PARIS (Reuters) – In March, emergency room doctor Frederic Adnet needed to move COVID-19 patients from his fast-filling Paris hospital to less hard-hit regions of France to free up beds, but unlike during the first wave last year the transfers weren’t happening.
It was a scene playing out across the French capital and other virus hotspots, mainly because families were now refusing to give consent, interviews with Adnet and half a dozen other emergency room and ICU doctors reveal.
The inability to move patients deprived public health managers of a vital safety valve to manage pressure on the healthcare system, and contributed to President Emmanuel Macron having to order the third lockdown he had striven to avoid.
The difficulties came as a surprise to Adnet. During the epidemic’s first wave, 252 COVID-19 patients in the Paris region were relocated to outlying areas over a three-week period. Scores more were moved from eastern France.
“We were buoyed by the success of transfers during the first wave. It gave us a real breather,” Adnet told Reuters. “But we were wrong to think we could copy and paste the playbook.”
France caught world attention last spring when it used modified high-speed TGV trains to whisk COVID-19 patients across the country to provincial hospitals.
Hospitals in Paris targeted moving 100 patients each week during the third wave, Adnet said. But only 35 transfers have been completed since mid-March, the local health authority said.
During the first wave, the virus was little known and hospitals had been so swiftly overwhelmed that relatives were kept away from wards. It meant less to families if a relative was treated nearby or 500 km (300 miles) away, said Bruno Megarbane, head of ICU at the Lariboisiere hospital in Paris.
As intensive care units buckled under the strain, transfers were often presented to families as non-optional, said Stephane Gaudry, a critical care doctor in Bobigny on the northeastern edge of Paris. It was a grim experience, he said.
In March this year, things were different. Hospital visits were allowed and the transfers were more about winning breathing space than patient survival. Meanwhile, public frustration at the pandemic was growing.
Macron and his government were clear that relieving the pressure on hospitals in Paris was crucial to keeping the country open. But this irked families, whose consent doctors said they felt ethically compelled to seek.
“Families (were saying) to themselves, ‘if we’re only doing that so that others are not locked down, then no’,” said Gaudry.
“At one point the government raised the prospect of no longer seeking consent. That’s unreasonable and inhumane.”
Families have been reluctant to speak out on the issue, but Olfa Hamzaoui, ICU doctor at the Antoine Beclere Hospital in Paris said: “Families know their relative could die at any moment. Not being able to visit that person because he or she has been moved far away adds to the distress.”
On March 17, Macron convened his COVID war room and decided to lockdown Paris and much of northern France. Afterwards a government source told Reuters that the failure to transfer more patients had played into the decision.
“We did not do all the medical evacuations that we could have done,” the official said. “We are going to lockdown 13 million people when, objectively, we could have done more.”
Pressure remains acute on hospitals, which say COVID patient numbers in intensive care have not yet peaked and may still reach the first-wave high of 7,019. France reported 5,705 in ICU on Thursday.
Other complications have also hampered transfers during the third wave. More hospitals nationwide are reaching saturation point while the higher number of gravely ill patients means fewer are suitable for moving, the doctors said.
Transfers remained a “precious tool” for saving lives, Health Minister Olivier Veran said last week.
Lille Hospital’s emergency room chief Patrick Goldstein said the northern Hauts de France region was managing to move two or three patients a day, but for the past week had needed to do five to ten.
Transfers helped overloaded wards get ahead of the curve, Goldstein said, and this was a time when hospitals should feel able to forego seeking consent.
France should follow neighbouring Belgium’s lead, he said. “They inform, but they don’t ask permission.”