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“The Covid is a sneaky animal”

In this second wave of Covid, some, influenced by the doubt entertained by deniers (there is no rebound, deaths are falsely labeled Covid …) still ask the question of the usefulness of hospitalization. They know patients who have had no sign, and, because of the controversy created around the number of hospital beds in France, the need to deprogram again surgical interventions, the resentment created by this new confinement which is not one, start to dream that we can treat more patients at home, to “relieve” the hospital, without social restriction. They do not realize the complexity of the management of a Covid patient with pulmonary involvement.

Clarisse Audigier-Valette is 49 years old. Pneumo-oncologist at the Toulon hospital center, she tries to hang on to this life before, where she had hoped that the first wave would be the last. Here is his testimony.

“The Covid is a sneaky animal that sneaks into the emergency services at nightfall.

“Certainly, at the start, it can take several forms, but in the end in intensive care all patients affected by Sars-CoV-2 ended up looking alike or almost to the point that during the first wave, our resuscitators confused them over their long Changing of the guard because their files were superimposed, so the alignment of these bodies in the prone position became routine, so identical care was repeated over and over again until the caregivers were exhausted.

“The coronavirus rages at night and floods the emergency services… All doctors will tell you. Patients arrive in clusters, entire families or strangers degrading at the same time in the emergency room without our having yet a clear explanation for these simultaneous massive arrivals.

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“How many resuscitators and emergency physicians will tell you that they had to intubate five to ten patients in a chain in an emergency corridor already crowded? Our colleagues from Ile-de-France and Grand Est have already experienced this in the spring. In the South, we are preparing for it, the first wave was less violent, but this one promises to be identical or even more severe as evidenced by the initiation of phase 5 of the white plan by the Regional Health Agency on Last weekend. Can we be really ready in the Covid? I don’t know, you always have to be one step ahead, this is the princeps lesson of the first wave and the successive crisis meetings.

“Oxygen remains the cornerstone”

“Covid is an infectious disease, but its severity is respiratory and its management revolves mainly around pulmonologists and resuscitators. To simplify the management of this virus, the Covid can be divided into three groups:

– The so-called “cold” Covid, where the disease only passes without giving any criteria of severity, the PCR test is positive, the signs are ultimately minor (fever, muscle aches, headaches, severe fatigue) and are calmed by the paracetamol. City surgeries, hospital services, nursing homes and nursing homes are full of cold Covid. Hospitalization, which would seem unnecessary in the absence of respiratory signs and the need for oxygen, can sometimes be made necessary by the exhaustion or desertion of caregivers who also find themselves contaminated and isolated. The cold Covid is sneaky, making home care impossible for elderly people living alone.

– The “hot” Covid, these are those who already arrive in respiratory distress upon admission and are transferred directly to intensive care, often intubated because the phase of respiratory deterioration was too rapid or went unnoticed at home.

– The most complex and unpredictable remains the “lukewarm” Covid with respiratory criteria (the oxygen requirements start below a saturation threshold of 92%) for which the patient will have to be monitored in hospital because, remember the Covid is devious… Suddenly, it causes a sudden drop in the level of oxygen in the blood, regardless of the extent of the pulmonary lesions on the scanner systematically performed on admission.

“The Covid is all the more devious in that the drop in blood oxygen saturation will hardly be felt by the patient who presents this particular phenomenon of characteristic” happy hypoxia “(the neurological transmission of the feeling of shortness of breath does not occur. not producing, the patient suffocates but does not realize it).

“These patients with respiratory signs present a risk of aggravation occurring classically seven to ten days after the onset of symptoms and for them the monitoring must be hospital, sudden desaturation very often occurs in less than ten minutes causing the oxygen to switch. Requirement of 1-2 liters / minute to 6-9 liters / minute, which leads to the indication of high flow oxygen therapy from 50 to 100 l / min with transfer to the intensive care unit. The recent proposals by our health authorities to initiate home oxygen therapy in the early phase are medical unconsciousness in the face of this happy / silent hypoxia which the patient does not feel the aggravation. Which Samu in France can intervene in less than ten minutes in a patient in respiratory distress, what emergency strategy to put in place in these patients left to themselves and their families? Oxygen remains the cornerstone of the management of Covid but the early phase can lead to hypoxic cardiac arrest.

“Go in a torch”

“This morning, at the turn of the visit to the service, I discovered yet another story that had become almost banal, a young man of 35, with no particular history, hospitalized for three days, perfectly stable under 1 liter / minute, with 96% saturation , who during a febrile peak of sudden onset suddenly presents respiratory distress with 87% desaturation. In less than ten minutes we increase the oxygen to 4, then 6, then 9, then 15 liters per minute, without success. Just enough time to see the resuscitators arrive at his bedside to ask for the indication of high flow oxygen therapy (50 liters / min) in the intensive care sector… We touch on the enormous risk-taking at home… There is no had no warning signs of worsening. The patient did not complain about anything before going off in a flash… This home situation would run the risk of intubation, worse, of hypoxic cardiac arrest. The Covid is sneaky.

“We all agree on this point, the Covid seems constant, the same scanners, the same gas measurements, the same risk factors (obesity, diabetes, hypertension), but it is dangerous, devious and can affect all ages with criteria of gravity which will logically assume greater proportions in old age. The Covid does not only destroy our elders, it can also throw our friends, our colleagues, our neighbors, our young people, our parents in intensive care. The Covid strikes at random, the prudent and the reckless. It doesn’t necessarily kill them, but it sows fear and anguish in the eyes of those we hospitalize, terrified at the idea of ​​joining the morbid registers of Public Health France.

“The Covid is sneaky and invades hospital capacities after dark. The curve is flying away and caregivers are worried that they will not be able to accommodate you in their hospital beds. We implore you to be extra vigilant. We know you’re stunned with prevention messages, but the Covid is sneaky, it doesn’t care about it like its first pangolin, it keeps blowing up hospital capacities, it lives at night and doesn’t take a weekend. “

Christian Lehmann doctor and writer


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