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COVID-19 STATS

EXPLAINED: What is the emergency ‘Plan Blanc’ being launched in French hospitals?

Local authorities across France are, once again, having to take urgent measures to mitigate the strain on hospitals amid another surge in hospitalisations because of Covid-19 - with health services in all regions triggering their plan blanc.

Two nurses in full PPE care for a Covid-19 patient in an intensive care unit at a hospital in Paris
Two nurses in full PPE care for a Covid-19 patient in an intensive care unit at a hospital in Paris. Extra staff are to be mobilised across France as part of the 'plan blanc'. Photo: Thomas Samson / AFP

All hospitals in Ile-de-France initiated a plan blanc on Wednesday, December 8th, following a rapid increase in cases, piling further pressure on the region’s healthcare system. This protocol will be rolled out across the entire country in the coming days. 

In a statement, the regional health authority said that it had decided to activate the plan because of ‘a situation that has been clearly deteriorating since mid-November’.

What is a plan blanc?

It is an emergency device, enshrined in law in 2004, that allows the temporary mobilisation of additional personnel to deal with an exceptional health situation, such as Covid-19. 

Once triggered, it allows hospitals to postpone non-essential surgeries and call-in staff who are on holiday. It is used in cases of a massive influx of victims following a major accident or disaster with numerous casualties, an epidemic or a deadly and lasting climatic event. It also allows for the mobilisation of a ‘health reserve’ to ensure healthcare levels are maintained.

It can be triggered by individual hospital bosses as required, as well as regional health authorities, prefects or the Prime Minister and is only lifted once the health situation has stabilised.

A back-up ‘extended plan’ – reserved for situations in which the organisation of the health system alone is not sufficient to deal with a health event, such as Covid-19 – allows departmental prefects to mobilise additional vital resources as necessary. 

READ ALSO Paris opens new Covid vaccination centres to battle Covid surge in capital

In the past, plans blanc have been triggered nationally during the influenza epidemic of 2017 and the deadly heat wave of 2003, and in six departments to deal with an outbreak of gastroenteritis in 2005.

In the case of Covid-19, the first plans blancs were triggered on February 25th, 2020, in the hospitals of Creil and Compiègne to deal with the first clustering of coronavirus cases. On March 6th, all hospitals in the Grand-Est and Ile-de-France followed suit, then all hospitals in France were put on the emergency footing a week later. 

A number of hospitals and regional health authorities have already unlocked their plan blanc. When Provence-Alpes-Côte d’Azur announced it had done so earlier on Wednesday, the deputy director of the Regional Health Agency said that “all hands were welcome”, and called on medical students, and self-employed and recently retired health professionals to offer their services.

READ ALSO What are the Covid recommendations around socialising in France this Christmas?

On December 8th alone, health authorities in Auvergne-Rhône-Alpes, Occitanie, Pays de la Loire, Bourgogne-Franche-Comté and Île-de-France instructed all hospitals to trigger their plans blanc. The Regional Health Authority in Hauts-de-France asked hospitals in the Lille metropolitan area, Hainaut and Oise to activate their plans, and called on all hospitals to ready a total 114 additional ICU beds.

Over the past week, hospitals in Mulhouse, Colmar and Nancy, in the Grand-Est; Saint-Malo, Dinan and Cancale (Brittany); Le Mans, Alençon, Orléans; Tours (Centre-Val de Loire); and Bayonne and Bordeaux (Nouvelle Aquitaine) have all activated their plans.

Why the urgency?

Nationally, Santé publique France figures published on Wednesday revealed that more than 61,000 new cases of Covid-19 had been recorded in the previous 24 hours, compared to the figure of 49,610 published the previous Wednesday. A total 129 deaths were recorded.

Meanwhile, 13,044 patients were being treated in hospital for coronavirus infection, including 2,426 in intensive care. On December 1st, 10,558 Covid-19 patients were hospitalised, with 1,886 in intensive care. 

