Covid-19: resuscitation can only be the “last resort”



In the processions of anti-health and anti-vaccine protesters as well as on social networks, the argument comes up regularly: “People are not dying from the Covid but from the lack of beds in hospitals”, “The abolition of intensive care beds is a pretext to restrict freedoms”, “We wouldn’t have to be vaccinated if there was more room in the hospital”

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For a year and a half, the saturation of hospitals has been one of the indicators used to measure the epidemic situation of the country and decide on health restrictions. At the end of the first wave, the Minister of Health, Olivier Véran, had also assured that France could soon, if necessary, double its reception capacity in intensive care (a goal never achieved). Would increasing the number of beds be “the” solution to get through the epidemic without imposing restrictions?

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Not enough staff

“To think that resuscitation can be, on its own, a solution to save people from Covid is a huge mistake”, answers, without hesitation, Jean-Michel Constantin, head of the service at the Pitié Salpêtrière and secretary of the French Society of Anesthesia and Resuscitation (Sfar). First, because opening a sufficient number of beds to accommodate the flood of serious contaminants that the lifting of the barrier measures would induce “Would be impossible”.

Since April 2020, the opening of units “Ephemeral” has become a regular exercise, but which supposes an exceptional mobilization. If the price of a respirator reaches € 30,000, and that of intensive care monitors € 80,000, “In France, it is not the equipment, but the lack of personnel which makes it impossible to open more beds”, says Éric Le Bihan, anesthesiologist at Beaujon Hospital (AP-HP) and general secretary of the SNPHAR-E union. For each bed created, “It takes about five nurses, four nursing assistants, not counting the doctors”, lists Professor Constantine.

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Human needs that the hospital is unable to provide in the short term, nor to support in the long term. “We can call on doctors and nurses from other services, but this prevents these services from functioning normally and requires the deprogramming of operations”, recalls Éric Le Bihan.

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Resuscitation also requires specific training: “Not everyone can exercise there, explains the doctor. This requires a mastery of specific drugs, dialysis, respirators, electrocardiograms … “

“Resuscitation is the last resort”

For Jean-Michel Constantin, “Let people get infected and welcome everyone to the hospital” is not only not possible, but not desirable. “Resuscitation is not always a chance, it is very violent for the body and represents a solution of last resort, which is far from saving everyone: people with severe forms who return have about 40% of chance survival rate, 20% for those over 75, details the secretary of Sfar. It is not a solution, but a safety net with big holes. Today we have vaccines that allow us not to play Russian roulette. “

For patients discharging from an intensive care unit after an acute respiratory distress syndrome, “Studies show that the after-effects and the quality of life in the years that follow can be catastrophic”, emphasizes the doctor. It also notes that, more generally, the serious or long forms of the Covid, with or without a transition to critical care, “Cause symptoms in patients which we do not yet know if they will ever recover”.

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Finally, resuscitation has a high financial cost: a single day of hospitalization amounts to approximately € 2,000 for Social Security, to which will then be added the follow-up care which the doctors estimate could be spread over. months, even years. “A cost that the French hospital system would be unable to absorb if it were generalized”, concludes Jean-Michel Constantin.

→ PODCAST. “Covid-19, when everything changes to intensive care”

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