The traffic on the B line of the RER in the paris region will be “extremely disturbed for the day on Thursday and Friday as a minimum “ after the derailment on Wednesday evening, June 24, near the station of Denfert-Rochereau, a train not carrying passengers, announced on Thursday 25 June in paris.
→ TO READ. Déconfinement : the RATP at the forced march, prior to may 11,
“Interconnection continues to remain suspended at the gare du Nord Thursday “continues the RATP, which indicates that the trains will run on Thursday morning all of the 17 minutes between Denfert-Rochereau and gare du Nord train Station and with a frequency of 15 minutes between Laplace and Massy-Palaiseau, Laplace and Saint-Rémy-lès-Chevreuse and between Robinson and Bourg-la-Reine.
[ ❌ Incident technique] : the traffic is interrupted between Denfert Rochereau and Laplace and disturbed about the whole line. Bus replacement between Denfert and Laplace #RERB
— RER B (@RERB) June 25, 2020
Three cars of a train of the RER B are out of the way Wednesday at 19 hours, without being injured. “For a reason still under investigation in the framework of an internal investigation, a car the rear of the train out of the rail. The front of the train is stayed on the track while the other three cars were to horse between the ballast and the other track “continues the RATP, which indicates that it is an accident “extremely rare “.
Emergency response heavy
The teams, which were received Thursday morning by the visit of the president of the RATP, came to support the officers, proceeded in the night to early interventions to lift the train, which is expected to last 24 hours. Once the rolling stock removed, the teams will proceed to the rehabilitation of track and equipment way of the affected area, before you repair the catenary damaged and perform a complete revision of the signalling equipment, specifies the RATP.
The authority has put in place a service of bus substitution on this famous line B of the RER, very busy, since it connects the two airports of paris and carries approximately a million passengers per day.
The deconfinement promises to be critical Monday, May 11, in public transport in Ile-de-France, where compliance with the rules of distancing will drastically reduce capacity.
After operating at idle for seven weeks, public transport will not leave at full speed on Monday: the RATP intends to provide around 75% of the service and the SNCF between 50 and 60% for its commuter trains.
However, the government has decided that social distancing would also apply on board, to limit the spread of the coronavirus. Forcing travelers to stay at least one meter from each other reduces their number by 80%.
Limited transport capacity
Suddenly, the carrying capacity will be limited to around 15% of normal, calculates the CEO of RATP Catherine Guillouard. The big unknown on May 11 is the incoming flows in our networks, she admits.
We do not know how many Ile-de-France residents will take the RER, metro, tram or bus with deconfinement, among the 96% who have deserted them.
The Minister of Ecological Transition Élisabeth Borne wants to limit them to 15%, but the Secretary of State for Transport Jean-Baptiste Djebbari estimated them between 20 and 30%.
There is a problemsums up a sector official, who would rather expect 40 to 45%, with wide disparities depending on whether residents will be forced to physically go to work or can stay in their living room. Hence a whole series of measures to limit the frequentation, with a massive use of telework when possible and staggered hours in businesses, so that peak hours are less marked.
During peak hours, access reserved for certain people
Élisabeth Borne also announced that access to public transport in Ile-de-France would be reserved for peak hours for people with a certificate from their employer or with a compelling reason to travel : health reason, convocation of justice, accompaniment of children…
This employer certificate will be checked between 6:30 a.m. and 9:30 a.m. and then between 4 p.m. and 7 p.m., the president of the Ile-de-France region, Valérie Pécresse, said on France 2 this Friday.
“The employer certificate will be checked between 6.30 am and 9.30 am and between 4 pm and 7 pm” warns @vpecresse
The authorities promise a tolerance for the first few days. But without this certificate, users will then risk a € 135 fine, similarly if they do not wear a mask (compulsory in public transport from Monday for anyone over the age of 11).
Those who are afraid of the crowd should be able to fall back on self-service electric scooters, take advantage of the new cycle paths designed for deconfinement or… take their car, if they have one and if they are not afraid of traffic jams. .
