Analysis. For months, the front of the “war” against the Covid decreed by Emmanuel Macron seems to focus on hospital services, summoned to hold out against the onslaught of the coronavirus, the grumpy caregivers on the front line in front of the vaccine cavalry. Would the official toll of more than 105,000 deaths from Covid-19 have been less heavy if France had fewer intensive care beds? Would it not then have been imperative to intervene more upstream to reduce the number of hospitalizations, which would have automatically resulted in fewer deaths?
Modeling approaches this question from another aspect, that – crucial – of the moment of the installation of containments. Epidemiologist Mircea Sofonea and his colleagues at the University of Montpellier estimated, in May 2020, that if the first confinement had occurred a week earlier, 1,500 intensive care beds would have been sufficient, well below the 7,148 patients in “Sheave” at the peak of the epidemic, on April 7, and 13,300 fewer people would have died from Covid-19. If it had been decided a week later, 32,000 beds would have been necessary, leading to an excess mortality of 53,000 deaths compared to the spring 2020 toll.
Would lower resuscitation capacities have saved lives by hastening the confinements? Epidemiologists are divided on the question, above all theoretical. “It may seem paradoxical and counter-intuitive, but it is a reality, estimates Pascal Crépey (School of Advanced Studies in Public Health, Rennes). This amounts to lowering the thresholds from which we trigger strong epidemic control measures, containment or otherwise. The earlier these measures are taken, the less the epidemic is allowed to spread, the fewer deaths there are. ” Conversely, he underlines, if the overload of intensive care units serves as a compass, if we had been able to accommodate twice as many patients in intensive care, as some have sometimes advocated, we would have expected even more. before breaking the epidemic dynamic, with the consequences that this entails in terms of mortality.
“Decide who has a chance to survive”
Samuel Alizon (CNRS, Montpellier) recalls that“We must assume that the strategy would have been the same, that is to say at all costs to avoid triage of patients in the short term. By ‘sorting out’ I mean deciding who has a chance of surviving ”. In practice, to observe a reduction in mortality, France would have had to have had much fewer beds, because “Without a really low number of places, the reasoning would probably have been the same, that is to say wait until the last minute to apply the remaining options – confinement”.
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