Were there fewer patients in hospital during the epidemic than in previous years?

Throughout this health crisis, skeptics and conspirators have constantly minimized the impact of Covid patients on the hospital. “How can we make the non-vaccinated responsible for the deprogramming of operations, when there were fewer patients in hospital and fewer stays in 2020 and 2021 than in 2018 and 2019?”, asked a user on his Twitter account, Sunday, January 16, by publishing two graphs representing the number of patients and hospital stays by region, over the past four years.

Behind this question, there are those of the places available in hospitals and the workload of caregivers before and during the epidemic. When were health professionals most overwhelmed by the influx of sick people? To compare the number of hospitalizations since 2018, it is necessary to turn to the side of two organizations: the DREES, the statistics unit of the Ministry of Health, and then the ATIH, the Technical Agency for Information on hospitalization. This is precisely the source of the graphics published on Twitter. Indeed, a link refers to the Scan Santé site, the ATIH data restitution platform. The figures put forward by this Internet user are therefore verifiable.

Data on hospital admissions are sorted by activity: medicine, surgery, obstetrics (MCO), which represent more than 80% of visits, follow-up care and rehabilitation (SSR), home hospitalization (HAD) or psychiatry . To simplify, let’s take the number of patients admitted to MCO in four years. According to ATIH, the MCO received 12.3 million patients in 2018 and had 28.9 million stays (full and partial hospitalizations, i.e. without overnight stays). Then 12.4 million patients were admitted and 29.5 million stays were made in 2019. In 2020, when the virus emerged, 11.1 million people were hospitalized in MCO, which recorded 27.5 million stays. Finally, these services had 11 million patients and 26.3 million stays in 2021 (the latter data is still updated weekly).

The statement relayed above is therefore true: the number of patients and stays was more consistent in MCO before the epidemic. But that does not mean that hospitals have been less overwhelmed since the Covid than in the previous two years. This is explained first of all by the disorganization observed during the first wave of the epidemic, in March 2020. Indeed, if Covid patients represented only 2% of hospitalized patients during this year- there, as we explained to you here, the latter did not arrive throughout the year, in scattered order. This figure is actually a smoothing over the year and does not reflect the periods of tension experienced by the hospital. For example, at the peak of the first wave, 7,000 people were admitted to intensive care for a Covid infection. For comparison, there are 3,852 today, according to the government.

As ATIH observes, this has also led to favoring Covid over other pathologies: “The sharp drop in MCO activity mainly concerns the months of March-April-May (1st wave of the epidemic), a period during which instructions for deprogramming non-urgent care were given for the entire territory and health establishments. Thus, the drop in activity over these three months of activity represents 80% of the overall decrease”. This is also the whole ambition of a white plan: deprogram operations considered less urgent and mobilize caregivers in the face of an exceptional health situation.

In addition, care has also had to be deprogrammed due to a lack of beds, some having had to be closed because of the epidemic. “To limit contagion, many double rooms have been transformed into single rooms, again reducing the number of full hospital beds available at the end of the year”, thus explains the Drees, which points to the elimination of 5,000 full hospital beds that year.

The closing of beds is also a structural trend: between 2013 and 2020, no less than 27,000 full hospital beds were closed, “a drop of 6.5% in seven years”. For the Dres, “this general movement results from the desire to eliminate excess beds and reorganize the offer, or from staff constraints preventing the maintenance of beds. It reflects the structural evolution of the forms of care, which are increasingly turning more towards alternatives to full hospitalization”. In other words, the increase in day hospitalization beds (8,200 places in seven years) may have contributed to the decline in the number of full admissions, with overnight stays.

In summary, the number of hospitalized patients has dropped from 2020. But this drop cannot therefore be read without the impact that the epidemic has created on the hospital. The Covid initially led to the deprogramming of care and therefore to the refusal of admissions: we can see this with the 80% drop in MCO activity during the first wave of the epidemic. The health crisis has also led to the removal of double beds in favor of single beds to limit the risk of contagion.

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