the Vatican refines its doctrine on the end of life

Twelve points developed over twenty pages. The Congregation for the Doctrine of the Faith published, Tuesday, September 22, a dense document on the end of life. Entitled “The Good Samaritan, on caring for people in the critical and terminal phase of life”, the text does not change the doctrine but specifies the positions on euthanasia and assisted suicide expressed by the Catholic Church since 1980. Details made necessary by recent debates on these practices, going in some countries until their legalization.

Catholic hospitals cannot perform euthanasia

The Congregation is speaking out very clearly, and for the first time in these terms, against relentless therapy. The exclusion of any relentlessness is even, in his eyes, a « obligation morale ». “In the imminence of an inevitable death, it is therefore lawful, in science and in conscience, to take the decision to give up treatments which would only lead to a precarious and painful prolongation of life”, indicates the Congregation.

→ READ. The “ethical opposition” of the bishops to euthanasia

If the text is, by definition, general in scope, its authors, without ever citing them explicitly, allude to recent debates, in particular those which have taken place in Belgium or France. The Congregation confirms, for example, that hospitals displaying themselves as “Catholics”, cannot avail themselves of this title if they practice euthanasia or assisted suicide. The Holy See recently not allowed to the organization which manages the health works of the Brothers of Charity of Belgium to take advantage of the title of “Catholic” hospitals.

A full paragraph is devoted to the situation of people in a vegetative state and of minimal consciousness, such as Vincent Lambert, who died in July 2019 in Reims after ten years of legal battle. ” It is always totally misleading to think that the vegetative state and the state of minimal consciousness, in subjects who breathe independently, are the sign that the patient has ceased to be a human person with all the dignity that is due to him. clean », Says the text.

Nutrition and hydration, “Basic care”

These patients, add the authors, have the right “ to diet and hydration “, Which the Congregation considers as” basic care “. However, she admits that ” in some cases (artificial nutrition and hydration) may become disproportionate », Especially when they generate “Unacceptable suffering for the patient”.

→ READ. In Belgium, the hospitals of the Brothers of Charity want to continue euthanasia

Going into so much detail, the Congregation strikes a balance between the prohibition of euthanasia and the condemnation of relentless therapy. But it does not stop in the search for this crest line, by explicitly settling questions on the behavior to be taken in countries where euthanasia and assisted suicide are authorized.

This is the case with the very delicate point of the spiritual accompaniment of people who have chosen to shorten their lives. On this point, the doctrine is clear, says the Catholic Church: those who have made such a choice cannot receive the sacrament of reconciliation, and therefore the last sacraments. This is, according to the Congregation for the Doctrine of the Faith of“A person who, beyond his subjective dispositions, has made the choice of a seriously immoral act and perseveres in it freely”. “He will be able to receive these sacraments when his will to take concrete measures allows the minister (to the confessor, Editor’s note) to conclude that the penitent has changed his decision ”. And therefore to renounce any euthanasia or assisted suicide.

→ READ. End of life: Alain Cocq gives up dying

If the Congregation encourages spiritual listening, it nevertheless considers that it is “Not acceptable on the part of those who spiritually assist these patients to make any external gesture that can be interpreted as an approval of euthanasia, for example to remain present when it is carried out”. There again, an allusion to certain countries such as Belgium, where certain priests have developed farewell ceremonies, at the time of carrying out euthanasia. “Such a presence, decides the Congregation, can only be interpreted as a complicity ”.

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“We cannot directly choose to harm the life of a human being”

Extract from the letter “Samaritanus bonus”, published by the Congregation for the Doctrine of the Faith.

“The inviolable value of life is a fundamental truth of natural moral law and an essential foundation of legal order. Just as we cannot accept that another man be our slave, even if he asks us to, we cannot directly choose to harm the life of a human being, even if he demands it. Consequently, suppressing a patient who requests euthanasia does not at all mean recognizing his autonomy and valuing it, but on the contrary, it is ignoring the value of his freedom, which is strongly conditioned by the disease. “

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Karine Lacombe: “We should not relive the situation we experienced in March and April”

She is certainly on the lookout, attentive to the rapid evolution of the situation, but we feel Professor Karine Lacombe at ease behind her desk, the window wide open. “We’re ready. And my service is in good shape. ” Nothing to do with the tension of last spring, when we met her then : the head of the infectious diseases department at Saint-Antoine hospital in Paris was then on her guard, sometimes tense. Today, if it weren’t for the threatening letters she continues to receive, everything would be almost fine. Despicable letters: “You big motherfucker, we’re going to screw you up, we know where you live, but first we’ll sodomize you with barbed wire, corrupt, murder, liar, your three children too, see you soon …”. Investigations are obviously open.

