All the lights are red. After a summer marked by the 4th wave of the Covid-19 epidemic characterized by the emergence of new variants, the fall is also struck by an epidemic upsurge, especially in Ile-de-France. According to
government-supplied data, the region is experiencing a rapid increase in all red flags.
The incidence rate in Ile-de-France was 162.17 per 100,000 inhabitants on November 18, an increase of 76% over the previous seven days. It was 171 for the whole country on the same date. The average daily number of new cases was up 76% over seven days to 2,841 people. A situation that is now spreading to hospitals.
Growing epidemic monitoring figures
“We are in the middle of the fifth wave, very clearly”, warns Professor Djillali Annane, head of the intensive care unit at the Raymond-Poincaré hospital in Garches (Hauts-de-Seine). Its department, with those of Paris and Val-d’Oise, respectively at 170, 220 and 168, are the three departments with the highest incidence rate in Ile-de-France. Regarding the hospital situation, according to the ARS, “the dynamic has also been on the rise since the end of October, but more in conventional hospitalization with 714 Covid patients, than in critical care with 290 Covid patients currently and rather with elderly patients ”.
“A month ago, we were one in four patients hospitalized for a serious form, accounts Djillali Annane. Today, it is more than one in two patients. Of the last three entrants in 24 hours, two were admitted for a serious form of Covid, he laments. In my department, there are almost 60% of Covid patients. “
As of November 21, on average over the last seven days, 18 patients were received in intensive care in hospitals in the Ile-de-France region. “We receive unvaccinated people but they do not constitute the majority of cases,” explains Djillali Annane. There are also patients who are fully vaccinated but who respond poorly because of their co-morbidity such as cancer or transplant recipients who have a severe form of the disease, regardless of their age. “On its resuscitation beds, there are also” patients vaccinated but with a second dose which dates from more than six months ago. ” To avoid taking risks with a too late booster dose, the orientation council of the vaccine strategy on Monday, November 22 opened the way to an enlargement of the public eligible for a booster dose.
Nursing staff already under stress
This upsurge in the epidemic comes at a bad time for Ile-de-France hospitals, already facing staff fatigue and an epidemic of bronchiolitis in newborns. “Even before the wave of Covid gained momentum, there were closed beds in hospitals, regrets Rémi Salomon, president of the AP-HP establishment medical committee. There is around 10 to 12% absenteeism, which is one to two points more than usual. Those who stay have more work. Many people in the nursing staff tell me that they are going to leave… ”
According to figures from Martin Hirsch, the director general of the AP-HP, invited this Monday to the morning of France Inter, “1,000 out of 18,000 positions are currently unfilled” in Ile-de-France hospitals. “There is little or no room for maneuver in Ile-de-France, regrets Djillali Annane. There is no staff on vacation that we could overwhelmingly recall from vacation. “Martin Hirsch also assesses” 300 patients in intensive care in AP-HP establishments, ie a quarter of all patients “. A situation that is all the more problematic as it can worsen in the coming weeks if no action is taken.
If the situation does not change “we explode”, alert a mathematician
“We learned over the course of the different waves that there was a 15-day lag between hospitalizations and intensive care,” explains Djillali Annane. It is normal that we do not yet have an exponential increase in intensive care, we will have it in two weeks, ”he says. According to Jean-Stéphane Dhersin, mathematician in charge of the modeling coordination platform CNRS Covid-19, “The peak of the current wave will depend on the measures that will be taken” because they will “impact the evolution of the epidemic”. “In an epidemic, there is where you are and how fast you go. It’s like in a car with a wall in front of you. If you slow down enough you don’t take the wall but if you don’t slow down you hit the wall no matter the distance. “According to him, if the situation does not change quickly” we explode.
To avoid the worst, Djillali Annane advocates for an “expansion of the third dose of vaccine”. He also believes that it would be necessary “to reconsider the return of gauges in places open to the public”. Finally, the head of the intensive care unit at Garches hospital believes that France and Europe must “ensure that this treatment is available from December. “” With vaccination, the effect on hospitals is much longer, analyzes Rémi Salomon. If the wave continues in Ile-de-France, I fear that the number of patients in intensive care may increase. “