“Covid is a sneaky animal”

In this second wave of Covid, some, influenced by the doubt maintained by deniers (there is no rebound, the deaths are falsely labeled Covid …) still ask the question of the usefulness of hospitalization. They know patients who have not been signed and, due to the controversy created over the number of beds in France, the need to de-program the surgeries again, the resentment created by this new hospitalization which is not one, begins to dream that we can cure more patients at home, to “give relief” to the hospital, without social constraints. They do not realize the complexity of managing a Covid patient with pulmonary involvement.

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

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

“Of course, at first, it can take many forms, but eventually in ICU all Sars-CoV-2 patients ended up resembling or almost to the point that during the first wave our resuscitators confused them in their long Changing of the guard because their registers were overlapping, so aligning these bodies in the prone position became routine, so identical care was repeated over and over again until caregivers were exhausted.

“The coronavirus rages at night and floods the emergency services… All doctors will tell you. Patients arrive in groups, whole families or degrading strangers at the same time to the emergency room without we as yet have a clear explanation for these simultaneous massive arrivals.

Previous epidemic registerCriticisms of re-confining: between the art of living and eugenics

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

“Oxygen remains the cornerstone”

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

– The so-called “cold” Covid, where the disease passes only without giving any severity criteria, the PCR test is positive, the signs are finally minor (fever, muscle pain, headache, severe fatigue) and are appeased by paracetamol. City clinics, hospitals, nursing homes and nursing homes are full of cold Covid. Hospitalization, which would seem superfluous in the absence of respiratory signs and the need for oxygen, can sometimes be made necessary by the exhaustion or abandonment of caregivers who also find themselves contaminated and isolated. Cold Covid is sneaky, making home care impossible for older people living alone.

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

– The most complex and unpredictable is the “lukewarm” Covid with respiratory criteria (the oxygen requirement begins below a saturation threshold of 92%) for which the patient will have to be monitored in the hospital because, remember that Covid is sneaky … Suddenly, it causes a sudden drop in the level of oxygen in the blood, regardless of the extent of the lung lesions on the systematically performed CT scan upon admission.

“Covid is all the more subtle as the decrease in oxygen saturation in the blood will hardly be felt by the patient who presents this particular phenomenon of characteristic” happy hypoxia “(the neurological transmission of the sensation of shortness of breath does not occur. the patient suffocates but does not notice it).

“These patients with respiratory signs have a risk of aggravation that typically occurs seven to ten days after the onset of symptoms and for them monitoring must be hospital, sudden desaturation very often occurs in less than ten minutes causing the change of oxygen. Need from 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 intensive care. The recent proposals of our health authorities to start home oxygen therapy in the early phase are medical unconsciousness in the face of this happy / silent hypoxia of which the patient does not feel the aggravation. Which Samu in France can intervene in less than ten minutes on a patient in respiratory distress, what emergency strategy should be put in place in these patients left to themselves and their families? Oxygen remains the cornerstone of Covid management, but the early stage can lead to hypoxic cardiac arrest.

“Go to a torch”

“This morning, in turn of the visit to the service, I discovered another story that has become almost banal, a 35-year-old young man, with no particular history, hospitalized for three days, perfectly stable under 1 liter / minute, with 96% saturation, who during a feverish peak of sudden onset suddenly presents with respiratory distress with 87% desaturation. In less than ten minutes we increase the oxygen to 4, then to 6, then to 9, then to 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 ICU sector … Let’s touch the enormous risk-taking at home … has shown no warning signs of deterioration. The patient did not complain of anything before exploding into an exacerbation … This family situation would run the risk of intubation, worse, of hypoxic cardiac arrest. Covid is sneaky.

“We all agree on this point, Covid seems constant, the same scanners, the same gas measurements, the same risk factors (obesity, diabetes, hypertension), but it is dangerous, sneaky and can affect all ages with criteria of gravity that will logically assume greater proportions in old age. Covid not only destroys our elderly, but can also precipitate our friends, our colleagues, our neighbors, our young people, our parents in intensive care. Covid affects randomly, the prudent and the reckless. It does not necessarily kill them but sows fear and anguish in the eyes of those we hospitalize, terrified at the idea of ​​becoming part of the morbid registers of French public health.

“Covid is sneaky and invades hospital capacity after dark. The curve is flying away and healthcare workers are worried that they won’t be able to accommodate you in their hospital beds. We beg you to be more vigilant. We know you are flabbergasted by the prevention messages, but Covid is sneaky, it doesn’t care like its first pangolin, it keeps blowing up hospital capacities, lives at night, and it doesn’t take a weekend. “

Christian Lehmann doctor and writer