“Today, she insists with this measured way she has to analyze the present moment, things have evolved well. Everyone understood the need for masks in confined spaces. I have the feeling that the start of the school year will be clearer, even if we are never immune to surprises. ” Without hesitation, she admits that she did not expect such an early recovery from the Covid. “I thought it would happen a little later, in October rather than September.” For the rest, it confirms what all the experts note: “We knew and we know that the virus continues to circulate, especially among young people. We know that it is not young people who are hospitalized. We know that before the elderly or the frail are affected, there is a time lag. At the same time, these are groups in which barrier gestures are applied rather well. ” And add: “I am confident, we should not relive the situation we experienced in March and April.”

“I am much more concerned about the social and economic impact”

However, Karine Lacombe agrees, the trend for the resumption of the epidemic is real and even seems to be accentuating. “If we have a lot fewer times in hospitalization or intensive care, we still have.” The AP-HP figures are clear. “Today my 9 bed Covid unit is half full.” Then this observation: “I don’t see any real risk of saturation. We have adaptation plans with the general management of the PA, which we review every week. I am not too worried. I am much more concerned about the social and economic impact than about the health impact. ”

For Karine Lacombe, a series of decisive changes in patient care has changed the game. “The treatments have nothing to do with the first wave. We put the patients on corticosteroids, and most do well. In addition, we know which patient to put on anticoagulants to avoid embolism. ” And the techniques are refined: “In our departments, we also know how to put our patients in a prone position without going through the sheave.” The advances do not stop there. “There is a series of very encouraging trials, not with the non-prescribed remdesivir, but with the polyclonal antibodies. We also have antivirals; they don’t cure the patient, but they can make him non-contagious, a bit like with flu treatments. ” In short, the range has greatly expanded.

“We are going to have a lot of Covid babies”

At Saint-Antoine hospital, life has largely regained its course. “It’s an almost normal life, we have played down the Covid, we have an almost classic operation.” The staff ? “Many have experienced post-traumatic stress disorder, she admits. But at the same time, many have resources. They play down, and the team is in good shape. ” In his service, there is no departure. “At home as elsewhere, we will have a lot of Covid babies, conceived during confinement”, she quips. Then, still optimistic: “What we experienced during this spring meant that we forged links with other services. Things are rolling. With the administration too, there is a real change. This has strengthened the ties, and so far it holds. “ There remains the recurring problem of the shortage of personnel with systematic recourse to temporary workers.

Does she have any regrets? On scientific production, Karine Lacombe is almost annoyed. “In France, we have an administrative burden, we live in a straitjacket to produce tests which is really heavy and which puts us behind.” And to quote the delay of more than a month to obtain the simple opinion of the ethics committee and of more than two months for the National Commission of Computing and Freedoms (Cnil). “In addition, there was no prioritization of trials. It wastes us a lot of time. ” Why give attacks she suffered against her vested interests ? “We tried to discredit my word while my interests are transparent, without conflicts.” She adds : “It fell on me because I am a woman. But I can tell you, I never had the feeling of being put in difficulty, I have nothing to hide. “

Read alsoThe coronaviruses of the crisis

His day is overcrowded, as always. She fears for the school of her last 7 year old daughter. “If they close it because of Covid, how am I going to do it?” I should stop working to keep her… ” Karine Lacombe, solid and unchanged: “In any case, I understood why I was there. I like to carry a team. And in this crisis, we have seen on a daily basis how essential teamwork is. ”


Eric Favereau

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Good kisses from Guyana (with a mask)

At the age of 27, in order to get a change of scenery and to leave the hospitals of the metropolis for a while, Arthur (1) had chosen a medical internship in Guyana for the summer of 2020. It was just before the pandemic:

“I chose my period well, you will tell me: after the first deluge of patients in metropolitan France, the Guyanese wave. Without being a journalist myself, I will try to follow this quote from Albert Londres: “Our job is not to please, nor to do harm, it is to carry the feather in the wound.” This testimony will therefore necessarily be unique to me, with my vision as a caregiver, my bias as a metropolitan and the inherent bias in preserving anonymity while trying to remain faithful to what is happening away from cameras and institutional social networks. I will mainly talk about hospital and territorial management but will not address the issue of city medicine due to ignorance of the subject.

