By Joshua Robinson and Noemie Bisserbe | Photographs by Agnes
Insight Online News
CHAMBÉRY, France—In a wood-paneled boardroom not far from the packed intensive-care unit, the director of France’s hardest-hit hospital this fall gathered his department heads for a Covid-19 crisis meeting. The next 48 hours figured to be decisive. Just like every 48-hour stretch for the past six weeks.
There were struggling patients who needed to be put on small jets to less-crowded facilities around the country. There were nursing students on their way to help plug staff shortages. And there was the relentless high-wire act of keeping just enough beds open for the next day’s Covid-19 arrivals.
“For the hospital, it wasn’t a first crisis and then a second crisis,” said Florent Chambaz, the director of Chambéry’s regional hospital. “It’s been a continuous crisis since February.”
Seven months after the pandemic first peaked in the West, hospitals are once again on the brink. There were 79,410 Covid-19 patients in U.S. hospitals as of Wednesday, a record. In France, that figure has reached 33,000, outstripping the April mark of 32,000. The country’s ICU occupancy rate has reached 94%. And in Italy, the number of people in hospitals last week hit 34,000, exceeding the country’s previous record set on April 4. More than half of all ICU beds in the region of Lombardy, once again Italy’s epicenter, are now occupied by Covid-19 patients.
“The situation,” Mr. Chambaz reminded the staff, “is still very tense.”
Hospitals in France have converted facilities into Covid-19 wards and stocked up on ventilators and other supplies. Patients are receiving more effective care than they would have seven months ago. Things might seem, as Mr. Chambaz told his staff, “less worse”—daily reported new infections have fallen to a seven-day average of 30,000 from more than 45,000 a week ago as France enters its fourth week of a national lockdown.Rising TideFrance has more Covid-19 patients in hospitalthan at any point in the pandemic.Number of people hospitalized with Covid-19Source: France’s national health agencyNote: Data as of Nov. 15April 2020Nov.05,00010,00015,00020,00025,00030,00035,000
But health-care workers now view these declines as temporary lulls in a war of attrition. The government of President Emmanuel Macron is currently in deliberations over how to lift renewed lockdown restrictions and salvage holiday shopping, raising the specter of another surge. And there are few reinforcements available, because countries haven’t had enough time to train nurses and other staff, particularly those working in ICUs.
“You cannot just add a respirator next to a hospital bed. You need staff,” said Frédéric Valletoux, the president of France’s Federation of Hospitals, adding that 30% of hospital jobs nationwide remain vacant.
Nursing staff monitored the health of patients in the ICU of Chambéry’s regional hospital in France on Monday.
Chambéry has enlisted the help of local nursing students in the second year of their three-year programs and even asked recently retired professionals to help on a volunteer basis across the hospital. ICU trainees practice on elaborate simulator dummies.
“Even if I wanted to add 50 to 100 new nursing jobs, there wouldn’t be 50 to 100 nurses on the market to fill them,” Mr. Chambaz said.
Under normal circumstances, Chambéry’s regular stable of 18 ICU beds would be enough to serve a population of 400,000, according to Mr. Chambaz, offering care to much of the region. In a typical winter, this hospital at the foot of the Alps even adds a couple to deal with skiing accidents. But now, its ICU has more than doubled its capacity as the hospital treats nearly three times as many Covid-19 patients as in the spring, when it peaked at a relatively manageable 93.
That said, Chambéry is substantially better at fighting the virus today than it was then. Oxygen therapy is better understood, as is the use of corticosteroids, and patients aren’t intubated quite as readily. The problem is that Covid-19 hospital stays remain at least eight days long, according to Dr. Emmanuel Forestier, the head of Chambéry’s infectious-disease unit.
Someone who moves to the ICU might occupy a bed for up to a month, authorities say. A team of five to six doctors, nurses and nursing assistants are required to run one ICU bed, and they face a long list of tasks every day. Covid-19 patients require round-the-clock monitoring in the ICU, and they must also be repositioned every few hours to facilitate their breathing.
In Chambéry this week, it took a team of five doctors, nurses, and nursing assistants—some freshly out of ICU training—to lift, then flip a single unconscious patient without disconnecting the ventilator that kept him alive. That delicate exercise takes place a dozen times a day across the ward.
So even as hospitalizations begin to plateau, ICU chief Dr. Jean-Marc Thouret said, it will take weeks for a hospital such as Chambéry’s to feel a major change in workload.
The stress is transforming the way the entire hospital functions. Everyone with the qualifications to carry out technical intensive-care procedures, such as assisting with intubations or managing ventilators, has been reassigned to the ICU.
Those who don’t are pressed into Covid-19 service elsewhere, like Lorene Descamps, a nurse who usually looks after patients recovering from urology surgery. Before the pandemic, her team would only see a patient die every four or five months. She helped people heal and walk out. Now her ward is full of the Covid-19 patients least expected to survive.
Ms. Descamps and her team were so nervous about confronting the virus that they often overdressed in protective gear, simply to reassure themselves, she said. (Ms. Descamps lost her grandfather to it over the summer.) Her responsibilities now include inviting desperate families to say a final goodbye while limiting their exposure. Those families know something is wrong when they get the call, since visits are otherwise forbidden and exceptions are made for only a few minutes. When patients die of Covid-19 here, most tend to die alone.
Earlier this month, Ms. Descamps’ team hermetically sealed 14 body bags in 13 days.
“We’re in a department where patients normally do quite well,” she said. “And now suddenly most of them are at the end of their lives. This many at once, and with this many deaths, we didn’t expect it. It was very violent.”
The sheer ubiquity of infections in the latest wave is preventing authorities from transferring patients to less-crowded hospitals. That was a key pressure valve in the spring, when France transferred 644 patients from epicenters such as Paris and eastern France to other parts of the country, often on high-speed TGV trains. Since October, hospitals have only transferred about 100 patients.
Mr. Chambaz attends a conference call with other hospital chiefs to find out who might have a spare bed. As of last Friday, he had arranged 17 transfers.
But even in the few areas of the country that aren’t feeling the brunt of the second wave, such as Bordeaux, hospitals continue to grapple with a backlog of non-virus patients who suffered from delayed treatment in the spring. That is making it difficult for hospitals with spare capacity to give priority to Covid-19 patients.
“We are very careful to avoid any delay in treatment or diagnosis for other patients,” Bordeaux hospital director Yann Bubien said.
In Chambéry, staff morale has taken a hit. Doctors and nurses admit the first wave came with a certain professional exhilaration. Treating a mysterious new virus while maintaining a furious rhythm tested their training in ways they had never experienced.
The spring also brought front-line workers a level of solidarity and recognition that made it easy to keep going, from the nightly rounds of applause that echoed around Chambéry to the local pastry chef who plied the staff with cakes daily.
“We felt defeated,” Dr. Thouret said. “We didn’t see ourselves being hit with a wave like this. Then we got back to work.”
SOURCE : WALL STREET JOURNAL