Doctor Jean-Marie Forel hangs up his phone and puts it away in his blue block pants. He has just refused the transfer of a Covid-19 patient to his department. “66 years old, too in difficulty and too old to be placed in an Ecmo, extracorporeal respiratory assistance …”, sums up the person in charge of resuscitation at the North hospital in Marseille.
The site he manages with Professor Laurent Papazian is the regional reference for pulmonary distress, and usually hosts the most serious cases in Provence-Alpes-Côte d’Azur (PACA). At the end of the line, his colleague from La Ciotat hospital (Bouches-du-Rhône), whose continuous monitoring service has been transformed into “Covid sheave”, received some technical advice. And the difficult one “Prepare the family”.
At the North hospital, as in all the hospitals in the South-East, patients infected with the coronavirus are saturating the intensive care units. On this last day of the year 2021, they are 31 out of the 44 beds, all occupied, on the first floor of this large bar overlooking the motorway. On all the sites of the university hospitals of Marseille (AP-HM), their number climbs to 75. Of which 86% are not vaccinated.
In PACA, the regional health agency decreed the white plan on December 7 and activated just before Christmas, level 5 of its Covid strategy. Since November 15, the AP-HM has recorded 92 deaths from the virus. The incidence rate at 1is January, 1,400 cases per 100,000 people, gives no cause for optimism. And pushes 500 doctors from Marseille hospitals – but none of Professor Raoult’s IHU practitioners – to sign a forum in Provence, Monday January 3, to encourage the inhabitants to be vaccinated. “We don’t have a case of Omicron in real time so far, but it can change very quickly. Our fear is that by reaching more people in a territory where the unvaccinated are numerous, this variant will cause an influx of patients ” Doctor Forel, one of the signatories of the rostrum, projects himself.
At the AP-HM, nearly two-thirds of non-urgent surgical interventions, all specialties combined, are deprogrammed to free nurses and decongest resuscitations. December 24th, Mediapart revealed the existence of a working document in which resuscitators discuss the sorting of patients that an acceleration of the pandemic might impose on them.
Days punctuated by “ventral decubitus”
“It’s not common to turn someone down for a sheave and nobody feels comfortable with that. But the selection, we operate for several days depending on the number of places. The older, the more comorbid do not fit. We give them a chance with high flow oxygen, but we prefer to keep the beds for people with a better prognosis. », explains Jean-Marie Forel. The choices are collegial and measured on a case-by-case basis. At the end of the day, a 60-year-old patient from the Alpes-Maritimes will also see his transfer refused. A few minutes later, the preserved bed will be assigned to a young thirty-something, pregnant, with a more favorable prognosis.
You have 69.42% of this article left to read. The rest is for subscribers only.