Balance sheet. The coronavirus has killed 544 more people in France in the past 24 hours, bringing to a total of 21,340 deaths linked to Covid-19 recorded since March 1. Worldwide, the virus has killed more than 180,000 people. Our direct.
Expected at the turn. The government handed over its copy this Wednesday on the deconfinement announced from May 11. The ministers have given Matignon a first version of their sectoral plans, which will be integrated by the end of the month into a global project that looks like a puzzle for education, transport or business, in a health context still most uncertain.
Displacement. “Thank you for feeding the country”: Emmanuel Macron spent the afternoon Wednesday in a tomato greenhouse and then a supermarket in Finistère, to pay tribute to the entire chain of “The farm France”, symbol of the “Second line” against the coronavirus.
Right of asylum. The Paris administrative court, seized by associations, on Tuesday ordered the resumption of asylum registration systems, suspended by the prefects of Ile-de-France at the start of confinement.
United States. Donald Trump confirmed on Wednesday morning that he would sign a decree during the day temporarily suspending the issuance of green cards to protect American jobs in the midst of the coronavirus crisis.
Partial unemployment. The Minister of Labor Muriel Pénicaud announced on Wednesday that more than 10 million workers are currently unemployed, nearly one in two private workers, and called on business leaders to resume their activity if they could .
Social Security. The coronavirus will explode the Social Security deficit to more than 41 billion euros, “never seen” even at the height of the financial crisis, warned the Minister of Public Accounts, Gérald Darmanin.
Popular neighborhoods. For the fourth consecutive night, urban violence erupted in the Paris area, where a school was partially burned in Gennevilliers, the authorities however describing sporadic incidents and of lower intensity than the previous nights. Read our article.
Football. In the absence of a very hypothetical resumption of the championship, the L1 should deliver a classification: either that at the time of the interruption, or that at the end of the first matches. The least worst solution. Our ticket.
To read on Liberation.fr today
Schools. The announcement of a gradual resumption of classes on May 11 is rather coolly received by teachers in lower-income neighborhoods, who, while waiting to learn more, prefer to focus on their actions in favor of the most vulnerable families. Our article.
Deconfinement. The places of worship will not be reopened on May 11 and probably not until mid-June. Macron tested the idea of a future National Resilience Council in an interview with religious and lay representatives.
Photo. A report by photographer Amnon Gutman on the streets of Shuafat, a Palestinian neighborhood in East Jerusalem, relegated to the other side of the separation wall. Our slideshow.
Municipal in Paris. Unite or continue opposition? Change everything or keep your lists and proposals? Since the election was paused, which could start again from scratch for a second fast round, the candidates’ troops have questioned themselves. Our article.
Absurd. To make the apology for the tracking application (StopCovid), François Bayrou the mayor of Pau cites as an example the murder of a teenager in 2011. Our article.
Tomorrow in Libé
In the summary of your diary of this Thursday, you will find our event on family life in times of confinement, a report in the Dutch red light districts, the action plan of the deconfinement, the story of the cruise liner Magnifica income of four months around the world, an interview with the German philosopher Hartmut Rosa, a book of maritime history of the Monty Python Michael Palin in Culture pages, and the portrait of the navigator François Gabart.
Béatrice de Lavallette is vice-president of the Ile-de-France regional council in charge of social dialogue and 4th deputy to the mayor of Suresnes, delegate for human resources and social dialogue. This former collaborator of former Minister Gilles de Robien is renowned, both in France and abroad, for her practice of social dialogue given as an example in many companies and local authorities. Olivier Dussopt, the secretary of state for public service, recently delegated a mission to his services in Suresnes to study the model that she has implemented for more than a decade.
The current health emergency is a time bomb. After the “yellow vests” movement and the painful episode of pension reform, the economic crisis looming in the months and years to come carries with it the seeds of social explosion. With a recession expected to rise to almost 8% of GDP in 2020, our country can expect to experience one of the worst crises in its recent history in peacetime, when many indicators are already in the picture. red: growing economic, social and territorial fractures, growing mistrust of institutions, public hospital crisis, etc.
