© Pascal Bastien
In Strasbourg, in December.
Never since the blur of February and March 2020 have hospitals made their comeback in such a thick fog. Entangled in the delta wave and already under tension with some 19,000 patients diagnosed with Covid-19 and hospitalized on Sunday, including 3,572 in critical care, health establishments are anxiously watching the arrival of omicron, which could well upset everything for them in January. With more than 160,000 new infections every day on average, the new hyper transmissible variant, now the majority in France, is causing a cold sweat as its impact on the healthcare system remains uncertain.
According to the latest models from the Institut Pasteur, published on December 29, the future peak of daily hospitalizations linked to omicron (and expected in the second half of January) could, depending on its virulence and the measures taken to limit its circulation, cap at a manageable level or on the contrary reach a record level. The likelihood of each scenario is difficult to assess, leaving caregivers to fear the worst.
In Ile-de-France, a region with a record incidence rate – 2,400 Ile-de-France residents out of 100,000 diagnosed positive from December 24 to 30, 2,646 for the city of Paris alone – the regional health agency (ARS) asked the deprogramming, starting this week, of all non-urgent operations. The maneuver aimed at anticipating the hospital impact of viral spread, through a first level of reorganization and the redeployment of certain staff to critical care beds, already 50% occupied by Covid patients ( the vast majority infected by delta), indicates the ARS.
To the detriment of usual patients
At the Assistance publique-Hôpitaux de Paris (AP-HP), the instructions had already been sent. “The Samu are handling a considerably higher number of calls than usual at the same time of year […] ; the critical care beds are all occupied, all this in a context where the schedules are even more complex to organize given the sick leaves, set the direction in an email sent on December 29. This leads to the duty, both in medicine and in surgery, […] limit the activity scheduled for next week to treatments for which a vital prognosis is at stake. “
“Deprogramming is a disaster because it causes silent deaths.”
Francis Berenbaum, head of the rheumatology department at Saint-Antoine hospital in Paris
An air of déjà vu that would have gone well without Francis Berenbaum, head of the rheumatology department at the Paris Saint-Antoine hospital. Within the walls of his unit, eight of its seventeen conventional beds are already occupied by patients admitted for Covid-19, to the detriment of his usual patients
“Deprogramming is a disaster because it causes silent deaths, he laments. In an emergency, we say to ourselves that a patient in respiratory distress must be given priority over a person in whom a hip prosthesis must be placed. But in the meantime, this person, to whom we will postpone a first, then a second, then a third time their operation, will continue to remain immobile, worsen their cardiovascular risk and may end up dying of a heart attack. There is a risk that we will fall back into a period of lost luck for non-Covid patients. It would be dramatic. ”
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Problems of understaffing
Thursday, Francis Berenbaum was invited to the 134th crisis meeting of his hospital. An appointment that has become almost usual since the tsunami of March 2020, but which is now turned upside down by the arrival of omicron. “We do not know whether our reorganization plans, which have been run in wave after wave, will be able to be used identically”, he explains.
If the severity of the variant turns out to be really reduced, the establishments do not rule out the possibility of a massive influx of Covid-19 cases in hospital beds. “People with breathing difficulties or poorly tolerated fevers, who do not require critical care but require additional caregivers. And by extension, the cancellation of operations to redispatch personnel not in intensive care, but in conventional Covid units, develops the doctor. It is one scenario among others. This variant takes us on an unknown path, we must prepare for everything. ”
“We are at 3,000 daily calls to the Samu, against 1,500 usually. One in five calls concerns Covid and we know that it will intensify. ”
Pierre-Yves Gueugniaud, head of the emergency department, resuscitation, anesthesia and Samu at the Edouard-Herriot hospital, in Lyon
In Auvergne-Rhône-Alpes too, deprogramming is underway. 487 patients are now in critical care. This is much less than the highest peak recorded by the region, 866 patients, on November 16, 2020. But enough for hospitals shaken by understaffing problems and which are beginning to bear the brunt of the giant incidence rates recorded in recent weeks in the region (in Savoie and Haute-Savoie for example, with more than 2,600 cases per 100,000 inhabitants).
“We are at 3,000 daily calls to the Samu, against 1,500 usually. One in five calls concerns Covid and we know that it will intensify, explains Pierre-Yves Gueugniaud, head of the emergency department, resuscitation, anesthesia and Samu at the Edouard-Herriot hospital, in Lyon. Colleagues surgeons, who have seen their activities deprogrammed, are already there to reinforce [de téléphone]. This is not too much for our undersized teams. ”
“Between six to ten work stoppages at the same time”
Regarding resuscitation, the bed occupancy rate by patients contaminated with the delta variant is “Passed from 10% in November to 46% last week”, relates the Lyon doctor. For “to decongest” these heavy care services before a possible rebound in severe cases linked to omicron, the region has also relaunched itself in the heavy task of patient transfers. Towards Brittany and Normandy mainly, attests Pierre-Yves Gueugniaud. As her neighbor practices Provence-Alpes-Côte-d’Azur, just as much on the line since December. “Except that the ARS explained to us that even the north-west of France was going to stop supporting us, to keep a margin for the weeks to come. Today, we are told that our drop-off points are in Italy. Naples, Bari, Rome “, he reveals.
“A lot of people think about the aftermath, about life change projects, because nobody believes in real changes anymore.”
Aurélia Papin, intensive care nurse at Angers University Hospital
In the North-West precisely, Aurélia Papin, intensive care nurse at Angers University Hospital, says that her 32-bed service already includes 20 occupied by Covid patients. “We usually have 24 beds. But we will not be able to go up to 37 beds as in previous waves, because we no longer have enough paramedical staff to consider it, she exposes. We shoot between six and ten work stoppages at the same time, we are asked to come back in overtime, it is unlivable. “
For this paramedical, the monthly premium of 100 euros intended for its specialized profession, and announced on December 28 by the Prime Minister, Jean Castex, “Does not improve” his morale or that of his colleagues. “Many think of the aftermath, of the projects life changingbecause no one believes in real change anymore. The government still has not understood that the key is not money, it is good working conditions. ”