COVID-19: Advice From a French Doctor on the Frontline

COVID-19 cases in France are rising but is the country heading for infections on the scale seen in Italy? What measures have already been taken in hospitals? Are they enough? What advice can infectious disease specialists give to healthcare professionals? Dr Benjamin Davido is an infectious disease specialist at Raymond-Poincaré hospital in Garches, on the outskirts of Paris.

He is the lead referral for COVID-19 and clinical lead for their ‘Plan Blanc’, the planned response to exceptional healthcare situations, which became a requirement following the terror attacks in 2014.He spoke to Medscape’s French Edition.
Since the beginning of [last] week, we have had a worrying and very significant increase in the number of cases. Currently, we receive one phone call for a screening request every 2 minutes, and one request to evaluate a patient suspected of having, or already tested positive for, COVID-19 every 10 minutes (and try to find a bed). We have had to assign two doctors full time to handle this. In addition, today [13th March], outpatient screening of caregivers suspected of having the disease revealed that 40% tested positive for SARS-CoV-2.
There is now a worrying degree of infection that shows the virus is circulating outside but also inside the hospital. This figure is all the more worrying because, 10 days ago, we were close to 0%. The increase did not happen by chance. When we had only 40 cases in France, we relied on level 1 Health Referral Centres (établissements de santé de référence; HRCs), such as Bichat or Pitié-Salpêtrière hospitals in Paris, to absorb the flow of patients. Now we have more than 3000 infected individuals, it is obvious that the dozen level 1 HRCs across the country are no longer enough. Consequently, second line centres, like our hospital, are taking their turn, just in time. We have had to adapt and put in place dedicated COVID-19 units. We have, as of today [13th March] a total of 11 beds, with a planned increase to 20 beds next week. Centres no longer have the time nor the space to receive and respond to the demand for screening.
Fifteen days ago, the screening of suspected patients had to be done in the hospital with containment measures. Today, it is no longer possible as these places are taken by confirmed cases. Screening is therefore performed in the emergency department. This is stage 3 crisis management, although this has not yet been officially announced, which underlines the pressure from the flow of patients arriving in hospitals. Some hospitals have installed tents for urgent services, but you still need to have the capacity, to have the space and enough caregivers. And these tents only allow outpatient diagnoses, they don’t allow for patients considered fragile or severe cases requiring hospitalisation in a dedicated isolation facility. It is certain that the curves of the Italian and French epidemics can be superimposed; they are just separated in time by around 10 days. One difference between the two countries is that Italy has a particular set-up in which healthcare is organised separately by region, which may have led to a delay in the organisation of care. Italy also organised the situation by geographic area; thinking, for example, that only the north of the country was affected, which was, in hindsight, probably a mistake. But in the same way, in France, in mid-February, we thought only in terms of clusters or people returning from at-risk zones, 10 km outside of which patients were not considered suspect, only for, the next day, those areas to become clusters. Today, in France, we no longer talk of zones or foci of COVID-19, and we no longer take into account travel.
On the contrary, we consider the severity of the illness, and it is the presence of unexplained pneumonia that makes us suspect a COVID-19 diagnosis, especially if it is serious straight away (in resuscitation, for example). We are now in the middle of a major public health problem. We have stayed at stage 2 in terms of the health alert, in that we screen people with relevant symptoms, even if they are minor. But as we no longer include history of travel, and the relevant symptoms are flu-like, such as having a fever, a runny nose, or coughing, and that, chronologically, it is the peak of the flu epidemic, we have an enormous influx of patients who may have flu or seasonal viral infection (mainly rhinovirus). These are consistent with the new coronavirus and, as such, we cannot, for benign cases, make a clinical distinction between them. It becomes therefore impossible to screen everyone. In any case, we don’t have enough kits. We are at the stage of counting the number of cotton swabs to take samples… Yes. Personally, for 10 days, I and my colleagues have struggled with the healthcare teams to urgently set up a hospitalisation and scree

Post time: Mar-23-2020

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