Read alsoIn Guyana, caregivers “keep their fingers crossed so that nothing goes wrong”

“Before talking about Covid, I would like to paint a quick picture of the health situation here: Guyana is currently suffering from a dengue epidemic, and for a long time that of HIV. And that’s without counting the problems that are much more frequent than cardiovascular disease or cancer. Take Saint-Laurent-du-Maroni for example, for a population pool of several tens of thousands of people, the number of hospital beds in acute medicine outside the Covid-19 period is … 30. It is not to sink into the miserable but it is certain that 30, that calms down … In total, there are three hospitals on the coast distributed in the big cities (Cayenne, Kourou and Saint-Laurent-du-Maroni) and centers of health dispersed in land and along waterways. We all know that the investment and skills of caregivers are very heterogeneous in the hospital… but here we can say that it is pushed to its climax. Before detailing the dysfunctions in the management of this crisis, I would like to greet some incredible caregivers: those who have been pillars of care in this department for several years, those who have set up services, those who allow the hospital to stand up. But alongside these staff, we find jumbled mercenaries who don’t care, those who don’t have the skills but don’t realize it, and those who feed their ego. In such a difficult environment, the contrast is striking.

Staggering lack of communication

“You have to adapt in Guyana all the time. We have to adapt to patients: to a sometimes exacerbated precariousness, to the different language barriers, to their paperwork problems, to their life outside the big cities of the coast. We have to adapt to the means: digestive endoscopies are Cayenne, urology is Kourou, ophthalmology is Saint-Laurent-du-Maroni. Certain biological examinations… it is the metropolis. So I can understand that we cannot work as I am used to in metropolitan France, that we have to juggle and make compromises. But some situations are just indecent. Not in France, not in 2020: we do not refuse to take a patient in his thirties in intensive care under the pretext that he is HIV and Brazilian. We do not die after having an epidural for childbirth. We are not saying that we do not care if we made a mistake because the patient speaks poor French and will not file a complaint. You cannot be unreachable when you are on call… I think that in metropolitan France, no one would accept some of the things that I have seen here. And that can be brushed aside with the back of the hand since “It’s that or nothing, there is no one else”. It is not acceptable, it is indecent. And still I’m lucky in my medical practice, I’m a guy, people listen to me. It sucks, but that’s how it is. This is clearly not specific to Guyanese hospitals: more than once when I was a student I was spoken to instead of my boss. But here it is exacerbated, I am ashamed to have to repeat what my female colleagues say so that less competent men listen to them. It is blatant, it is shameful.

Also read, the previous episodes of the Epidemic JournalEpidemic Journal, by Christian Lehmann

“The patients, at least as far as I have come across, have illnesses made worse by many social problems. Two like that in your room in metropolitan France, it burns you out for the day. Here it is everyday. Illnesses as in the books and patients who do not fit into the administrative framework. I don’t want you to imagine the Wild West by reading this, but there are so many great projects to strengthen or create, I think our fellow citizens deserve to be done better. So inevitably, when a pandemic emerges, we are not serene. We had two major advantages: a young population and a few weeks ahead of the mainland. We quickly forget the weeks in advance, they were squandered by internal quarrels between hospital management, crisis management and the ARS. It was almost as if we were discovering the problems day to day, with a beautiful ball of hypocrites constantly parading in the media and on social networks. I am very happy to see the director of ARS Guyane, Clara de Bort, pose on the tarmac of the airport with her staff and congratulate herself on carrying out Evasan (medical evacuations) in a beautiful cooperation with hospitals. Unfortunately, it has happened several times that some of these evacuations were announced on television or on the Internet… before warning the doctors who directly took care of the patients concerned. The first time it was a family who came to ask us at what time their loved one would be evacuated when we had not been informed …

