Transfer of patients, deprogramming, vaccine … Ways to avoid reconfiguring

One by one, the lights turn orange, or even red. And in fact the situation of France’s Island, the region most affected by the Covid-19, begins to seriously worry authorities and caregivers.

Since mid-February, the departments of the Paris region have indeed experienced a surge in their incidence rate, from 243 cases per 100,000 inhabitants on February 10, to around 400 cases per 100,000 inhabitants.

This very high rate has a direct influence on the situation in hospitals, where the intensive care rooms are already overcrowded.

According to the latest published data, the number of intensive care patients in the region was indeed approaching the total observed at the height of the second wave.

And the situation could get even worse. “If the pace continues to be the same, we will exceed 1,500 Covid patients in intensive care in Île-de-France at the end of March, which corresponds to a critical threshold for hospitals in this region”, thus warned Olivier Véran, the Minister of Health, during his press briefing on Thursday, March 11.

The idea of ​​confinement back on the table

The deterioration of the health situation is such that a new confinement, partial or total, is officially envisaged.

Asked by BFMTV this Sunday March 14, Jérôme Salomon, the Director General of Health, for example indicated that “Confinement is not taboo. If it is necessary to confine, we have already done it twice, we will do it ”.

Jérôme Salomon: “If it is necessary to confine, we will do it, knowing that it is a difficult measure for the French” pic.twitter.com/Ab8HfCc6Gw

— BFMTV (@BFMTV) March 14, 2021

Asked by Samuel Étienne on Twitch this Sunday March 14, Jean Castex also warned: a confinement of the Île-de-France “Is not excluded”, specifying nevertheless: “We must use all the weapons at our disposal to avoid it.”

But what are these weapons? And can they really prevent a re-containment of the region?

Will the vaccines have sufficient impact in the short term?

“Obviously the solution is vaccination”, recalled geneticist Axel Kahn on LCI this Monday March 15.

#COVID19France.

Pr @axelkahn : “Obviously the solution is #vaccination. But the question is to wait for the vaccination to take effect: not with the knife under the throat in the tension ” #Reconfinement.

Interview with @jmaphatie sure # La26. pic.twitter.com/ZllAsMBac7

— LCI (@LCI) March 15, 2021

But will this solution come about quickly enough to avoid a new confinement in Île-de-France?

A priori, no. At least this is the opinion of Rémi Salomon, the president of the medical establishment commission of the AP-HP (Paris hospitals). “You have to vaccinate a lot if you want to slow down” the epidemic, he recalls. “But we don’t have enough doses. “

And in fact, despite recent efforts, if 90% of nursing home residents are vaccinated in the region, only 43.5% of those over 80 are. A proportion that falls to 41.1% of 74-79 year olds and even to 13.2% for 70-74 year olds.

It is therefore difficult to wait for a sufficiently strong aid from the vaccination to avoid a re-containment of Île-de-France. “We will not have a sufficient brake with vaccination”, summarizes Rémi Salomon.

Is it possible to transfer more patients?

It is the other major card of the government. During his press conference on Thursday, March 11, Olivier Véran indeed indicated that “Tens or even hundreds” of patient transfers from Île-de-France would be operated to relieve the region’s hospitals.

These indeed began a few hours after the intervention of the Minister, with the destination of large hospitals in the West. “There, we push the last cursor with the transfers of patients”, indicated to the AFP a majority cadre.

Read also : VIDEO. Covid-19: two patients from Hauts-de-France evacuated to Saint-Malo by plane

But if we are to believe Rémi Salomon, not sure that this is enough. “We will not be able to transfer a lot of patients, he believes. And it is not a solution if the number of entries [en réanimation] increases “.

In addition, Professor Bruno Riou, crisis medical director at AP-HP, indicated Monday March 15 on France Inter what “These transfers will not be able to be done with the same intensity as what could have been observed”.

Pr Bruno Riou: “Ces #transfers will not be able to be done with the same intensity: the number of places in other regions will be limited, families will be reluctant, we will therefore have difficulty finding enough patients to transfer ” #APHP # le79Inter pic.twitter.com/E2X7R1G5hX

– France Inter (@franceinter) March 15, 2021

Read also : Covid-19. How many patients transferred from region to region since the start of the health crisis?

And indeed, these transfers of patients could also come up against a non-negligible tension in the regions supposed to welcome the patients of Ile-de-France. In the current situation, “The capacities of the Bordeaux University Hospital in terms of resuscitation are nevertheless relatively limited”, indicates for example to France Blue, Laurent Petit, head of the surgical and post-trauma resuscitation unit at Bordeaux University Hospital.

Without the deprogramming of operations, massive transfers of patients may therefore be complicated. However, these deprogramming are not a panacea, according to the caregivers.

Should we deprogram more operations?

On Monday March 8, the Île-de-France Regional Health Agency requested that 40% of non-vital operations in the region be deprogrammed, so as to be able to open additional beds in intensive care.

“We are indeed going to reach 40%”, confirms Rémi Salomon. Could we consider deprogramming even more interventions? “We can deprogram more but it’s more complicated than before”, summarizes Rémi Salomon in West France, “Because we know the consequences”. “Considerable consequences”, abounds Bruno Riou at the microphone of France Inter, evoking the sequelae in other patients with unprogrammed operations.

Above all, indicates the medical director of the AP-HP, “Even 60% deprogramming may not be enough. Because the virus will rise. “

A dynamic anyway difficult to stop?

Isn’t Mass already said? In any case, that’s what Bruno Riou, AP-HP crisis medical director, seems to think. “The next 15 days for admission to intensive care have already been written down”, he indicated this Monday, March 15 on France Inter, before specifying that the intensive care admissions at the end of March will be linked to the contaminations which are currently taking place and are very numerous.

However, the number of people in intensive care is already higher than that observed during the second wave. “And the incidence rate is still going up”, notes Rémi Salomon, while it had been falling for ten days when the peak of resuscitation of the second wave was reached.

Hospitals in the Paris region should therefore already expect to receive a significant flow of Covid + patients.

The decision in the hands of politicians

The hospital situation at the end of March could therefore be much more complicated than that of the fall, simply because of the epidemic dynamic. Dynamics that the various measures implemented will struggle to stem.

But if health data has changed, so have political data. Is it still time for re-containment? Once again, the answer will most certainly come from the Élysée.

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