Covid-19: cascade deprograms before a tense week in hospitals in Ile-de-France

The Covid-19 pandemic in Francecase

Expecting an influx of Covid patients, the leaders of the AP-HP have warned their teams that, next week, the activity will be limited to only “care for which a vital prognosis is at stake”.

The crisis meetings we have held these days show […] complicated outlook for the coming days“. It is with these laconic words that begins the email sent Wednesday by Martin Hirsch and Bruno Riou, respectively director general and medical director of crisis at the Assistance Publique-Hôpitaux de Paris (AP-HP), to all of their services. The subject of the message? Avoid the saturation of health services in the Ile-de-France region in the face of the surge in Covid-19 contaminations in the region. And to do this, we will have to make choices.

The email specifies that the scheduled activity for next week will be limited “treatment for which a vital prognosis is at stake“. The choice of programming will therefore be based on a “prioritization on medical and collegial criteria“. Thus, some patients may have their operations postponed later. At the AP-HP, it is feared that the 1,500 intensive care beds, whose occupancy rate is around 60%, will soon be occupied only by Covid cases.

The number of contaminations in France reached this week its highest level since the start of the epidemic and the Île de France is one of the most affected territories. There are approximately 2,000 cases per 100,000 inhabitants according to data from Public Health France. The epidemic pressure is already being felt on the SAMU telephone line in the region, whose number of calls is “Higher than usual at the same period” according to the direction of the AP-HP. This Wednesday, there were also 3,771 hospitalizations due to Covid-19 in Île-de-France.

“The white plan has become the ordinary operation”

A critical situation which prompted the Regional Health Agency (ARS) to activate the “white plan” from December 8 in hospitals. Already in place in five other regions, it should enable establishments “To increase their bed capacity for Covid-19 patients in critical care and medicine, if necessary by organizing deprogramming, and reorganizing staff schedules to ensure continuity of care”, according to the press release published by the ARS.

A reorganization that does not go smoothly. “The white plan has become the ordinary operation […] with what that implies of canceled holidays, overtime»Laments Marie-Pierre Martin, president of the Interurgences Collective in an interview given to AFP. Weariness is felt, while the Ile-de-France hospitals are running with reduced staff during this period, between end-of-year leave and sick leave due to Covid. The latter make “the schedules are even more complex to do“, Underline the two leaders of the AP-HP in their email.

Injured patients

So despite everything, to allow yet another mobilization of caregivers in the face of the post-holiday wave, the government reactivated several levers of support. Among which, the increase in overtime of 50% and the exceptional compensation for paid leave not taken up to 2,000 euros. In the process, the AP-HP also indicated to facilitate the care of the children of its staff, in particular “by reimbursing home care costs up to a maximum of 50 hours per child and per week“. But after two years of pandemic and repeated white plans, the public hospital appears to be at the end of its rope. “The situation has never been so serious“, Laments Marie-Pierre Martin, specifying that at the end of the chain”patients pay a high price“.

Last Wednesday, a group of fifteen doctors from Nouvelle-Aquitaine had thus relayed in a column published in Le Monde this question: “Is it fair to leave a patient with a digestive infection in the emergency room on a stretcher for ten hours, because the infectious diseases department is filled with patients with Covid-19?“. One way, for this collective of doctors which has several resuscitators, to point out the responsibility of unvaccinated people in the congestion of hospitals. “Not getting vaccinated means preventing some more vulnerable people from accessing intensive care, delaying the care of other patients with chronic pathologies“For good reason, today 70% of patients who are in intensive care in Paris hospitals are not vaccinated, recalled the Minister of Health, Olivier Véran, during his hearing at the National Assembly on Wednesday.

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