The director of the AP-HP remains cautious about the improvement in the situation due to the exhaustion of caregivers in hospitals.
Even if encouraging signals are accumulating on the Covid-19 front, Martin Hirsch, the boss of the Assistance Publique-Hôpitaux de Paris (AP-HP), reports a very complicated situation between the continued rise in conventional hospitalizations, sustained non-Covid activity and absences of infected caregivers.
The peak of contamination seems to have been reached at least in Ile-de-France. Is this decline noticeable in AP-HP hospitals?
We cannot speak of a decline. There is a drop in Covid calls to the Samu and a virtual stabilization of Covid patients in critical care: on Monday they were 829 compared to 805 the previous Monday. On the other hand, it is still increasing in conventional hospitalization: in Ile-de-France, there are 2,900 patients this Monday against 2,600 a week earlier.
You said you feared that “tongue” to the hospital. It’s the case ?
Yes, it rocks, that’s the right word. Alongside Covid patients who occupy 30% of beds, we have hyper-sustained non-Covid activity. We must manage both positive staff and patient care. The first week of January was sporty. The second too, since we recorded a record of contamination of caregivers, with 2,462 staff infected, against 800 at the end of December. Today, we passed the roaring forties but we are still on very rough seas.
How do you explain the improvement?
The key is the drop in contamination by delta, less contagious but more virulent than omicron, between the beginning of January and today. Contrary to what many people think, there were more delta contaminations in early January than in early December. Certainly, omicron having become dominant, delta only represented at the beginning of January 12 to 13% of contaminations in Ile-de-France. But 12 to 13% of almost 100,000 contaminations per day, that’s more than the 7,000 contaminations per day for which delta was 99% responsible at the beginning of December… Delta was a little overshadowed by the omicron tsunami but it was still very strong January 4.
Is it the delta’s decline that relieves the hospital?
Yes. We analyzed the paths of all the delta and omicron patients from December. We have confirmed that an omicron patient is three times less likely to go to intensive care than a delta patient. And when he does not go to critical care, his hospitalization is shorter and his oxygen needs less frequent.
Have you been forced to deprogram a lot of non-Covid patients?
We have deprogrammed a lot of interventions in the second half of December, because of the Covid but also the drop in the number of caregivers, on leave or sick. Today, we are making considerable efforts to have a dynamic non-Covid activity. The major fact of this period is the rise of ambulatory activity, day hospitalization and home care. Today, our activity in partial hospitalization is stronger than last year and stronger than before the Covid. Between the majority and three quarters of operating theaters are operational.
Are you worried that this new stress shot will push caregivers to flee the hospital?
There is exhaustion, worry, that’s obvious. The feeling is fatigue. The figure is 2.5 million overtime hours last year, just on the AP-HP. But we do not stay with both feet in the same shoe. To retain caregivers and replenish teams, we have put in place three systems.
First, nursing students are now systematically offered a study allowance in the semester preceding their graduation, along with an eighteen-month contract with the AP. Two, and this is a first, we are putting in place a system to prevent the flight of caregivers to the interim. Between now and February 28, they are offered a contract of six months or nine months with remuneration comparable to that of the interim, that is to say around 20 euros per hour, and flexibility in the timetables. Our key argument is that for equivalent remuneration, it is better to integrate into a team than to function day to day.
Thirdly, it is proposed to staff who want to commit to working a specific number of overtime hours in return for which they will be paid 50% more than a normal overtime hour. Today we have 1,400 vacant nursing positions. The objective is to make up for half of this delay by the start of the 2022 school year. Combined with the return of sick staff, this should allow everyone to relax.