Wednesday, March 31, 2021
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if it is necessary to sort the patients, “it is the young people that will obviously be privileged”, warns an infectious disease specialist

Faced with the outbreak of the Covid-19 epidemic, if hospitals were to sort patients, “it is the young people that we will obviously privilege”, said Sunday March 28 on franceinfo Benjamin Davido, infectious disease specialist at the Raymond-Poincaré hospital in Garches in Hauts-de-Seine. He is one of the signatories of the forum published in the Journal du dimanche, in which doctors from the AP-HP indicate that they are preparing to make a “sorting of patients” with Covid-19.

franceinfo: When we hear about “sorting patients”, we wonder how this sorting will be done. Do you know on what criteria you will have to make these very difficult decisions?

Benjamin Davido: First of all, we must reassure listeners: the choice in medicine is our daily life. We are used to making choices, according to an age criterion we know that there are people who benefit more or less from intensive care. We have observed younger and younger people arriving at the hospital and it is these young people that we will obviously be privileged. But we would not like to find ourselves in a situation where, for lack of space and saturation of hospitals, we are in a quality of care that is degraded.

The big difference compared to last March is that the hospital is now full of Covid patients, but also non-Covid patients. Today, hospital beds can be counted on the fingers of one hand.

Benjamin Davido, infectious disease specialist

to franceinfo

We wonder how we are going to do when there are patients left in the morning in the emergency department for whom we have not been able to find hospital beds. At some point, there is going to be an extremely complicated situation when there will be life-threatening emergencies to manage and there will be no room left in inpatient departments.

Does that mean that it is still possible to avoid this situation?

I think that everything that can be done to reduce contamination today is necessary. We can clearly see that, on the side of the politicians, some are active to open urgently hospital beds in intensive care, in particular in Ile-de-France. But what must be understood is that we will not be able to extend these hospital beds ad infinitum.

The example of Germany has shown that with three times as many resuscitation beds, we weren’t saving more people and that at a given time, what is needed above all is to curb contamination.

Benjamin Davido

to franceinfo

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What we would like, overall, is to find a solution with a wave of a magic wand and for everyone to stop infecting themselves. We know that the choices are extremely difficult at the political level, confinement is a political decision, and that there is an economic, psychological and societal impact. But very clearly, we arrive at a very insolent contamination rate of more than 40,000 contaminations and that brings back bad memories to us. The severity and volume of patients arriving at the hospital today is strangely similar to what happened last spring.

Isn’t it still too early to assess the impact of the current containment measures? Do you have the feeling that it’s not going to change much?

As of Wednesday, we should be able to see or not whether the external containment measures have been effective. I think the idea of ​​outer confinement was a good one. Simply, the communication around was not clear enough. We saw en masse people last weekend leaving especially from the Ile-de-France region, even though travel between regions was prohibited.

I had pleaded against this regionalized confinement, since the reality is that confinement only makes sense when it is national, so that the measures apply to everyone.

Benjamin Davido

to franceinfo

When it is better to live in one place rather than another in France, you de facto create population movements. The next Easter holidays are around the corner. So there are a lot of urgent decisions to be made today that will impact hospitalizations in the next 15 days. And therefore, we will have to have decisions that both free up hospital beds and allow people to live with the virus.

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This forum also warns about the consequences of the deprogramming of non-emergency operations, which can lead to the death of patients in the medium term. ?

Exactly. In the Raymond Poincaré hospital where I work, there is high-level plastic surgery. Patients have been on waiting lists for several months and sometimes come from all over France. Postponing these scheduled operations which are already in a certain emergency can impact the vital prognosis of patients. And I’m not even talking about cancer surgery! It is extremely difficult to accurately assess the loss of luck for patients. But what we want is not to have to catch up in August all the complications that would arise from this hospital saturation. The reality is that interactions between individuals must be limited to reduce contamination. This is the only thing that will make it possible to influence resuscitation and have better days while waiting for the vaccination campaign to take effect. For that we know that it will take another two to three months to feel an improvement in hospitalizations.

Do you have the feeling that these deprogramming decisions are taken lightly by the executive?

No I don’t think so, I think there is a choice between intensive care patients who arrive for reasons of life or death and a patient who is scheduled. There is an urgency which is immediate and an urgency which is relative. I am extremely worried because we are reliving the scenario of last March, which is an admission of failure both political and health. Many of my colleagues had praised the improvement in the quality of care. The reality is that the virus has taken precedence over us and that even with the best of wills, the best of energies, we see that we are in the same situation as last year and it is demoralizing. We will arrive at a time when we will have no other choice but to re-define.

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