Today, the urgency is to save lives and fully support our healthcare staff to stem the spread of Covid-19. This should not, however, prevent us from thinking about the “next world”, especially the world of work. The consequences on the job market may indeed be disastrous, because if the government has used so much – rightly – the short-time working scheme and guaranteed 300 billion euros in business loans, the hypothesis of a massive wave of layoffs at the end of the crisis cannot be definitively ruled out…
Besides the question of the unemployed, there is also the question of the health of employees. Widespread confinement, whether experienced through partial unemployment or permanent and forced teleworking, involves many risks of burnout in the event of over-solicitation, but also of isolation, confinement, disocialization or impairment mental health. Thus, even with “deconfinement”, the Chinese experience shows us that we are not immune to an outbreak of psychosocial disorders and depression among employees (37% of French people already say they show signs of psychological distress , according to the Coconel survey of April 2020).
Maintaining a permanent, active and constructive social dialogue, both nationally and locally, is the sine qua non for a healthy and sustainable economic recovery in our country.
Beatrice de Lavalette
Faced with this looming human drama, neither the government, nor local authorities nor businesses can act alone. They must rely on key players in our social democracy, the social partners, who are essential relays for raising employee concerns and negotiating “win-win” agreements with the employer. Let us be clear: the maintenance of a permanent, active and constructive social dialogue, both at national and local level, is the sine qua non for a healthy and sustainable economic recovery in our country.
This is the message delivered on March 19 by all of the national social partners, MEDEF and CFDT in mind, stressing “The essential role of social dialogue and collective bargaining” in this time of crisis. This is also the message I wanted to carry at the local level with our unions, recalling, in a joint declaration, that social dialogue should not be put on hold.
In the Ile-de-France region, the leading economic region in Europe (30% of France’s GDP, 4.5% of the European Union’s GDP, 1 million businesses), we are mobilized on all fronts behind Valérie Pécresse to face this crisis, in particular with a vast emergency plan for the SMEs of her territory. In this, since 2016, we can rely on a rich, innovative and constructive social dialogue, with the signing of 7 “win-win” agreements (whereas the previous executive had not signed any agreement in 17 years) and a stone Angular: the Charter for the recognition of the trade union path (unique in the public service), welcomed by the ILO, which has today become a reference for many local authorities and large companies; but also internationally, as demonstrated by our active participation in the Global Deal, a global platform for promoting social dialogue, for which we have been asked and for which we are today the only representatives of the public sector.
The City of Suresnes, for its part, is regularly qualified as “Capital of social dialogue”, the relations with the unions are so rich, constructive and peaceful, with more than thirty agreements signed (compensation scheme with increasing and decreasing merit, union check, “mutual for all”, etc.) and only a half-day strike in 12 years for local reasons! An assessment that many communities would like to have, and which has recently led Secretary of State Olivier Dussopt to send a commission to study and probably disseminate the “Suresnois model” of social dialogue, characterized by systematic agreements upstream of the authorities, and already considered by the ILO, the UN agency specializing in labor law, as “Successful, concrete and transferable”!
Social dialogue with mutual respect, listening and a strong sense of responsibility can help defuse many potential social conflicts
Beatrice de Lavalette
The social human impacts of the economic crisis, “The worst since the Great Depression of 1929” according to the IMF, must therefore anticipate today, drawing on the experience and field knowledge of the social partners. In this, the successful examples of local communities such as the Ile-de-France Region and Suresnes should be a source of inspiration, because they show that a social dialogue imbued with mutual respect, listening and great sense responsibilities can help defuse many potential social conflicts. Even the President of MEDEF Geoffroy Roux de Bézieux went back on his polemical remarks, inappropriate and regrettable in my opinion on working time and public holidays, by declaring that the management of the post-crisis could not “To be done only in social dialogue”.
The new working and management methods drawn from this crisis, with the necessary resilience of organizations and teleworking which has become almost generalized wherever possible, could also generate gains in the future. significant productivity while improving the quality of life at work with in particular the agility developed by companies during this confinement period. In any case, we can remain optimistic, because history teaches us that after each period of “war economy” succeeds a phenomenon of massive economic rebound carried by strong growth. However, the possible adjustments in working time, which would prove useful in many businesses in the short, medium and long term, cannot be decided from above and in a comprehensive manner. They must be the subject of negotiations with the unions, company by company or by branch, depending on their economic context, so that each party finds a fair compromise, with a real sense of social justice.
