How can France increase hospital ICU capacity to 10,000 beds?

How can France increase hospital ICU capacity to 10,000 beds?
Health personnel at the intensive care unit of the Andre-Gregoire Hospital in Seine-Saint-Denis, outside Paris, treat a Covid patient on April 1st. Seine-Saint-Denis is the area suffering the highest pressure from the epidemic on hospitals. Photo: BERTRAND GUAY / AFP
French health professionals have greeted with scepticism President Emmanuel Macron's pledge that ICU capacity in the country's hospitals would increase to 10,000 beds to cope with rising Covid-19 hospitalisations.

On Wednesday, Macron outlined plans for an “extraordinary mobilisation” of the health sector in the coming days. 

Since the start of the pandemic, the number of hospital intensive care beds has been brought up to 7,665 beds from its usual base of 5,000. Of those, 7,053 are now occupied – 5,109 by Covid patients, according to Covid Tracker.

Health Minister Olivier Véran said the number of patients in intensive care could peak at 10,000 at the end of April. In comparison, at the peak of the health crisis last spring, on April 8th, 7,148 people were being treated in intensive care units across France.

During the second wave, intensive care patients peaked at 4,919 on November 16th. 

Healthcare issues

Increasing the number of beds to cope with rising Covid infections comes at the expense of non-Covid patients who needed medical help, several senior doctors have said.

“Theoretically, it is feasible, but to achieve it concretely it would take at least three weeks or a month,” said Alain Ducardonnet, a doctor and health consultant for French TV channel BFM.

Bruno Mégarbane, head of the intensive care unit at Paris’s Lariboisière Hospital, told French news channel LCI: “It can be done by transforming recovery rooms, operating theatres, or other sectors of medicine into new, temporary intensive care beds.”

The issue is not finding the beds.

Mégarbane explained the cost to staffing: “Doctors, nurses and anaesthetists would need to be redirected from operating theatres to these new beds.” 

It is estimated that 40 percent of non-Covid related surgeries have already been postponed to allow treatment for the number of patients with the virus. The health minister said last week that the aim was to increase this number to 80 percent in the greater Paris region Île-de-France, where hospitals are struggling to cope.

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Thierry Amouroux, spokesperson for the National Union of Nursing Professionals and a nurse at Saint-Louis hospital in Paris, described the knock-on effect. 

“When you postpone 5 percent of the operations, it is only cosmetic surgery [that gets cancelled], but at 40 percent, it starts to get serious, and when the [regional health authority] posts a target of 80 percent deprogramming, it touches on oncology (cancer treatment),” he told French daily Le Parisien.

Staffing and training 

Mégarbane said that, as well as current staff, the health system in France would have to mobilise its healthcare reserve, a list of 26,000 retired doctors, military medics and students at the end of their studies to be able to care for the number of people requiring the level of treatment and monitoring involved in intensive care.

But, then there is a question of training. Intensive care is highly specialised.

“In normal times, we can take less trained people and supervise them. Here we cannot, everyone is at the limit of what they can do,” Nicolas Bruder, head of the intensive care unit at La Timone hospital in Marseille, told BFM TV.

“So we need fully-trained people from tomorrow and we do not have them.”

Jean-Daniel Lelièvre, head of infectious diseases at Mondor hospital in Créteil told Le Parisien: “It seems completely unrealistic. We have the equipment and the physical space in the hospitals, but what will be lacking is the staff. 

“The president seems to say that we will find reinforcements, but will he learn resuscitation himself in two weeks? It is not my habit to criticise, but you should not announce anything.

“Going to 10,000 beds is a third more than the peak of last year. We do not know how we did it [then] and today staff are exhausted, while patients with other diseases are in a much more serious state because of breaks in care.”

Others have been rather more direct. These medics at the CHU de Nancy demonstrated their professional opinion of Macron’s statement in a tweet:

“We obey our president:

 – we make the effort

 – we move the walls to accommodate 10,000 ICU beds”

 


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