Read alsoIn Guyana, endless confinement

“Finally, I would have had the right to the same speech here as at the start of the wave in metropolitan France:” No, but France is different, it will not be like Italy “,” No, but Guyana, that will be fine, it won’t be like in the metropolis. ” One day you will explain to me which part of “pandemic” you did not understand. I don’t know, honestly, how we could confidently say that everything was ready, that we didn’t need help and that everything was going to be fine. I feel like I heard Macron say that we never ran out of masks. Nobody one day could assume to say “It’s shit, but we will adapt as quickly as possible, everyone is on the front”? Must always put everything under the carpet? Fortunately, we had help, a lot of help, a lot of people who came to give a helping hand whether it was on their leave, on an agreement between hospitals, via the army or the health reserve. However, I would still like to underline the astounding lack of communication between hospitals, ARS and health reserve. You try to round up your friends to fill in the holes, put on the patches to keep it going and you finally discover that a whole team is arriving but no one has seen fit to warn the staff. You may even hear the phrase “There are too many reinforcements” while services are still understaffed. I know that in the end the whole technostructure will congratulate itself on the excellent management and will go with its little comment, but it is the caregivers who make it possible to hold on.

Infernal mixture of care, public opinion and political interests

“The health reserve I still have a few complaints. Throwing in the room retired general practitioners who have not done hospitality since their start of their careers and putting hospital workers in town, doesn’t that sound like a bad idea? I have no desire to be ungrateful to my colleagues, more than courageous, who volunteered to come, but maybe estimating the needs and positioning the reinforcements accordingly would be a good start. So inevitably when by ego we say that all is well in the services, we find ourselves hearing that a pulmonologist or infectious disease specialist is not necessary in Guyana. Anyway, we are no longer close. Ah and I greet you dear resuscitator colleague who did not want to see respiratory distress because you were eating. I do not forget you. Same for the reinforcements who complained about not being able to tour, I do not forget you either.

Read alsoIn Cayenne, unwelcome hunger: insufficient humanitarian aid

The climax of this infernal mixture between care, public opinion and political interests was the trial planned for plasma therapy (with plasma from patients who had developed antibodies). If we summarize the situation, a trial concerning the interest of plasma therapy in Sars-CoV-2 infection had started in metropolitan France and was to continue in Guyana. There are two advantages to this: to provide patients with a potentially useful treatment and to succeed in including enough patients to reach a robust conclusion. In a context of mistrust of health authorities, media hubbub and the habit of this department being left behind, announcing this news from Paris was very clumsy. Let us add to this that this was done not by a PUPH (university professor-hospital practitioner) but by a PUPH, Karine Lacombe, and it was gone. Everyone has gone there from their affiliations to promote themselves, deputy, local collectives, close to Didier Raoult’s IHU. And in this mess, in the end, people were therefore pushed to demonstrate to refuse the help of an infectious disease specialist and her team in a territory that badly needed it. Admittedly, the announcement was awkward, but we saw people chanting loud and clear that they refused therapeutic help. I thus saw a good number of messages passing to say that the Guyanese patients were not guinea pigs. It’s such a no-brainer: no one is ever forcibly included in an essay if they don’t want to. This is the very basis of our ethical principles. But obviously to say it would do a disservice to the conspiracy discourse. On the other hand, promoting the use of hydroxychloroquine without any proof of its effectiveness in Covid, that was to use patients as guinea pigs. Associations have been calling for the creation of a university hospital in Guyana for years… and when a university team comes to do research, the door is vehemently slammed in its face.

“All this reflects a profound ignorance of clinical research and its functioning. So I hope that some people’s political agenda was worth it. In all of these ego bickering, whenever politics take precedence over caregivers and scientists for the wrong reasons, it is the patients who drink. While the Guyanese are worth it that we are interested in their territory, that we invest in improving access to healthcare here and that it be worthy of France. ”

(1) The first name has been changed.


Christian Lehmann doctor and writer

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Cured Covid-19: “As if you were touching your marrow with a trowel”

They drooled. Sweat. Coughed. Sometimes kept a log of their symptoms. They managed their fear or considered making a will. But they survived. With or without antibiotics. With or without the famous chloroquine of which the Marseille professor Didier Raoult extols the merits. “98% of people recover”, recalls Jérôme Salomon, the director general of health who, since March 17, gives every day the number of Covid-19 patients discharged from the hospital, while comforting the litany of deaths (Wednesday evening, there were nearly 31 000 “cured” discharged from hospital). With data from the hospital environment, “We must add the probable tens of thousands of cured people in town“, Underlines the general direction of health.