The temptation to nationalist withdrawal, the growing attraction for vertical power and authoritarianism (…) are all direct threats to our model of social and liberal democracy
Beatrice de Lavalette
But the current crisis also risks completely overturning our model of society. According to a recent Odoxa-Comfluence poll (April 8-9, 2020), 61% of French people believe that our societies “Will never be able to function as before and that our relationship to others, to the environment, to growth, and to globalization will change profoundly”. The question is which side our country will tip over. The temptation to nationalist withdrawal, corollary of a European Union powerless in the face of the crisis, the growing attraction for vertical power and authoritarianism, supposedly better equipped, as in China, to fight against the current pandemic, are as many direct threats to our model of social and liberal democracy.
It is essential, in this regard, to affirm loud and clear the central role that all intermediate bodies will have to play at the end of this crisis, first of all the social partners, central actors of social democracy, as well as local elected officials, essential actors in local democracy. The post-crisis will open up a new world, in which the social partners must be central actors. In this, the “laboratory of social innovation” that we have set up aims to inspire the whole country through a method of social dialogue recognized by all, and that works, because it is certain that the “world of ‘after’ can only be built collectively, strong and united, in social dialogue.
With its 12 million inhabitants, Île-de-France is still far from deconfinement. While in normal times 5 million people – 500,000 today – use public transport daily in this region, in particular to commute to work, it is impossible to imagine metro trains again crowded at rush hour from May 11. “The Ile-de-France region will not be defined overnight“, Already warns Valérie Pécresse, president of the region and Ile-de-France mobilités (IDFM), in an interview at Parisian. Ile-de-France residents will therefore still need to be patient. What to expect in transportation after May 11?
A very gradual recovery in metro and RER traffic
By that date, 50% of the transport network should be returned to service. “SNCF and RATP should offer an offer of around 50% of traffic, compared to 30% currently“, Specifies the president of IDFM. However, traffic could be increased “above 50%On certain lines that are particularly busy in normal times. Like RER A, RER B, RER D, or tram 1, line 13 of the metro, and line 1. Lines that cross “popular territories in which the inhabitants move to go to work“, Specifies the president of region.
This rate of resumption of public transport will also depend the pace of school recovery. “Operators, RATP, SNCF, Optile (for buses in the outer suburbs) have a high absenteeism rate for their agents today, almost 40%, because a large proportion of these agents keep childrenExplains Valérie Pécresse.
Wearing the mandatory mask in public transport?
The idea of imposing the wearing of masks on public transport was raised on Monday evening by Emmanuel Macron during his last television address. “I confirm that this is an assumption that we are working on“, Stressed the Minister of Transport, Jean-Baptiste Djebbari, in an interview at La Dépêche du Midi, published Thursday. The president of Ile-de-France pleads to make the wearing of the mask compulsory and asks the government “authorize agents to verbalize those who do not wear them” Masks and hydroalcoholic gel could be sold in all shops of train stations and metro stations, according to Valérie Pécresse, who also calls on companies to equip their employees with masks insofar as “commuting is part of working time“
Massive telework until summer
“If we set up safety distances as we all know them now, we could only transport 20% of travelers“Underlines Valérie Pécresse. As such, IDFM calls on all companies and administrations to maintain the maximum of their employees in telework. “We will have to continue to telework massively after May 11 and until the summer. Because we must avoid overuse of our public transport, there must be much less than the 5 million regular passengers», Underlines Valérie Pécresse in another AFP interview. Since March 17, with the general confinement of the population, millions of French people began to telework almost overnight. A practice that should therefore continue, in Ile-de-France at least, far beyond deconfinement.
To avoid an influx in public transport during rush hour, trips should also be staggered. Companies and administrations are therefore invited to organize themselves so that their employees do not arrive at the same time. “We will work on smoothing peak hours in conjunction with the social partners and local authorities in order to avoid the crowding effects“Said the Minister of Transport, Jean-Baptiste Djebbari.
