As elsewhere in France, the number of Covid-19 patients in intensive care has jumped at the Lyon-Sud hospital. But, according to department head Vincent Piriou, the number of beds can still be increased in view of a peak in admissions which will last “at least until mid-May”.
What is the situation in the intensive care units of Lyon-Sud? With what impact on scheduled operations?
“We are in a phase of ascent of the epidemic with resuscitation beds which are totally saturated in the city and the region, which is a new situation. When patients arrive at the hospital, we have to anticipate and free up beds. There are no more inter-regional transfers because the whole of France is involved in the Covid. In Lyon-Sud, we usually have 27 intensive care beds in two units, but we have reopened many: eleven since the beginning of September and nine more this week. We expect to reopen more beds, this time in operating theaters that are no longer in use, in increments of 5 beds, with the possibility of reopening others if necessary, even if the conditions of care could end up being degraded for lack of staff. With experience, we have this agility to close operating theaters and open resuscitation beds. The problem is that we have also accumulated a lot of delays in our functional and non-urgent surgeries for a year. However, all cancer surgery and urgent or semi-urgent surgery were well taken care of.
An epidemic peak expected in “ten days”
Are the restrictions imposed in the Rhône since March 27 and the rise of vaccination already having an impact?
It is difficult to assess whether the restrictions that have been proposed have had an effect on our resuscitation capacities, because when these restrictions were imposed on us, we did not have the same proportion of British variant as today. The epidemic has probably been mitigated by the restrictions, but we have a proportion of the variant that has also increased concomitantly, which means that, in the end, the epidemic is difficult to control. We think that the peak should come in about ten days, and there is always a lag between the city and the intensive care unit, because our patients stay about 15 days, three weeks, even a month in intensive care. This means that the intensive care units will be saturated at least until mid-May, and we do not expect a return to normal before mid-June. With the arrival of the variant and the vaccinations that we have already put in place, we have slightly younger patients, but still the same type of profile: patients who have comorbidities or a little obesity. Some of these patients had access to vaccination but before they had an immune status that protects them. We have had recently vaccinated patients who developed a serious Covid infection because the time between the second dose of vaccine and contact was too short for there to be immunity.
“There is staff weariness”
This is already a third wave. What state of mind drives the hospital staff, who are heavily involved?
“In the first wave, we had an effect of astonishment, where France stopped with a very solemn speech from the President of the Republic and everyone was indeed at attention. There the atmosphere is complicated. Indeed, there is staff fatigue because people no longer see the end of this epidemic. It has been going on for a year now and there are a lot of concerns. And these transitions from operating room staff to intensive care units are causing concern. On the one hand, because it’s a new job for them, but also because it disrupts their personal life. They no longer have the same hours and work at night, which creates very significant complications in their home. But we have to face it, it is the caregivers above all, and this motivation still exists despite a real phenomenon of weariness. “