While there is more and more talk of deconfinement, Dr Bernard Lecomte, crisis medical director and former head of intensive care at Ajaccio hospital, takes stock of the management of Covid in his establishment. And protests against the fake news circulating about the virus
What is the situation today at Ajaccio hospital?
The situation at the hospital has improved slightly, we must not forget that we are still out of step with the positivity rate noted in the general population. Since most often, the aggravations justifying hospitalization occur 8 to 15 days after the viral attack. According to statistical data, the epidemic has clearly regressed in Corsica as on the continent. The incidence rate fell below 200 cases per 100,000 inhabitants last week. Three weeks ago, that rate stood at over 800 cases per 100,000 population. It is therefore an undeniable effect of confinement on the epidemic and viral circulation. However, if we have noticed a slight improvement in recent days, the intensive care unit as well as the Covid medical unit of Mercy still have many patients affected by the epidemic (9 people in shifts, and 31 in the conventional unit according to the report of the ARS of November 21, editor’s note). So we cannot yet say that the regression is truly confirmed and that the wave is behind us.
The announcement of deconfinement is expected this week. As a resuscitator, do you fear it?
We are necessarily worried. However, if people understand that we must respect the barrier measures and avoid large family reunifications, lifting the confinement seems a good measure. Above all, people need to stay alert, protect themselves and others.
A controversy has arisen over the figures for the death rate of the Covid, some believing that the count of deaths from the pandemic would include deaths not directly linked to the Covid. What do you think ?
There are several elements that make it possible to attribute a death or not to the Covid. First of all, the death certificates. This is an analysis which is made by the authorities on the basis of the declarations of death. In a death certificate, it is written what the patient died with the possibility of specifying: “the cause of death was consecutive to”. Several lines can be filled.
The second source that makes it possible to report deaths linked to Covid is the civic directory, which is a national tool for crisis management, both for attacks and for the coronavirus. From the start, establishments have entered any patient arriving for the Covid and their hospitalization journey is then traced by this software. Developments, deaths, returns home, transfers, etc., everything is listed there. It is a source of information which can count potential errors, the entries not having always been uniform.
The third source of information is that of the establishments themselves. For any passage of a patient in a medical unit, a standardized discharge summary is drawn up. This summary shows the primary diagnosis and associated diagnoses. It is in the analysis of these standardized discharge summaries that it is possible to clearly identify diagnoses linked to Covid. In the group, there will be patients treated for something other than Covid, whose main diagnosis will be, for example, a myocardial infarction, and in whom a Covid has been discovered. It will therefore be specified in the associated diagnoses that these patients were carriers of the Covid without necessarily having the symptoms. And if these patients die of their infarction, they will not be counted as Covid deaths.
The ambiguity that some people raise – these same people also often testify to a real doubt of the very existence of the Covid – comes from the fact that they claim that elderly people were counted in the Covid who, in any case , would have died their beautiful death this year, without even having been affected by the epidemic. Or no! These people would not have died in the same way. And each time a patient is listed as deceased from Covid, it is because he had developed a respiratory disease linked to Covid.
We also often hear that hospitals are inflating their Covid figures because they would have a financial interest. This is absolutely false and once again false news.
What did you think of the controversy surrounding the film Hold-up supposed to denounce “lies and corruption” about Covid?
I refuse to look at it, if only so as not to be counted among those who saw it. I find it incredible that one can deny the truth. The truth in our establishment in Ajaccio is that 75 people have died from Covid since the start of the epidemic (36 people have died in Bastia hospital, 19 people in island nursing homes, editor’s note). We currently have a 40-year-old man between life and death, a 22-year-old woman arrived earlier this week and all of our other patients are in a very difficult state of breathing. The fact that since the start of the epidemic in March, more than 250 patients with the same disease have presented to our hospital, is truly an exceptional health event. That people can deny it is not only stupid but also very badly lived by the caregivers and by the patients who suffer from this disease and its consequences.
What do you think of the voices of epidemiologists or health specialists who speak out against the strategy of containment?
I am not an epidemic management strategist. But what is certain is that the containment of March and we hope this one, allowed hospitals to treat everyone. Which would not have been the case if we had not been confined.