READ ALSO French pharmacies to stay open on Sundays for Covid-19 vaccinations

“Regional plans blancs will be triggered in the coming hours in major regions of France due to the influx of covid-19 patients. A patient with a serious form of the disease enters the intensive care unit every 10 minutes,” Health Minister Olivier Véran warned in the Senate on Wednesday.

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COVID-19

EXPLAINED: Why Covid cases are rising again in France

France on Monday removed many of its remaining Covid rules, but even before that date case numbers were rising. So why is this happening? And is it something that we need to be worried about?

EXPLAINED: Why Covid cases are rising again in France

“Infections will rise again for 10 to 15 days,” Health Minister Olivier Véran told Franceinfo on Wednesday, two days after the country had done away with the vaccine pass and lifted mask rules in most areas.

“What the modelling of the Institut Pasteur tells us is that it will indeed go up until the end of March, we risk reaching 120,000 to 150,000 infections per day, and then we can expect a decrease,” he went on.

But he insisted the government had made the “right decision” in choosing to end most restrictions earlier than anticipated and in spite of an apparent epidemic rebound, saying “there is no risk of saturation of hospitals“.

So what’s happening?

Cases

Daily Covid numbers in France reached record highs in January, when an average of more than 366,000 new cases a day were recorded.

Current figures are well below that, but still high. On Tuesday, France reported more than 116,000 new cases in the previous 24 hours – a marked rise on the figure of 93,050 recorded the same day a week previously, and breaking the 100,000 barrier for the first time since mid-February.

The daily average figure – which irons out statistical quirks such as delayed reporting at weekends – is 65,143, a 25 percent increase on the previous week.

Map: Covidtracker.fr

“More than 50 percent” of new cases are due to the sub-variant of Omicron, BA.2, which is “more transmissible” but less severe, the Conseil scientifique said. 

Hospitalisations

The number of people being hospitalised with the virus has started ticking up again, after falling from a peak of 2,900 per day in early February. On March 13th, there were 973 new patients in hospital.

“High vaccination rates have made it possible to limit the hospital impact of these infections,” the Conseil said.

But about 4 million adult people remain unvaccinated and almost 5 million have not had a booster dose.

“The number of hospitalisations will increase temporarily in the coming weeks,” it added.

Admissions to intensive care and death rates both continue to decline, but usually any effect on these figures is not felt until at least two weeks after case numbers begin to rise.

European trend

France is not the only country that is seeing an uptick in cases, Germany, Austria, the UK, Belgium and Italy have all reported rises in recent days.

School holidays

Since the relaxation of the French rules only happened on Monday, it is clearly not the source of the increase.

Rather, regional variations in the spread of the virus indicates that schools reopening after the winter holidays has been a key driver of the latest rise in infections.

Schools in France are divided into three zones and take their February holiday at different times.

Guillaume Rozier, founder of the CovidTracker website, told AFP at the weekend. “The rise in cases is most apparent in northern France and along the Mediterranean coast, roughly corresponding to the areas where children returned to school earliest (on February 21st).”

Upticks in Covid figures have been spotted, too, in zones A and C, which returned to class later.

Spring

“The current cold climate remains an element that favours viral transmission. This should improve in the coming weeks with the arrival of the good weather,” says the Conseil scientifique.

As the weather improves and temperatures rise, socialising and activities tend to move outdoors, where the transmission risk is lower. This follows the pattern also seen in 2020 and 2021 when the virus receded in the summer, before returning in autumn.

Not a wave

“This rebound is not a wave,” says Véran. However he added: “The end of the obligation does not mean the end of vigilance. I invite French women and men to wear the mask in all circumstances which may expose them or those around them to the risk of infection.”

Institut Pasteur forecasts published on March 10th suggest that “in all the scenarios explored, the peak of cases [in March] remains much lower than the peak in January”. 

Experts are also confident that the combination of vaccinations and immunity because of previous infection will keep serious cases to a minimum.

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