Are these survivors now immune? If yes, for how long? The question remains thorny (read page 6-7). Have they all been really infected with the virus? If some have been tested, many have had to rely on a diag

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Pierre-Henri Allain in Rennes

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Stéphanie Maurice in Lille

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Catherine Mallaval

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François Carrel in Grenoble

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Gilles Dhers

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Stéphanie Harounyan in Marseille

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Guillaume Tion

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Tania Kahn

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Juliette Deborde

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Jérôme Lefilliâtre

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Guillaume Krempp in Strasbourg

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Coronavirus: what are the implications for cancer patients?

Grandstand. With the coronavirus, we are living much more than a health crisis. It is also a test of resistance for our health systems, even for the countries considered as “best ranked” by the various evaluation institutes or bodies. The indicators used, such as economic performance criteria, minimization of the cost of production, satisfaction of a standard of equity specific to each company, now appear to be poorly calibrated and insufficient in the face of such an epidemic crisis. As this pandemic progresses, we understand less the absence of indicators relating to the conditions of practice of those who provide care and to their dedication.

The fight against Covid-19 goes beyond a fight against the epidemic. It is also a struggle to maintain care for other chronic or acute pathologies that have not disappeared during this epidemic period. No one can also conceal the social and economic consequences, possible obstacles to access to care for all. An estimated 3.5 million French people are affected by cancer in France and 382,000 new annual cases in 2018, i.e. around 1,450 new cases diagnosed every day of the week. The Minister of Solidarity and Health regretted that cancer screenings were no longer carried out, “Calling the French” to return to their doctor for these diagnostic procedures. This announcement is important but may not be sufficient or essential to avoid the potential serious consequences of delayed or unannounced diagnoses, treatments degraded by necessity, renunciations of care or the interruption of inclusions in therapeutic trials.

A national strategy to be implemented

It would now be necessary to quickly implement a coordinated national strategy with a coherent territorial variation adapted to the local epidemiological and health situation, even when efforts are made to limit the spread of the virus by containment and barrier measures. The paradox of our society overdone with inflationary regulations and saturated with organizations of all kinds, but which ultimately finds it very difficult to organize or impose cooperation in this unprecedented context. Yet we have entered a period when things that once seemed impossible are inevitable.

Read also “My confinement started in January, when the pain put me in bed”

Since the epidemic crisis and the post-containment period are expected to last several months, the fear of the medical community with which I associate and of the nursing staff of my establishment specialized in the fight against cancer is that we are faced with a first “wave” of more serious cases than before linked to deferred care. After this period of crisis, the duration of which no one can seriously determine, health facilities that have been under tension for many years may find it difficult, especially if they have been considered as “Covid-19 hospitals”, to be absorbed into reasonable times the care of patients awaiting treatment as well as the flow of patients with newly diagnosed cancer reintegrating a course of care. It will most certainly take months to restore optimal organization. In addition, even if the epidemic crisis ends, the deterioration of the economy could accentuate inequalities with all its consequences on access to healthcare, particularly in the case of cancer.

Towards an increase in mortality?

For breast cancer, the most frequent cancer in women, whose annual number of new cases is estimated at 54,000 in France, the surgical management of patients with favorable prognostic criteria has been postponed, in accordance with the opinion of the High Council of Public Health available from mid-March and on the recommendations of learned societies. Even if these are remarkable recommendations which are unanimous during this period, it should not be forgotten that these are expert agreements for degraded care which should not last, at the risk a loss of luck for patients with even cancer said to have a good prognosis. Other examples could be taken, such as pancreatic cancer, the incidence of which has more than doubled over the past twenty years and whose unfavorable prognosis means that any delay in diagnosis by limiting access to radiology services, that any delay in surgical management due to the absence of an available operating theater or access to post-operative resuscitation could inevitably lead to an increase in mortality.

