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Flu: Touraine calls on hospitals to postpone non-urgent surgeries to free up beds

In recent days, hospitals are facing an influx of elderly people affected by the flu virus and emergency services are overheating.

LE MONDE| 11.01.2017 with 05h47 ? Updated on 11.01.2017 with 12h44 |
By Fran?ois B?guin
Faced with an influx of elderly affected by influenza type A (H3N2), emergency departments have been overheating for several days. "Some hospitals are so overloaded that the ambulance can not even discharge their patients, the situation is extremely critical," says Fran?ois Braun, president of SAMU-Emergencies of France, who sees all the symptoms of a "health crisis" . The peak of the epidemic is expected next week.

On Wednesday morning, health minister Marisol Touraine called for postponing non-emergency operations to relieve congestion in hospitals. "The challenge is to ensure that there are hospital beds available," the minister said on Wednesday. She announced that she had instructed hospitals to immediately initiate all necessary measures, including their "white plan", to avoid any saturation of emergencies.

"The outcome of the epidemic will probably be heavy, since the number of sick people is particularly important, but the health system is responding, "she added.

"Exceptional Saturation"

Observing the "exceptional saturation" of some of its emergency services, the Paris Public Hospitals (AP-HP), like most university hospitals in France, had not waited for these ministerial instructions and had asked as of Friday January 6 at its 39 establishments to activate level 3 of the plan "Hospital in tension" which allows to release additional beds. The day before, the Parisian hospital of Piti?-Salp?tri?re had, for example, had to ask for a "shedding" and refuse any new patient.

"Everywhere, it cracks," reports Dr. Christophe Prudhomme, from CGT-Sant? to AP-HP. According to him, in some institutions, patients must now wait "on stretchers more than twenty-four hours to find a bed". Conditions of hospitalization which he considers "unacceptable and inhuman". For him, "our system is so energized that it is unable to manage a rise in activity, linked to a predictable flu epidemic, as it happens every four to five years."

"Respiratory complications"

If some institutions are close to embolism today, it is because the type A (H3N2) virus mainly affects people over 65 years of age. "Seniors are more affected than in previous years, there are 20% more people in this age group affected than expected," says the Research Institute for Valorization (IRSAN), an influenza surveillance network, based on the 10,000 daily acts of the SOS-M?decins network. Since the beginning of the epidemic, the share of hospitalizations after passage to the emergency for influenza has been 51% for people aged 65 years and more, stresses Public Health on Wednesday. A proportion considered "very high".

For the health system, the effect of this overrepresentation of seniors is immediate. "Where children with seizures can be sent back home after 24 hours, the more fragile elderly need to be hospitalized and monitored for several days because the flu can cause respiratory complications," explains virologist Bruno Lina. Hence the phenomenon of bottling in hospitals. It is like a rolling staircase where no one would evacuate the arrival area, everyone telescope. "

In order to make the system more fluid, health authorities have to succeed in liberating beds in services which are not normally intended to accommodate this type of patient and to deprogram non-urgent activities such as surgery.

" Lack of staff "

While the winter 2015-2016 epidemic had led to an excess mortality of 18,300 people, 90% of whom were over 65 years of age, the directors of in-home services and establishments for elderly said today to be "extremely worried". "We were told that the virus was as virulent as it was in 2015, but nothing has changed since that year in helping seniors. There is a constant lack of staff, "deplores Pascal Champvert, president of the Association of Directors in the Service of the Elderly, the day after a meeting at the Ministry of Health.

In a retirement home in Lyon, Korian-Berthelot's elderly care home (Ehpad), 72 of the 110 residents were infected and 13 died in 15 days, it was learned on 7 January. This case questions the degree of vaccination coverage of the residents of the institution but also that of the nursing staff.

Faced with the worries of seeing the 2014-2015 scenario renewed, the virologist Bruno Lina wants to be reassuring. "Two years ago, the vaccine was not suitable. This winter, it is, although it is only effective at 40 to 45% for people over 65, he said. So there will be excess mortality this winter, but I do not think it will be as high. "