Wednesday, March 31, 2021
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are intensive care patients really getting younger?

A sign that does not deceive ? For weeks, resuscitators have been drawing attention to one of the symptoms of the worsening Covid-19 epidemic in France: patients admitted to intensive care are younger than before. But this observation, made in particular in hospitals in Ile-de-France, is questioned on social networks by many Internet users. Some accuse doctors to lie and affirm, like the lawyer Fabrice Di Vizio, very critical of the authorities’ management of the health crisis, that “the average age has hardly changed”. Are these reviews true or “fake”?

In intensive care, a slight rejuvenation

Public data on hospitalizations categorizes patients by age group. They therefore do not make it possible to calculate the average age of Covid-19 patients treated in intensive care.

The AP-HP, cited by Le Monde (subscribers article), However, confirms this rejuvenation noticed by resuscitators. In Ile-de-France hospitals, the median age of intensive care patients has thus fallen from 65 years in 2020 to 63 years in 2021.

This trend is confirmed nationally. In its epidemiological update of March 25, Public Health France (SPF) notes that “since January 2021, a slight rejuvenation of the population admitted to intensive care has been observed”. “There is a slight shift in the average age. He is not of legal age, but it is clear”, comments for franceinfo Pierre-François Dequin, head of the intensive care unit of the University Hospital of Tours, who tempers: “The majority of patients are still of middle age.”

The patient profile has changed since the start of the year in the French intensive care units. There are almost half as many people over 80. They represented 12.9% of patients on January 1. They only count for 7.5% on March 24. Conversely, the proportion of 40-59 year olds increased from 18% to 24.8%. As for those under 40, from 2.8% to 3.5%. The proportion of 60-79 year olds, who represent the vast majority of patients, has remained stable, from 66.3% to 64.2%.

In his Raymond-Poincaré hospital in Garches (Hauts-de-Seine), Djillali Annane, head of the intensive care unit, sees this “transformation of the face of the epidemic”. “About a month ago, patients in the 20-40 age group represented one in twenty patients in intensive care, for a week they have represented one in ten patients. The proportion of severe forms admitted in intensive care for young people of the 20-40 age group is increasing and the majority of patients are under the age of 60 today in intensive care units “, he explains to franceinfo.

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“Even if they are rarer, we have cases of young patients, generally with the same comorbidities as the older ones. They are very often overweight patients, but not necessarily, confirms Pierre-François Dequin, at the University Hospital of Tours. We also have severe forms from time to time in young people, with no obvious risk factor. ”

The proportion of young people increases among those hospitalized

This development is even more obvious in terms of hospitalizations, in the Paris region as well as at the national level. People 80 and over represented more than 50% of hospitalized patients at the start of the year in France. As of March 24, they only account for 37.8%. Conversely, the proportion of 40-59 year olds has almost doubled, from 8.9% to 15.2%. That of the 60-79 age group has also increased, from 38.2% to 43.3%. As for those under 40, from 2.6% to 3.8%.

A trend already observed during previous epidemic waves …

This increase in the number of younger patients hospitalized as placed in intensive care is not a specificity of this third epidemic wave. It was observed, both in Ile-de-France and nationally, at the peak of the first wave for resuscitation, early April 2020, as at the peak of the second, mid-November 2020.

But if the number of patients aged 60 to 79 admitted to intensive care has not yet exceeded that of the peak of the second wave, that of 40-59 years is already higher than that recorded in mid-November. However, they remain far from the levels reached during the first wave in April.

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This phenomenon is linked to the very dynamics of an epidemic, explains Pascal Crépey, teacher-researcher in epidemiology and biostatistics at the School of Advanced Studies in Public Health, in Rennes. “The youngest age groups, those under 65, are more active and have more contact. The virus therefore reaches them more quickly and spreads more quickly in these age groups, before reaching the most aged, describes the expert. In a growing phase of the epidemic, we first have the young people who are affected and then the older ones. “

The incidence rate, i.e. the number of positive tests per 100,000 inhabitants, is increasing in all age groups, except among those 75 and over, according to SPF. This increase is particularly marked between the first two weeks of March. The most significant increase is observed among 0-14 years (27%) followed by 15-44 years (15%), 45-64 years (13%) and 65-74 years (8%). In addition, “the demography of the region plays”, notes Pascal Crépey. As the Ile-de-France has a slightly younger population than the national average, as noted by INSEE, this statistical difference contributes to increasing this slight rejuvenation in this region.

… Accentuated by the variant B.1.1.7 and the vaccination of the elderly

The variant identified in Great Britain also contributes to this effect, according to Pascal Crépey. Because this variant B.1.1.7 is both “associated with increased transmissibility (36% to 75%)”, but also “possibly to a more severe form of the disease, a higher risk of hospitalization and a higher mortality”, warns SPF. And it is now identified in over 76% of variant screening assays, according to data from SPF.

“The increased contagiousness of the ‘English’ variant affects all age groups. It increases the overall risk of hospitalization and of going to intensive care., describes the expert. But, because the variant is transmitted more, you are going to have more young people affected in the rising phase of the epidemic than in previous waves. It accentuates this gap. “

This slight rejuvenation is also partly due to the vaccination of people over 75, which prevents them from severe forms of the disease, according to SPF. However, “the incidence rates, hospitalizations and admissions to critical care services, which had significantly decreased among people aged 75 and over, (…) were slightly increasing over the past two weeks”, notes the health agency. Indeed, if 71% of residents of nursing homes have been vaccinated, only 25% of people aged 75 and over are, according to figures from the Ministry of Health. “At this stage, vaccination mainly protects residents of nursing homes, but in the general population, it does not yet cover enough people”, explains Pierre-François Dequin.

The practitioner puts forward another possible explanation: “TAll intensive care units are on. The pressure on the beds means that we may have to be more selective about the profile of patients. “ Resuscitators could thus “filter the patients a little more” taking more into account the “age criterion” and “co-morbidities associated with age”, what they were doing maybe less “at the start of an epidemic outbreak”, considers the specialist.

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