The Lombardy region of Italy, very affected as everyone knows by the pandemic, has managed to organize itself to maintain adequate care for cancer patients during this epidemic plague. Several platforms (HUB centers) have been set up, dedicated solely to the treatment of cancer patients (including the European Institute of Oncology and the National Cancer Institute in Milan). They receive newly diagnosed surgical candidates from area hospitals more dedicated to treating Covid-19 patients. These Covid-19-free cancer hospitals can continue to care for cancer patients even if they are small cancers with good prognosis.

This attention-grabbing pandemic should not make us lose our minds. After having wagered on economic performance for years, we suddenly moved on to the almost exclusive total fight against the Covid-19. It must be remembered that there is a middle way in everything that avoids extreme attitudes while preserving the future.


Emmanuel Barranger Surgeon oncologist, director general of the Center for the fight against cancer Antoine Lacassagne, Nice (Fédération Unicancer)

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Diary of a doctor in Ehpad: “In the night, unexpected death is hard”

On the front line with the elderly, Jean-Paul Duplan, 69, is the coordinating doctor of two accommodation establishments for dependent elderly people (Ehpad) in the department of Essonne.

For request of Release, he keeps a logbook of his daily work in the face of the coronavirus. The fight is tough.

This article is the updated version of the logbook published in its first version in the edition of Release April 4-5.

March 25

For how long ?

“Four of the six tests I managed to do came back positive! Now is the time to implement the program that we had defined as a team. Dedicated area set up in the morning of March 23, with a nurse, a nursing assistant, FFP2 protective masks, a disposable gown and overcoats (keep stocks up to date). Contain all residents in their rooms as of today. For how long ? Some have been asking for it for several days, without realizing

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Sylvain Mouillard

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Shortages extend to drugs

Faced with the unprecedented scale of the crisis and the influx of patients, stocks are running out. First those of protective masks. Then reagents used in diagnostic tests from Covid-19. And the respirators, whose production is struggling to keep up with demand. Little by little, everything necessary for hospitalization and treatment of patients is running out. Even the most common equipment, the most common drugs.

“Hospital stocks of muscle relaxants, sedatives and painkillers are consumed quickly”, is alarmed by the European Alliance of European University Hospitals, and “At their current rate of consumption, stocks will be empty within a few days in the hospitals hardest hit, and within two weeks for those with the largest reserves.” In their press release published on Tuesday, forty doctors and directors of establishments in France and other European countries call their respective leaders to coll

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Camille Gévaudan

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Resuscitation drugs: “We fear a shortage of stocks”

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.


Anaïs Moran

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Chloroquine, the presumption of antidote – Release

We only talk about her, we believe strongly. And in this second week of general confinement, while France now has 860 dead (186 more in twenty-four hours) and more than 2,000 patients in intensive care, chloroquine is on the verge of being presented as the miracle cure against the coronavirus, and the grumpy would delay its distribution guilty as the massacre continues. Thus, all this weekend and again Monday, definitive declarations have multiplied on this molecule widely used around the world for fifty years for its antimalarial virtues, as well as for the treatment of autoimmune diseases like lupus or polyarthritis rheumatoid. The boss of LR senators, Bruno Retailleau, on Sunday urged the government not to “Fall behind” and prescribe the drug “In a hospital environment”. The mayor of Nice, Christian Estrosi (LR), himself infected with the coronavirus, said the same day that he had “Want that

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Eric Favereau

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Checknews Service

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A resuscitation doctor: “It’s the start of the war”

Marc Amouretti, 32, is a doctor in the intensive care unit at Louis Mourier Hospital in Colombes (Hauts-de-Seine), an establishment dependent on the Public Assistance of Paris Hospitals (AP-HP). In the front line facing the Coronavirus epidemic, he tells Release his daily life and how his service is organized to cope.

Read also More than 7,000 dead worldwide, help for companies… update on the coronavirus

“The Covid-19 becomes a reality for more than a week. We are now going beyond the “anecdotal” cases linked to a few well-established clusters, where we could almost trace the chains of contamination from one family member to another. From now on, the cases are multiplying, in more or less serious forms, and occupy an increasing part of the resuscitation beds. This pushes us to rethink our organization every day to optimize patient care, and in particular to ensure that those who do not have the coronavirus are not

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Sylvain Mouillard

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