PARIS (AP) – During an overnight shift this week, three new COVID-19 patients were taken to Dr. Kareem Depot’s small intensive care unit in the southern French city of Arles. At his service are now more viral patients than the first wave of infections, and are eager to create new ICU beds elsewhere in the hospital to accommodate the sick.
Similar scenes are unfolding throughout France. COVID-19 patients now occupy 40% of the ICU beds in the Paris region and almost a quarter of the ICUs across the country because the infections, which have been growing for several weeks among young people, are spreading among the vulnerable.
Despite being one of the richest countries in the world – and one of the most severely affected when the epidemic first washed around the world – France does not include the staff needed to manage significant ICU capacity or extra beds, according to National Health Institute statistics and doctors in many hospitals. Like the epidemics that have re-emerged in many countries, critics say, French leaders have not learned their lessons from the first waves.
“It’s so tense, we don’t have places yet,” Dr. Debt told the Associated Press. His hospital converts recovery rooms into ICUs, delays emergency surgery and sends more staff to high-maintenance cov- eral patients. When asked about additional doctors to help with new cases, he simply said, “We don’t have them. That’s the problem. “
When Paris General Hospital staff confronted French President Emmanuel Macron this week to demand more government investment, he said: “This is no longer a question of resources, it is a question of organization.”
He defended his government’s handling of the crisis, citing the 8 8.5 billion investment promised in July for the hospital system. After years of spending cuts, doctors protested that funding was too low and too slow to come because in 2010 France had half the number of ICU beds in 2010.
ICU aggression rates are considered to be an important indicator of how complete the hospital system is and how effective health officials are in protecting people at risk.
France’s numbers are not good.
It recorded more than 18,000 new daily cases on Thursday, and virus patients now occupy 1,427 ICU beds across the country – doubling in less than a month. According to figures provided by the National Institutes of Health, the total ICU capacity in France is 6,000, the same as in March.
In comparison, Germany entered the epidemic with five times more intensive care beds than France, with a similarly well-developed health care system and a slightly smaller population. To date, the number of confirmed virus-related deaths in Germany is 9,584, up from 32,521 in France.
Getting ICU capacity right is a challenge. Spain was caught short in the spring and has expanded its permanent ICU capacity by about 1,000 beds. Britain expanded ICU capacity by creating emergency field hospitals. The so-called Nightingale Hospitals have been moth-eaten because they are rarely used. However, the British government says they can reuse them if needed.
In the spring France added extra temporary beds – including those built by the military to the country’s first peace field hospital – the health agency said, adding that French hospitals could eventually double ICU capacity if needed this fall.
Doctors say French intensive care wards are better equipped this time around compared to March and April, with more safety equipment and more knowledge about how this corona virus works. Doctors are now placing fewer patients on respiratory machines, and hospitals are being trained on how to restructure their functions to focus on COVID-19.
The number of viral patients in the ICU at the new Civilian Hospital in Strasbourg doubled rapidly last month, but the atmosphere was surprisingly calm. An OP reporter looked at teams of physicians who closely coordinate to manage each patient’s course and treatment according to the strict protocols they are now accustomed to.
But that does not mean that additional practice will make it easier to manage recurring viral events in ICUs. In addition to additional respirators and other equipment, the addition of makeshift ICU beds requires time and effort – as in treating patients with COVID-19 in them.
Pierre-Yves, head of the intensive care ward at Lauren Military Training Hospital in Marseille, said the work was “harder and more time consuming” than other patients. He has no authority to identify by his last name due to military policy.
Seven or more of his 47 staff are required to rotate a patient slowly and carefully each time. Now entering and exiting the ward involves a long, careful dance to shift full body gear and disinfect everything they touch.
Dr. Debat, in Arles, said it took several months to train ICU staff, so he relied on the same staff in the spring, and he was worried they might burn out.
“I’m like a coach, I only have one team, no reserve players,” he said.
He also worries about non-viral patients who were already placed in the back burner earlier this year. He worries about the upcoming flu season sending about 2,000 patients to ICUs in France each year.
With more than 7,000 viral patients in intensive care at the height of the crisis, Serge Smatza, head of the emergency medical service SOS Medecins, did not think France would face the same situation it saw in the spring. She died in nursing homes without going to hospitals. But he said it was wrong for the French public and its leaders to think “the virus was behind us”.
“There are not enough beds … especially there is a shortage of staff,” he said. Seeing his service wear off a consistent progress in cases and epidemics, he warned that “missing is a deadline.”
Jean-Franோois Padias in Strasbourg, France contributed to this story.
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