only take severe cases, because we have the machines to use different oxygen therapy techniques ”, explains the resuscitator.
In the rest of Morocco, hospitals have doubled their capacity for intensive care and resuscitation and have been equipped with artificial respirators. “But it’s not the machines that are the problem. Equipment can be bought. People cannot be bought ”, the doctor decides.
Emergencies are overwhelmed
Because the nursing staff is sorely lacking. In recent months, doctors and nurses from other services have been called in to assist and the CHU has recruited several graduates from the nursing school to help the resuscitators. But the workforce remains insufficient at the national level. With 12,000 doctors in the public sector for 36.5 million people, the entire system is under strain. “It’s getting hard. Fatigue is being felt more and more », says Kamal Marhoum El Filali, head of the infectious diseases department, half of whose department has been requisitioned to participate in the clinical trial of the vaccine developed by the Chinese laboratory Sinopharm.
At the CHU, doctors admit that the mistakes made during the first wave made it possible to better understand the disease. Better equipped, more alert, intensive care and resuscitation units cope better with the virus. But all regret the behavior “Irresponsible” of the population and a “Generalized relaxation” faced with the gravity of the situation. “The patients who arrive here are already in serious condition. Either because they did not believe in Covid-19, or because they preferred to self-medicate ”, regrets Mr. Barrou. Patients have even installed resuscitation rooms at home, equipped with an oxygen extractor, to avoid going to the hospital. ” It’s very dangerous. Patients with respiratory failure should be closely monitored. Unfortunately, many die on arrival in the emergency room because it is already too late. “
Delayed diagnosis also increases the risk of fatal complications. Before arriving at the hospital, patients with symptoms go through a real obstacle course. “The circuit is long before we get to the right structure. Sometimes general practitioners do not detect the disease and things get worse “, recognizes Mr. Barrou. In recent weeks, regional hospitals and health centers have been taken by storm. Emergencies, particularly overwhelmed, can no longer cope with the flow of patients. “Even to get treatment at the hospital, it’s war! “, laments Moncef Chaouki, whose father has just tested positive: “We no longer know where to go or who to contact. The CHU only takes patients who are almost dying and for the others, there is no room anywhere. “