Health For hospitals in Ile-de-France, the great fog of deconfinement

For hospitals in Ile-de-France, the great fog of deconfinement

It is one of the three criteria retained by the government to assess the level of infectious risk of each department and to locally adapt the deconfinement measures: the state of local tension in the hospital system and more precisely the capacity of reception in the resuscitation services. On the provisional map presented Thursday evening by the Minister of Health, Olivier Véran, all the departments of Ile-de-France are colored in red. For good reason, despite the continuous decline in admissions to intensive care since the peak of April 9, 40% of 4,019 patients in acute respiratory distress hospitalized, are in the capital region, according to the Director General of Health, Jérôme Salomon. Bad news for Ile-de-France residents, who are condemned to endure restrictions on freedom and movement longer than others.

However, nothing is completely over. By May 11, this deconfinement map should be updated regularly, a department now in red that can change to orange or even green, if the cases of contamination collapse.

For caregivers in Ile-de-France, the question is central: should they expect to relive the “nightmare” from the beginning of April once the current constraints imposed on the French have been lifted, even partially? Or on the contrary caress the hope of breathing?

“Very wide range”

In a document that Release procured, the teams from the strategy and transformation directorate of Public Assistance-Hospitals of Paris (AP-HP) are trying to shed light on the future. Based on the model developed by Simon Cauchemez of the Pasteur Institute, taken over and extended until May 21, the modellers of the AP-HP made projections on the resuscitation needs in Ile-de-France on June 28 based on three assumptions.

(AP-HP document)

First scenario: after May 11, the coronavirus resumes circulating as quickly as at the beginning of the epidemic. Unsurprisingly, the worst is to be feared. After having reached a low point at the end of May (less than 500 patients in intensive care), the number of patients requiring intubation would then run away again, peaking on June 28 at around 2,800, a level higher than that reached in Ile-de-France hospitals at the peak of the epidemic…

Read also: Covid-19: the first deconfinement map unveiled

Second scenario: despite deconfinement, the reproduction rate of the coronavirus would stand at May 31 at 1.5. Clearly, two infected people would only infect three others. The pressure on the hospital system would become more bearable, with only 1,139 people being taken in intensive care as of June 30.

For Ile-de-France residents, the third hypothesis adopted is by far the most gratifying: despite deconfinement, the circulation of the virus would be controlled at 1.2 by 31 May, thus leaving the hope of an exhaustion of the epidemic (effective if the virus reproduction rate drops below 1). In this hypothesis, the Covid-19 would only mobilize in Ile-de-France more than 497 intensive care beds. A changeover in the green of the capital region would then be possible…

“So far the models have not been too wrong, estimates an AP-HP infectious disease specialist. But the range between the different scenarios is very wide. They serve as a fog light. combined with data from the city medicine business, it allows us to better anticipate what will happen at the hospital ten days later. ” Time for the hospital staff to adapt their capacity, but also for the executive to play vis-à-vis Ile-de-France residents with carrots or sticks.

Nathalie Raulin

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