very responsive hospitals plunged into a thick fog

The Nouvelle-Aquitaine Regional Chamber of Accounts (CRC) carried out an investigation included in the 2021 report of the Court of Auditors entitled “Health establishments facing the first wave of Covid 19: examples from New Aquitaine and Franche-Comté”. At the helm of this rather atypical report for the CRC of Nouvelle-Aquitaine, since the investigative work took place last November, in the midst of the Covid-19 crisis, to be published this March: Jean-François Monteils, president since 2015 of this regional neo-Aquitaine chamber, which he has just left for Paris.

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A report whose president Monteils presented the salient angles in the company of two other financial magistrates of the CRC very involved in this investigation: the vice-president, Jean-Noël Gout, and Philippe Honor, president of the 4th section. One of the revelations of this report is its assessment of the depth of the fog in which the hospital teams must have struggled. Almost impenetrable fog which gives an idea of ​​the power of the shock that the emergency regulation services and city medicine practitioners had to receive during this incredible first wave of Covid-19. A disease so little known that it was very difficult to identify.

“I repeat it was an unknown disease!”

The report from the CRC de Nouvelle-Aquitaine insists on this very great difficulty in diagnosing Covid-19 during the first wave of the pandemic. History to put the reader in the bath. Because during this initial pandemic phase, many patients affected by something else went from their doctor to the hospital with a suspicion of Covid-19 while, as at the Bordeaux University Hospital, it was false eight times out of ten. This is one of the key elements revealed in this very detailed report. Because the figures unearthed by the report suggest that the start of the pandemic in France caused the beginning of panic of the population, deafened by the confinement, and an overreaction of the medical profession. But beware of speculation.

“This crisis is not over so we must avoid extrapolating. We must keep in mind that this first wave was singular, that we were facing an unknown disease. In the first days nobody knew anything: I repeat c ‘was an unknown patient! It would be quick to take a critical view of these events, but I repeat, in the early days nothing was known, no treatment protocol could respond to the evolution of the disease. where the need to be very careful, “immediately warned Jean-François Monteils to properly reframe the issues.

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88% of suspected Covid-19 patients had something else

It must be said that the figures would almost be enough to make you dizzy. During the first wave, from March to May 2020, the Bordeaux University Hospital Center (CHU) thus received 6,815 patients suspected of Covid-19. However, it turned out that on this set, 88% of hospitalized patients, or 6,008, did not have Covid-19. The CHU has only diagnosed 807 patients with this viral infection. Even if it is already too much, this group of proven patients ultimately represents just over 11% of the number of people hospitalized for suspected coronavirus.

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At the Poitiers University Hospital the score is very close, since 90% of the 2,484 patients hospitalized for suspected Covid-19, or 2,243, were found to be not contaminated. The neo-Aquitaine peak in this gap was reached by the Orthez hospital center (Pyrénées-Atlantiques / Béarn) where, out of 36 hospitalizations for suspected Covid-19, only 2 were found to be positive: or 5.5%. “However, it is these latest data of suspicion (and therefore of risks) that have had consequences on the organization and activity of establishments.“, underlines the chamber of accounts.

Best result in Franche-Conté with 26% of patients identified

New Aquitaine was one of the regions least affected by the first episode of Covid-19 and that is why nine hospitals, out of the ten studied, are there. Because there was no question for the investigating magistrates to interfere with the nursing staff. The comparison with the experience at the Nord-Franche-Comté hospital center, a region where the epidemic was very virulent, is all the more interesting, even if it remains limited. Of the 3,147 patients hospitalized in this establishment for suspected Covid-19, only 808, or 26%, were actually affected.

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It’s much better than in Nouvelle-Aquitaine, but still far from 100%. Beyond their spectacular appearance, these data, which could bias the understanding of a pandemic of unknown type, bring a new dimension to the disarray and anguish generated in the population by this first wave of Covid-19. Especially since upstream of the initial ramp-up of the pandemic, the CRC report shows that hospitals had emergency tools that were not suited to this health crisis.

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The white plan, good for the attacks not for the Covid-19

Health establishments have the obligation to implement a crisis prevention and management policy and therefore to have a blank plan, which is part of an extended plan defining coordination between health actors. When the Covid 19 pandemic has occurred, all the establishments checked had a blank plan, most of the time updated (…)

On the other hand, it was not activated either at the Bordeaux University Hospital or at that of Poitiers, because in both cases considered unsuitable for long-term pandemic management, but rather designed for an influx of patients over a very short period of time ( attacks, accidents, etc.). This did not prevent the CEO of Bordeaux University Hospital (Yann Bubien -ndlr) from activating a crisis unit from January 24, 2020, that of Poitiers activating its crisis management procedure from February 24, 2020, with a unit crisis and a business continuity plan “, thus sheds light on the CRC report.

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Insufficient stocks of masks

The latter thus highlights the decision-making autonomy that hospitals have been able to benefit from and the development of initiatives within healthcare teams, which have made it possible to boost the responsiveness of hospitals, even the largest. At the start of the pandemic, most hospital stocks, in particular in masks, were no longer up to the needs.

With in some cases unexplained drops in volumes, such as at the Saintes hospital center (Charente-Maritime), where “The stocks of most of the products essential to the protection of caregivers had significantly fallen in an unexplained way (for example the number of FFP2 masks fell from 11,500 in 2018 to 4,950 in 2019). In Pau or Orthez, there remained a stock of expired masks dating from the H1N1 epidemic which, once controlled, could however be used (…)“thus sheds light on the report.

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When practitioners communicate to manage transfers

And then the disease being unknown, it was not the subject of any classification, of any of the essential administrative nomenclatures which make it possible to mobilize the adequate means. This only added to the problems of communication between hospitals and their supervisory administration, in particular to follow the evolution of the needs for resuscitation beds, to the point that hospital practitioners ended up innovating.

“(…) At the Poitiers University Hospital, the resuscitators monitored the capacity in resuscitation beds via an application developed and deployed by doctors from the Grand-Est region, while patient transfers at the start of the crisis , were organized directly between hospital doctors. In addition, the exchange of information on organizations and activity was carried out between hospital doctors and professionals in the area via a WhatsApp group. However, this “decentralized” management of patient transfers did not exist. not continued, the central administration then having taken charge of these transfer protocols (…)

The situation was more or less similar in the Bordeaux metropolitan area, where doctors used a local application called “e-cubam” to manage patient transfers from intensive care units. Unlike Poitiers, however, it does not appear that the central administration or the ARS (Regional Health Agency -ndlr) wished to end or replace it (…) “, however, notes the report.

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The pandemic has also boosted the absenteeism rate of hospital staff, sometimes by Covid-19 contamination but not always, observes the report, which points in particular to the case of the Oloron hospital center where absences affected 108 agents out of 400 full-time equivalents between March and June 2020. In the end, the CRC notes in particular that the healthcare system as analyzed in the report “appears globally ill-prepared for an unprecedented, deep and lasting crisis, with ill-suited plans and weaknesses in the flow of information”.

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