At 8.30am on Tuesday 26 January the waiting room of the emergency department at the Lariboisière hospital in Paris was still empty, festooned with signs reading “emergency department on strike” that predate the pandemic but have been left pointedly in place.
There were no shrieking sirens, nobody dressed in PPE. It was and continues to be calm, but the calm may not last.
Despite the 6pm-6am curfew that has been in place since 16 January, the proportion of Covid-19 infections accounted for by the so-called UK variant is increasing exponentially in France – by 50% a week.
Though that proportion is still low, at about 14%, the scientific committee advising the government expects the more transmissible UK variant to become dominant in the viral population by early March, if not sooner – and it has not ruled out a third lockdown to try to slow its progress, as has already been imposed in the UK, Ireland and Portugal.
Although the situation is worse in other parts of France, notably the south-east, the Lariboisière did not see a spike in Covid-19 cases after the winter holidays, nor any flu epidemic to speak of this winter, and hospitals across the Île-de-France region are far from saturated. The hiatus has allowed personnel to take stock.
The Lariboisière’s emergency department is one of the busiest in the country, seeing 250 patients a day pre-Covid-19, or roughly twice the national average.
Last Monday it logged 200 – a drop that the head of department, Dr Eric Revue, attributed to the curfew and, overall, less harm being done at night.
All patients are routinely and rapidly tested for Covid on arrival. There is a steady flow of elderly Covid-19 patients – though Dr Revue suspects more are staying and dying at home, their Covid-19 often going detected – but the other significant phenomenon has been the increase in patients with mental health problems.
Overnight the department had admitted a 55-year-old woman who had taken too many antidepressants, and a highly agitated, suicidal young man who was high on alcohol and cannabis.
“These cases are typical,” said Dr Revue. “Psychiatric patients have suffered the worst, not only because of medication shortages earlier in the year, but also because of confinement and interruptions to their follow-up.” He said he had seen a noticeable rise in victims of domestic abuse and, during the spring peak, a case of defenestration a day, on average.
In the hospital’s intensive care unit, half of the 18 beds were occupied by Covid-19 patients, one of whom had died in the small hours. He had been laid out awaiting the visit of his family, because his coffin would have to be sealed before it left the hospital, for risk of contagion.
The doors to the rooms of Covid-19 patients were kept closed, those of other – mainly toxicology – patients left open. One door was kept closed with very strict criteria for entry, because the Covid-19 patient inside had developed a form of pneumonia caused by a highly drug-resistant bacterium.
Yet, in general, the ICU staff were not dressed head-to-toe in PPE. With familiarity, fear of the disease had lessened, said the head of department, Prof Bruno Mégarbane. Nour Kaya, a nurse, concurred. “Sometimes, when I’m rushing to a patient who has desaturated [whose arterial oxygen level has suddenly dropped], I might even forget my coat or mask,” she said.
Kaya, 27, caught Covid-19 back in October and ended up infecting other members of her family, with whom she lives.
Her 47-year-old mother was admitted to hospital, but recovered. Most of her colleagues had similar stories, she said. There was exhaustion. They were offered a one-off payment of €1,500 back in the spring, which was welcome: “We would have preferred more equipment, more personnel, to be able to do our job better.”
Everyone was aware the crisis was far from over. “Vaccine protection won’t be significant until the autumn,” said Mégarbane, “so another wave is entirely possible.” Dr Revue said he had been gratified by his team’s esprit de corps: “Even the most militant strikers put their all into it,” he said. “They were heroic. We felt that we were doing our real work.”
But he said he worried about what would happen when the pressure – and the solidarity – finally lessened.
Kaya agreed. “I think it’s quite likely there will be strikes again,” she said.