'We are ready': inside the Paris hospitals bracing for coronavirus
With the number of cases of Covid-19 doubling every three days in France, the capital is preparing for the worst. In the northern sector of Paris, all 26 beds in the intensive care unit of the BichatClaude Bernard hospital are full, and the wards that have been turned over to Covid-19 patients are filling up rapidly. The Paris hospital system works by overflow, and the next in line is the Lariboisière, near the Gare du Nord train station.
“We are in the process of emptying the hospital to be ready to handle cases of Covid-19 cases, some of which could be serious,” says emergency physician Eric Revue of the “Larib”, as it is affectionately known.
The atmosphere at the hospital is calm. “My team is ready,” says Revue. But there is trepidation: “All the indicators suggest we are following exactly the same curve as Italy.” France may be a couple of weeks behind Italy – and the UK a couple of weeks behind France, if test results are any indication – but hospitals in Mulhouse and Strasbourg, in the north-east of the country, are already saturated.
And the mood in France is changing fast. Exasperated by the public’s nonchalance – the decision to close schools and universities from today prompted festive gatherings in parks and on the banks of the Seine at the weekend – the French president, Emmanuel Macron, is reportedly planning to impose more draconian measures including a curfew and neighbourhood-wide quarantines.
“What is frightening us a little are reports from our Italian colleagues that some of the patients are young and that they are having to choose between treating a patient of 40 and treating a patient of 60,” says Revue. “A terrible choice.” He considers the Italian hospital system and its demographic profile comparable to those of France. So
France is now at the point described by Daniele Macchini, a doctor in Bergamo, Italy, on 7 March:
“Well, the situation now is nothing short of dramatic,” Macchini continued. “The war has literally exploded and battles are uninterrupted day and night.”
“Samurai life,” another doctor working at the Niguarda hospital in Milan, wrote to me in an email on 13 March. “Something new we have never experienced before and that we will never forget.”
As of Sunday night, the Larib had 77 hospitalised cases of Covid-19 and another 44 in intensive care. Across Paris, there were 577 hospitalised cases and 123 in intensive care. The median age of Covid-19 patients in the capital is 62. In the northern sector the youngest patient hospitalised to date has been 26, with no underlying health problems. There have been cases among pregnant women, and studies are ongoing as to the effect of the virus in this group, but early indications are that it does not cross the placenta. One Covid-19 patient, an 86-year-old tetraplegic woman, has died at the Larib so far.
The picture is constantly evolving as new data comes in, but the
Paris hospitals are reporting that obesity and high blood pressure appear to be risk factors for severe cases. Smoking may be too. There is some evidence that the virus can infect the heart muscle, causing cardiac complications. “We are seeing two very different profiles,” says neurologist Claire Paquet, who is managing the Covid-19 response at the Larib. “There are cases that are immediately very serious, but that recover quickly, and others who get worse slowly and take time to recover.”
One problem in the hospital, as in hospitals across Europe, has been finding places for existing patients in retirement homes or other care facilities. This chronic problem has now become acute.
Another acute problem is the shortage of masks and of tests – and the wait for test results, which is currently around 24 hours. “If we had the results in an hour, that would allow a much more rapid throughput of patients,” Paquet says. As it is, the patients have to wait in the hospital until a decision is made as to whether to admit them or send them home.
The two problems exacerbate each other. “Because we don’t have enough masks for all our staff all of the time, there are staff who fall ill,” says Paquet. “If they have symptoms, we have to test them, because if they’re positive they have to stay at home.” The result is that patients and staff are competing for a limited supply of tests. “If we had masks for all our staff, we would have fewer who were ill, fewer who needed to be tested, more tests for the patients, and fewer staff contaminating patients.”
The Paris hospitals have a supply of around 2.5m masks. If these are used according to the health ministry’s current guidelines, Paquet says, they will last about two weeks. It doesn’t help that people are stealing both masks and hand sanitiser from the hospital. “The modellers tell us the epidemic will peak seven weeks from now. In two weeks’ time we will have nothing, unless we are re-supplied. What will we do?”
She has suggested asking fashion schools and prison workshops to help sew washable masks in large quantities. Meanwhile, UK-based company Mologic Ltd is working with the Pasteur Institute of Dakar in Senegal to develop faster tests, though these are unlikely to be ready for a couple of months, and luxury retail group LVMH – owner of perfume and cosmetic brands Dior, Guerlain and Givenchy – has announced it will turn factories over to producing hand-sanitiser for the hospitals. “Unless we come up with better barrier methods,” Paquet says, “the models suggest 50% of the population [of France] could become infected and 300,000 to 400,000 could die.”
In Revue’s team, absenteeism due to sickness is still under 10%, but the hospital is anticipating that it could rise to 20%. Calls have already gone out to medical students and recent retirees to help, and those groups are mobilising themselves. Meanwhile, Revue considers his first priority to sustain his team for the duration. “My job is to tell them, rest, pace yourself, because the fight is going to be long,” he says.