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South France hospitals prepare for second Covid wave

Hospitals in four “red zone” departments in Provence-Alpes-Côte d’Azur are preparing for a second wave, as numbers rise in the region.

The four departments are Vaucluse, Var, Alpes-Maritimes and Bouches-du-Rhône. Hospitals in these areas are now following a plan blanc (white plan) allowing them to quickly mobilise resources if a second wave does hit.

Director of care in regional health organisation the Agence Regionale de Santé (ARS), Anthony Valdez told news source Le Figaro the plan blanc is “an organisational measure to help hospitals face major events. It means hospitals can activate a daily crisis cell to monitor the capacity of the establishment, the flow of patients in dedicated units, and to survey patient passages through A&E and the level of medicine stock and materials".

Read more: What are France’s red zones and vulnerable departments?

Hospitals not feeling impact of rising numbers, so far

Activating a plan blanc can also allow hospitals to put non-essential operations on hold – something hospitals in Provence-Alpes-Côte d’Azur (PACA) have not yet done, even though cases in are rising.

Last week 7,966 people tested positive in the region compared to 4,729 the previous week.  

However, numbers of hospitalisations have not risen significantly.

There are 369 people currently hospitalised with Covid-19 in the region, with 61 of those being admitted in the last week. Of those 49 are in intensive care, a rise of 9 on the previous week.

This reflects national trends. Weekly figures released by health body Santé Publique France on August 27 show that in the seven days prior there were 26,890 new Covid-19 cases in France. However, only 1,084 patients were hospitalised, and 174 were admitted to intensive care.  

Mr Valdez said: “Covid is having a weak impact on hospital capacity for the moment, but we need to stay vigilant.” 

Read more: 7,000 new cases: Covid-19 in France spreading exponentially

Extra beds available

As well as the 480 beds normally available in intensive care, an extra 110 have been made available in PACA hospitals. This will help hospitals manage potential Covid cases alongside regular admissions following incidents such as road accidents. 

This has not always been easy during the healthcare crisis, according to Mr Valdez. He says hospitals: “have an enormous amount of catch-up to do for things that have been stopped for some months. If we have to restart and cancel things, it becomes very complicated.”

A major part of preparing for a second wave aims to make sure hospitals are in a position to “respond to the health needs of the population while managing Covid too”.

Professor Thierry Piche, president of the medical commission at the CHU Nice hospital agrees.

He told Le Figaro: “We need to integrate coronavirus like an illness, certainly a new illness, but an illness like all others. We don’t want the management of patients infected by Covid to impact other sick people.”

Nice hospital has calculated how many Covid patients it could care for, while still maintaining normal services for other patients. They calculate 15 out of 37 beds in intensive care could be dedicated to Covid patients. 

Professor Piche said: “Beyond this we would have to start cancelling other services. We have started working with doctors to decide which specialities would be impacted first.”


Hospitals working together 

Hospitals in the PACA region are also working together to try and respond to a potential second wave.

Professor Laurent Papazian is an intensive care doctor at the Nord hospital in Marseille and also monitors intensive care services in the region for the ARS. He told Le Figaro: “There is a principle of subsidiarity between the departments.

“Today Avignon has only one intensive care service so we will probably need to transfer patients. I’m in contact with all my colleagues in other departments and I communicate intensive care needs to the ARS. For the moment we are trying to not open too many beds as we don’t have the means.”

Medicines and materials also being monitored

As well as beds, hospitals are also working to ensure they have stocks of supplies such as protective masks and gloves. The ARS advises hospitals to stock three to four weeks of such supplies, something Marseille Hospital has done already, and Nice is confident it will be able to do soon. 

They are however struggling to recruit extra staff, something they are allowed to do when the plan blanc is activated.

Hospital authorities say that recruitment is often challenging, especially for specialist positions such as intensive care nurses.

However, Florence Arnoux, regional delegate for Fédération Hospitalière de France PACA told Le Figaro that psychological factors are also playing a role.

She said: “We are preoccupied by psychological fatigue and exhausted medical staff, that’s also why it’s difficult to find cover staff.

“Not everyone has recuperated psychologically since what happened in spring. Tiredness has set in, and what is difficult is that we can see we’re starting a period that will be much longer than the first wave. It’s not a good sign that this started in August.”

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