“The price to pay, beyond the saturation of the healthcare system, is a large number of deaths”

“The price to pay, beyond the saturation of the healthcare system, is a large number of deaths”
“The price to pay, beyond the saturation of the healthcare system, is a large number of deaths”
Karine Lacombe, head of the infectious diseases department at Saint-Antoine hospital in Paris (AP-HP) reacts to the measures announced Wednesday evening by Emmanuel Macron.

According to her, it is impossible, with these measures, to descend very low in the circulation of the virus, as in last May. On the other hand, vaccination should make it possible, at the end of the restrictions, to stem the disease … provided that the deliveries follow.

Will these new measures be sufficient in the face of the progression of the epidemic? Are they too late?

We must not look back, we are not going to repeat the pandemic. The epidemic is increasing so strongly, with such a vertiginous slope, that measures had to be taken. The measures that have been announced mainly concern the education system, where for several weeks we have seen an extremely high infection rate, among 10-30 year olds, for example. So we have a hope that it could have an effect on it.

But we will never go back down to the hollow we had after the first confinement in May 2020. It is impossible with these measures. This time, the bet is made, it is to keep the health system to take care of the sick until the vaccination campaign works.

Are we betting everything on the vaccine?

The bet of January was political, it was obvious that it was not going to work. As much there, the bet of the vaccine policy … We now know that the vaccine is effective, as well on the individual protection as on the transmission. And it should work, provided the planned deliveries take place! We have no guarantees on that side. Week after week, from January to March, we received about half of the planned doses.

Also, the term used was the correct one: these are “braking” measures. No measures to “contain” or “flatten” the epidemic, like a year ago. Semantically, this is not trivial … it means that we accept to live with the virus, that we hope that the health care system holds and that the vaccination works.

Were these choices made at the cost of tens of thousands of additional deaths?

Ah yes of course! We will exceed 100,000 dead, that’s for sure. In January, in February, we decided, chose, without it being said like that obviously, the price to pay. This price, beyond the total saturation of the healthcare system, is a large number of additional deaths.

The promise was not to reconfine, but the measures drag on and harden …

I no longer believe, now, that we will have a new confinement. On the other hand, I believe that the current measures will last well beyond four weeks. The schools, yes, will probably reopen in three or four weeks. But the rest will not be lifted, the restrictions will be maintained well beyond. We will stay a long time, again, with these braking measures.

Emmanuel Macron thanked the caregivers while asking them for new efforts. How are your teams doing?

They are exhausted, of course. Physically, psychologically … Where I usually have 36 infectious disease beds, I had to install five more. And they are all occupied by covid patients. The other patients suffering from infectious diseases, we don’t take them, they go elsewhere, I don’t know. We are not treating them at the moment. The teams are exhausted but hard at work.

But we make an effort! It’s a huge effort to convert and only treat one disease. The teams are exhausted, physically and psychologically, but we are tough people at work. We adapt. There, my teams were trained in the management of high flow oxygenation, for example, which are resuscitation techniques. We know that we will have to use them in the coming weeks, to participate in the discharge of the resuscitation services. There are resuscitation units that are going to open moreover everywhere in France, because we are not going to let people die at home! That would be intolerable for us, that!

We published columns this weekend, which were criticized. But the point was to give an electric shock, too. This is the only way to react, to remind people in what situation we are, on the edge of the abyss!

Precisely, other hospital officials believe that the situation is not yet so serious …

In fact, it’s like political power: they look at D-Day, at T-moment, without projecting themselves. Except that with the current dynamic, everyone has understood that things are going up exponentially. Those who say that we are not engorged now … but fortunately! Fortunately, we are not yet letting people die in the streets. But on D + 7 or D + 14, without measurements, we will be there! The statements of the Hospital Federation are really a very short-term vision.

We are taking action now for the future, otherwise it is too late. Everyone understands that a car launched at 120 km / h stops in more time than a car at 60. It’s the same, knowing that we are already going very fast. We will not see the impact right away, the coming weeks will be very hard.

Has the patient profile really changed?

Yes a lot. What is very surprising is that we still have conventional medicine beds. But in intensive care, we saturate: people go directly from the emergency room to the sheave. Before, they arrived, were hospitalized, then left for intensive care later, if their condition deteriorated. It was not immediate.

They are also much younger people: a third of our patients are under 55 years old. With an average of 60 years in intensive care, but an enormous standard deviation, and patients aged 30 in sheaves! We didn’t see that before. But it makes sense, in fact: there is still a relatively small percentage of patients of that age who end up in intensive care. But since they are much more numerous, we have more and more of them. No one is immune.

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