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For France, Coronavirus Tests a Vaunted Health Care System For France, Coronavirus Tests a Vaunted Health Care System
(14 days later)
PARIS — One of the world’s best health care systems is facing its severest test ever, and whether it succeeds will say much about the ultimate adequacy of a well-funded, well-equipped and broadly accessible national treatment plan.PARIS — One of the world’s best health care systems is facing its severest test ever, and whether it succeeds will say much about the ultimate adequacy of a well-funded, well-equipped and broadly accessible national treatment plan.
If France’s experiment in confining its citizens — less rigorous than the Chinese, more precocious than the Italian, far more organized than the American — yields the hoped-for flattening of the curve, it would be vindication not just for the underlying system, but for a Western democracy’s organized effort to combat the coronavirus. The verdict is still weeks away.If France’s experiment in confining its citizens — less rigorous than the Chinese, more precocious than the Italian, far more organized than the American — yields the hoped-for flattening of the curve, it would be vindication not just for the underlying system, but for a Western democracy’s organized effort to combat the coronavirus. The verdict is still weeks away.
President Emmanuel Macron has told the French, over and over, that the country is “at war.” On the surface, it is going into battle well prepared.President Emmanuel Macron has told the French, over and over, that the country is “at war.” On the surface, it is going into battle well prepared.
[Analysis: Coronavirus puts to the fore an improbable U.K. leader: Dominic Raab.][Analysis: Coronavirus puts to the fore an improbable U.K. leader: Dominic Raab.]
France spends more on health than most of its developed-world peers, offers world-beating access to doctors at less cost, and encourages all its citizens, through universal government-funded coverage, to keep track of their conditions. It has twice the number of intensive care beds that Italy has.France spends more on health than most of its developed-world peers, offers world-beating access to doctors at less cost, and encourages all its citizens, through universal government-funded coverage, to keep track of their conditions. It has twice the number of intensive care beds that Italy has.
Mr. Macron has not been shy about touting the virtues of that system, especially in comparison with the United States.Mr. Macron has not been shy about touting the virtues of that system, especially in comparison with the United States.
“What this pandemic is showing, right now, is that free health care, without regard to income, career, or profession, our welfare state, these are not costs or burdens, but precious assets when fate strikes,” Mr. Macron said in a televised address to the country two weeks ago.“What this pandemic is showing, right now, is that free health care, without regard to income, career, or profession, our welfare state, these are not costs or burdens, but precious assets when fate strikes,” Mr. Macron said in a televised address to the country two weeks ago.
“What the pandemic shows is that there are goods and services which must be protected from the laws of the market,” he added.“What the pandemic shows is that there are goods and services which must be protected from the laws of the market,” he added.
But with coronavirus cases doubling every four days, even France’s relatively luxurious system is creaking and straining. A week into France’s total lockdown — little stirs on the echoing streets of Paris and the normally traffic-bound Place de la Concorde is now an empty windswept plaza — there are no signs of a letup in the intensity of the epidemic.But with coronavirus cases doubling every four days, even France’s relatively luxurious system is creaking and straining. A week into France’s total lockdown — little stirs on the echoing streets of Paris and the normally traffic-bound Place de la Concorde is now an empty windswept plaza — there are no signs of a letup in the intensity of the epidemic.
“For France, this is a crash test of our system,” said François Bricaire, an infectious disease specialist at the National Academy of Medicine. It is small comfort to the French that the coronavirus numbers in their country are well below those in Italy and Spain, for the moment. By Thursday, 1,696 had died in the hospitals — in Italy, deaths were at 6,077 — more than 3,000 were in critical condition, and there were more than 29,000 known infections.“For France, this is a crash test of our system,” said François Bricaire, an infectious disease specialist at the National Academy of Medicine. It is small comfort to the French that the coronavirus numbers in their country are well below those in Italy and Spain, for the moment. By Thursday, 1,696 had died in the hospitals — in Italy, deaths were at 6,077 — more than 3,000 were in critical condition, and there were more than 29,000 known infections.
“Our centralized system is perhaps better adapted than the Italian to an epidemic,” Mr. Bricaire said, adding, “The decisions made in Paris are immediately circulated around the country.”“Our centralized system is perhaps better adapted than the Italian to an epidemic,” Mr. Bricaire said, adding, “The decisions made in Paris are immediately circulated around the country.”
But the authorities may be significantly underestimating the number of dead in France.But the authorities may be significantly underestimating the number of dead in France.
“The hospital deaths represent only a small portion of the mortality,” the French national health director Jérôme Salomon told journalists Tuesday night. In particular, more and more deaths in nursing homes, not counted so far in the official tallies, are coming to light, particularly in eastern France — 16 in Haute-Marne, seven in Haute-Savoie, 20 in Vosges.“The hospital deaths represent only a small portion of the mortality,” the French national health director Jérôme Salomon told journalists Tuesday night. In particular, more and more deaths in nursing homes, not counted so far in the official tallies, are coming to light, particularly in eastern France — 16 in Haute-Marne, seven in Haute-Savoie, 20 in Vosges.