The bicycle explosion?
After May 11, the car will resume its rights. But also the bicycle. The Ile-de-France region as well as the city of Paris want to promote this mode of transport. “Given the season, the bicycle, which proved its effectiveness during the strike (from December and January against pension reform), can also be used more intensively, and constitute an alternative to public transport at the time of deconfinement“, Considers the president of the Ile-de-France region, Valérie Pécresse. “Because it is spring, because the weather is nice“, The number of people on bikes could go from 400,000 (before the strikes in December) to 800,000 post-confinement, she anticipates.
For this, the bike paths must be secured. “The region is ready to design temporary bicycle paths on certain axes, in agreement with the cities, the inter-municipal authorities and the departments“, Adds Valérie Pécresse, who recalls that the premium of 500 euros for the purchase of an electric bike is” still active “. At the town hall of Paris, the first deputy, Emmanuel Grégoire, spoke on Tuesday of the possibility of temporarily transforming the boulevards of the capital into cycle paths. The objective: “prevent people from going back on public transport too massively at the same time“For those who can do without it but also”accelerate the development of cycling as a mobility practice“
As in Paris, to avoid an overcrowding of public transport, the metropolis of Lyon also announced Thursday to work on the provisional development of traffic axes for the benefit of cycling and walking. In Grenoble, the ecological mayor Eric Piolle is also reflecting on “ adaptations To complete the city’s cycle network.
… And the car?
Users should also massively take back their car. “ In China, we see that road congestion has resumed the same level as last year at the same time, when the traffic in the metro is just under 50%. It means that there are people who transferred from the metro to the private car “, Notes Joël Hazan, mobility expert at the Boston Consulting Group (BCG), quoted by AFP. However, a transfer to the car “would massively increase the cost of transport for the household budget“Points out the expert. And it would be “a traffic jam and pollution disaster” If users were to turn away massively, and for a longer time from public transport, it would also be a serious shortfall for the region, which is responsible for managing the bus, metro and RER network. For the duration of the confinement alone, for Ile-de-France transport, the shortfall is estimated at one billion euros in lost revenue.
The challenge of deconfinement will therefore be “find a way to restore confidence for public transportation», According to the mobility expert. “In a city like Paris, you will not be able to do without public transport. We do not have a choice !” The operators of the Ile-de-France transport network (RATP, SNCF and bus of the Optile network in the Greater Crown) are already called upon to “set up a reinforced cleaning and disinfection plan for rolling stock (trains and buses) but also public spaces in train and metro stations” The objective, as the Minister of Transport, Jean-Baptiste Djebarri emphasizes, is “restore passenger confidence“
See also – Here are the deconfinement scenarios envisaged by Emmanuel Macron
Following Emmanuel Macron’s announcement of the gradual reopening of schools on May 11, many of you asked us about the role of children in the spread of the epidemic. And especially those who have been contaminated and who show little or no symptoms.
Because the fact is now well established: children infected with SARS-CoV-2 develop symptoms of the disease much less frequently than adults. The low rate of positive diagnoses among the youngest could, for this reason, conceal a much higher infection rate. On this subject, works prepublished end of March – who have not yet been independently reviewed – suggest that children in contact with infected individuals are just as likely to be infected as adults under the age of 60.
However, several unknowns remain. First, it is not yet known whether infected children transmit the disease as easily as adults.
On the one hand, contaminations from child to adult are currently unnoticed in the case of asymptomatic contaminations.
On the other hand, little data exists on the infectiousness of the secretions (postillons, sputum) of children without symptoms.
More generally, the infectious potential of asymptomatic individuals, whatever their age, is not yet sufficiently documented – notably due to the difficulty of tracing these cases. At the beginning of April, WHO recalled the risk of contamination during the last days of incubation, at least three days before the onset of symptoms (“pre-symptomatic” transmission). Cases of transmission from carriers who never show symptoms can only be documented with great difficulty.
For all these reasons, the formulations used in the scientific literature devoted to this subject are still conditional (the asymptomatic character “Increases the possibility that children can be facilitators of viral transmission “, Etc.). All authors call for further investigation “On the role of children in the chain of transmission.”
