Paris, where the incidence of the virus is very high, may in turn quickly fall into the maximum alert zone. Intensive care admissions double there every two weeks. The capacities are likely to reach saturation in November.
It is not only in Marseille that the new anti-Covid measures do not pass. The Paris region is admittedly not yet classified as the Phocaean city in the maximum alert zone, nevertheless Paris and the inner suburbs shine bright red on the new coronavirus map of France. The verdict fell on Wednesday evening, and it raises loud cries: in this “heightened alert zone”, it will be necessary to close bars and restaurants at 10 p.m. maximum, close gymnasiums and sports halls, ban gatherings of more than ten people…
Thursday, the day after the announcements of the Minister of Health, Olivier Véran, the mayor of Paris Anne Hidalgo expressed her dissatisfaction. These restrictions on public freedoms are “Difficult to understand” and they were decided “Without any consultation”, she denounced. The president of the Ile-de-France region, Valérie Pécresse, was also moved by the method: “Faced with the return of the Covid-19, I call on Ile-de-France residents to exercise great self-discipline. But I also ask the government to respect a real consultation with the communities on the decisions impacting bars and restaurants already very weakened ”.
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The incidence rate in Paris is the highest in France after Guadeloupe, at 217 new infections per week per 100,000 inhabitants. The threshold for the enhanced alert zone is 150 per 100,000, and that of the maximum alert area is 250 per 100,000. The incidence in the elderly has also exceeded 50 per 100,000, and the threshold of 100 corresponding to the maximum alert could approach quickly.
Doubling of resuscitations every 15 days
The third criterion is regional resuscitation capacities. And here too, Ile-de-France is in bad shape. Nearly 1,000 people had to be hospitalized for Covid over the last 7 days, against 460 the previous week, explained Olivier Véran on Wednesday. “Even more striking, of the nearly 2,000 patients hospitalized with the Covid, 305 are hospitalized in intensive care, or 27% of the total resuscitation capacity in the region, against 18% a week ago”, he insisted. The threshold of 30% of the maximum alert stage will therefore be quickly crossed.
Worse, hospitals risk being turned on very quickly. “At the current rate of nearly 50 new entries per day in critical care, against fifteen per day a week ago, corresponding to a doubling of the number of intensive care patients every two weeks, 40% of regional intensive care capacities will be used around October 10, 60% around October 25 (700 patients), 85% around November 11 (1,000 patients) ”, explained Olivier Véran.
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In an internal document, the Assistance publique-Hôpitaux de Paris (AP-HP) estimates that the threshold of 1,000 resuscitations in Ile-de-France would be exceeded “Between 23 and 27 October”, assuming the average length of stay for these patients is 16 days. Admittedly, this average duration is today 12.3 days at AP-HP, but it is getting longer, because the more patients flow in, the less relatively mild patients are admitted.
“Every week counts”
During a press conference this Thursday, the hospital group also announced that it would start to deprogram certain surgical procedures this weekend, to make room. When asked if the measures taken in Paris were sufficient, Professor Piarroux replied: “A month ago they were more than sufficient, now we are a little on the edge. I hope it will be enough ”.
The epidemiologist expects a 20% drop in transmissions, in particular thanks to the early closings of bars. An American study has shown that their frequentation multiplied by three or four the risk of infection, and that of restaurants by two.
As for the implementation of the new restrictions for 15 days, this is the time necessary to see their effect on resuscitations. This is also the time it takes for the epidemic to double in size, underlined the infectious disease specialist Xavier Lescure. In other words, it is the smallest chronological interval allowing to judge the effects of a policy of containment of the epidemic.
The story of the coronavirus crisis at the Assistance publique-Hôpitaux de Paris