Researchers working on pandemic modeling are just as circumspect. “In studies published since mid-March, including a study prepublished this April 12, we’re looking at several age classes, including a school age class. “, explains Jean-Stéphane Dhersin, researcher at the CNRS and at the Sorbonne Paris Nord University and deputy scientific director of the INSMI (National Institute of Mathematical Sciences and their Interactions). “In the models used [pour estimer les effets des mesures sanitaires], a number of parameters have to be estimated: assumptions are made that people can get the disease, that they can be infectious, and that they can spread it. However concerning children, for the moment, we do not know everything. Particularly because an active test campaign in the general population has not yet been carried out, which is the most effective way of obtaining information. In the models, data are sometimes used that are available for influenza, but it is not known if this is relevant. At this time, it is unclear whether children play an important role in the spread of the epidemic. “
Expert opinions marked by uncertainty
On this dossier, the opinions of experts remain divergent. Assuming asymptomatic children are as contagious as adults, some point out that their social interactions are based on more and more prolonged physical contact than their elders – increasing the risk of infection.
In an interview granted in March to the Swiss daily Time, Arnaud L’Huillier, pediatrician and infectious disease specialist, conversely estimated that children would transmit SARS-CoV-2 less than they would participate in the spread of the flu virus. According to him, the coronavirus in circulation “Affects especially the deep respiratory tract and does not make the nose run, which in children is an important vector for the dissemination of pathogens”.
In an exchange with the AFP, Professor Keith O’Neal, epidemiologist at the University of Nottingham, noted that asymptomatic carrier children were less risky for the community gathered in a school “That entrusted to grandparents” by adults with no other childcare solution.
At the Ministry of National Education, we are told that the risk associated with asymptomatic or pre-symptomatic transmissions in schoolyards “Is one of the points to be discussed with the social partners” to prepare for the end of containment on May 11. “It is still too early to answer these questions”.
This April 14 sure France 2, Minister Jean-Michel Blanquer stressed that going back to school “would not be mandatory ” at the end of confinement. “The goal is that between May 11 and July 4 (summer vacation date), we have successfully resocialized […] that allows you to get back into learning. “
In an exchange with the journalists of France Inter, pediatrician Robert Cohen announced on April 14 the launch of a study in Ile-de-France on 600 children, intended to assess the percentage of asymptomatic patients carrying the virus.
Listen to the weekly behind the scenes podcast from CheckNews. This week: War of masks: does the state use regional orders?
D-18. The patient in room 172 has been fighting the Covid-19 for the last eighteen days. Intubated and ventilated, the man is 52 years old. Several probes gravitate around his naked body. His cheeks are pale, his eyelids yawn, his swollen hands are motionless. Everything seems extinct in him. Only his chest moves, under the impulse of the artificial respirator. At D-15, the resuscitators tried to free him from the machine. The latest analyzes indicated that the patient had regained enough strength to oxygenate himself. The family had been notified. But when he was extubated, the patient whistled, unable to breathe: edema had formed in his windpipe. We put him back to sleep and put the hose back on. “In the face of this disease, the fight for recovery is not a sprint. It’s a marathon “, recalls Jérôme Fichet, physician-resuscitator at the North Cardiological Center of Saint-Denis.
In this private clinic in Seine-Saint-Denis, 33 other patients
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INTERVIEW – Aurélien Rousseau, director general of the Ile-de-France regional health agency, calls on the authorities not to slacken containment efforts now.
LE FIGARO. – Does containment finally seem to produce effects in Île-de-France?
Aurélien ROUSSEAU. – Even if there is an undeniable slowdown in the progression of arrivals in intensive care, and hospitalizations in conventional medicine, the crisis is far from behind us. Each day, we always have more patients in intensive care than the day before (between 50 and 70 additional patients, compared to 250 last week). Most of them, however, do not come from outside: they were already hospitalized and are admitted to intensive care following the deterioration of their condition. This is another encouraging indicator.
Why do you remain worried?
We still have around 3000 patients, including 2500 Covid, in intensive care, while our usual capacity is 1200 beds. If we held out, it is thanks to the hard work of the health personnel, the reinforcement of nearly 500 carers from all over the country, and the transfers out of the Ile-de-France (there will be none
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Hold on. Respect the “stay at home” rule enacted four weeks ago. Resist the call of the sun, the need for fresh air, the irresistible urge to forget the Covid. Overcome the boredom of child squawks, spousal blows, telecommuting, confinement. The few French caught this weekend in the act of leaving (in Nice, for example) or on the holiday road – zone C – are they a sign of the beginning of relaxation? Will the possibility since Monday of filling out digital exit authorizations encourage breakaways? The fear of seeing the economy unscrew (according to INSEE, a month of confinement would cost France around three points of GDP over a year, and two months some six points) could she be right about health precautions?
Here and there, begins to (inevitably) begin the temptation to loosen the vice of confinement. It was formulated, then corrected, by the Prime Minister himself when he spoke on TF1 on April 2 the word “Deconfinement” (by age group, or territory) without giving a date. Overall however, the time still seems to discipline. If Martin Hirsch, director general of the AP-HP, launched a kind of alert on Twitter on Sunday (“Too many people on the streets, too many strollers”), the government was delighted with a fairly well-respected confinement, given the weather and the start of the school holidays. “There was no big movement” of population, summarized Sunday evening the Minister of the Interior, Christophe Castaner, to the television news of France 2: “The French have respected the rule even if in places, signs of relaxation have been noted, with joggers in the midst of families on the banks of the Ourcq canal in Paris or children playing in groups in building courtyards . “
Recall that this weekend, more than 160,000 police and gendarmes were mobilized, and nearly 1.4 million checks carried out. And in total, since March 17, there have been nearly 480,000 tickets issued on 8.2 million checks, according to the Interior Minister.
The abuses are marginal. But the caregivers are always on edge. “It’s not walking around the street that’s a problem: people generally respect safe distances, recognizes the Pr Rémi Salomon, president of the establishment medical committee of the AP-HP. The real risk is touching what others have touched: the door handle, the elevator button, the supermarket checkout, etc. The virus is very resistant, for up to several hours, on inert surfaces. However, by reflex, we put our hands in the face twenty times an hour. And there you can get infected, infect others, and reactivate the circulation of the virus. ”
Hospitalists want to avoid this scenario at all costs, as they begin to see the benefits of confinement for the first time in four weeks: the daily rate of death in hospital, such as the care of Covid patients in intensive care have ebbed this weekend. And there were at the end of the day Monday “only” 94 more patients in intensive care compared to the previous day (for a total of 7072). A slowdown in the rise which appears encouraging.
But this trend does not extend to the number of deaths recorded on this same day on Monday: the Minister of Health, Olivier Véran, indicated in the evening that 8,911 people had died since the start of the epidemic, that is to say 833 more in twenty-four hours, including 605 in hospitals and 228 in nursing homes.
In addition, resuscitation services are still on the razor’s edge in Ile-de-France as in the Grand Est. And the backlash, always possible. “If the containment is relaxed, it is certain that the hospital structures, today saturated, will be again congested”, predict the Dr Charles Cerf, head of the resuscitation service at Foch Hospital in Paris: “In Ile-de-France, we have doubled the number of critical care beds at the cost of an organization worthy of disaster medicine, in both material and human terms. Patient care is degraded compared to usual, even if acceptable in the context. Despite the tiny breath of fresh air of the past few days, the Ile-de-France health system is saturated. Reactivation of the epidemic too quickly would worsen management problems. “ Hospital troops could then find it difficult to follow. “Caregivers are not machines! warn the Pr Antoine Pelissolo, head of psychiatry service at the Henri-Mondor University Hospital in Créteil (Val-de-Marne). They can last a month or two in forceps, endure endless days by motivation. But for them, this crisis is emotionally very trying. Many caregivers, doctors and nurses have joined resuscitation services to help, but are not used to it. For young people with little experience, being in direct contact with multiple and repeated deaths, and the despair of families, is a major test. I had to stop some of them in overwhelmed stress, in such a state of amazement that their professional skills were impaired. “ To avoid the worst, only one instruction: keep.
Damien Roux, university professor and hospital practitioner of intensive resuscitation medicine, works in the medical and surgical resuscitation department of Louis-Mourier Hospital (AP-HP), located in Colombes, in the Hauts-de-Seine. As of last weekend, this doctor was responsible for reflecting – in collaboration with other colleagues from the Public Assistance taking care of Covid-19 patients – on the means of optimizing the use of drugs in the services of resuscitation, due to the ever increasing number of serious patients. “The aim was to anticipate the overconsumption of certain drugs in the same way that we have been trying to increase the number of nurses for the past month»He explains. Except that a week later, the fear of an imminent shortage of certain molecules became a reality in Ile-de-France. “Despite our prospects and our vigilance on the issue, it is clear that suppliers and manufacturers are no longer able to monitor the consumption of drugs or certain medical devices in our hospitals.He warns.
AP-HP Director General Martin Hirsch acknowledged at a press conference on Friday that “stocks are very short on certain drugs.“This Saturday evening, it’s Edouard Philippe who admits the existence of”supply tensions here and there” “We regulate them by ensuring the circulation of these products throughout the territory, because there are stocks.We guarantee it by making sure to encourage increased domestic and global productionAdded the Prime Minister. Update with Professor Roux.
What is the situation of Louis-Mourier resuscitation service today?
We fear the beginning of a stock shortage for the end of the weekend. We have visibility over two days. That is to say, we are not sure that our internal pharmacy will be able to supply us with all of the drugs necessary for optimal patient management. There is great concern because it is very likely that the AP-HP central pharmacy, despite all its efforts, may not be able to meet the demands of all hospitals and that we will end up with shortages during the restocking. This shortage situation is new but ultimately quite logical. Instead of having a variety of patients who require very different treatments, resuscitation services are currently finding themselves with a majority of Covid + patients who need the same molecules. It is this quantity of identical patients, hitherto unknown in our units, which causes the drug shortage.
Which families of molecules are likely to be lacking?
There is a strong tension on hypnotics. These are the molecules we use to keep patients in sleep in intensive care. The equation is therefore simple: if we run out of stocks, we will no longer be able to take care of new patients. It’s a real danger. We also fear a rapid shortage of curares, which allow the patient, once asleep, to prevent him from moving and therefore consume less oxygen. Curares are necessary because they allow these patients with acute respiratory distress syndrome (ARDS) to be completely ventilated by the ventilator. The last other concern concerns antibiotics. As we speak, I do not believe that an AP-HP hospital is lacking. But there is a risk of overconsumption in the days and weeks to come, because these serious patients in intensive care are at high risk of nosocomial infection. As you can see, the supply of these three groups of molecules is essential to save lives.
Your working group’s mission was to think of new protocols to save your stocks. A summary of your recommendations is currently being sent to all AP-HP hospitals. What does it contain?
At this stage, we propose an optimization of the sedation protocols in order to limit any use which is not absolutely necessary. A close relationship between the pharmacy and the resuscitation service is also necessary in order to anticipate any shortage of a molecule to refer to another close molecule. We also underlined the interest of associating other molecules making it possible to reduce the quantity of usual molecules to be administered. More specifically for sedation, one of the recommendations would also be to use the usual method of anesthesia in the operating room. It is a procedure that uses halogenated gases to put people to sleep and that we never use in most resuscitation services. This technique would also limit the use of curares.
At Louis-Mourier Hospital, where are you with your stock of syringe pumps, which allow the infusion of treatments? Some hospital structures already seem to be lacking…
We did the drawer bottoms and requisitioned all the units a little to find as many as possible. But indeed, faced with the impressive influx of resuscitation patients, we had to resolve to work with fewer electric syringe pumps per patient. For the moment, it does not degrade the quality of care but it causes discomfort in work for nurses who must regularly move this type of equipment from one room to another. Unless suppliers, especially Chinese, can quickly send us a large quantity of electric syringe pumps, we will have to modify the way we administer treatments to patients using less precise techniques.