Another 16 died in a Paris nursing home, according to French news reports.Another 16 died in a Paris nursing home, according to French news reports.
The epidemic was “worsening rapidly,” Mr. Salomon said Tuesday night, calling it “intense and severe.”The epidemic was “worsening rapidly,” Mr. Salomon said Tuesday night, calling it “intense and severe.”
Overstretched hospitals in Alsace, the hardest-hit region by far, have had to send out patients by military planes to less affected regions, and even in a “medicalized” train. A conference of 2,000 evangelical Christians at Mulhouse in February, where an unknown but significant number of those there were infected, has had the effect of a coronavirus bomb, first on Alsace, and then on all of France, as the participants spread throughout the country.Overstretched hospitals in Alsace, the hardest-hit region by far, have had to send out patients by military planes to less affected regions, and even in a “medicalized” train. A conference of 2,000 evangelical Christians at Mulhouse in February, where an unknown but significant number of those there were infected, has had the effect of a coronavirus bomb, first on Alsace, and then on all of France, as the participants spread throughout the country.
“We’re at the limit of our capacities,” Jean Sibilia, dean of the medical faculty at Strasbourg University, said. “As long as we’re doubling cases every four days, you can just imagine the load,” he said.“We’re at the limit of our capacities,” Jean Sibilia, dean of the medical faculty at Strasbourg University, said. “As long as we’re doubling cases every four days, you can just imagine the load,” he said.
Hospitals in Alsace are so full the French Army has had to scramble to set up a field hospital.Hospitals in Alsace are so full the French Army has had to scramble to set up a field hospital.
“What we’re living through here is completely exceptional,” said Jean-François Cerfon, an emergency room doctor in the eastern town of Colmar. “A massive influx of patients, over a short period, and they’re in for the long haul. Let’s just hope that by July we’re out of this nightmare.”“What we’re living through here is completely exceptional,” said Jean-François Cerfon, an emergency room doctor in the eastern town of Colmar. “A massive influx of patients, over a short period, and they’re in for the long haul. Let’s just hope that by July we’re out of this nightmare.”
Now, amid the same bitter debates taking place in other countries — opposition politicians are asking whether officials were prepared, why stocks of masks were not higher, and whether Mr. Macron moved fast enough — the government is holding its breath about whether the robust French system can hold. The debates have been muted though, because public anxiety has so far outweighed the country’s strong attachment to individual liberties.Now, amid the same bitter debates taking place in other countries — opposition politicians are asking whether officials were prepared, why stocks of masks were not higher, and whether Mr. Macron moved fast enough — the government is holding its breath about whether the robust French system can hold. The debates have been muted though, because public anxiety has so far outweighed the country’s strong attachment to individual liberties.
There are no guarantees. “No system can hold indefinitely,” said Philippe Juvin, head of the emergency room at Hôpital Européen Georges-Pompidou in Paris. ‘‘There’s always a moment when the wave is too big,” he said.There are no guarantees. “No system can hold indefinitely,” said Philippe Juvin, head of the emergency room at Hôpital Européen Georges-Pompidou in Paris. ‘‘There’s always a moment when the wave is too big,” he said.
“It’s going to be a test of organization, and a human test,” he added, noting that the wave of patients arriving at hospitals in critical condition was growing. “Will we have the capacity to hold up?”“It’s going to be a test of organization, and a human test,” he added, noting that the wave of patients arriving at hospitals in critical condition was growing. “Will we have the capacity to hold up?”
Weeks of protests by hospital personnel, before the crisis, over too-long hours and overstretched personnel underscored the health system’s low morale.Weeks of protests by hospital personnel, before the crisis, over too-long hours and overstretched personnel underscored the health system’s low morale.
Others are trying to put on a brave face. “The teams are holding up well,” said Martin Hirsch, the director of Paris hospitals. “They have extraordinary capabilities.”Others are trying to put on a brave face. “The teams are holding up well,” said Martin Hirsch, the director of Paris hospitals. “They have extraordinary capabilities.”
Updated July 7, 2020
The coronavirus can stay aloft for hours in tiny droplets in stagnant air, infecting people as they inhale, mounting scientific evidence suggests. This risk is highest in crowded indoor spaces with poor ventilation, and may help explain super-spreading events reported in meatpacking plants, churches and restaurants. It’s unclear how often the virus is spread via these tiny droplets, or aerosols, compared with larger droplets that are expelled when a sick person coughs or sneezes, or transmitted through contact with contaminated surfaces, said Linsey Marr, an aerosol expert at Virginia Tech. Aerosols are released even when a person without symptoms exhales, talks or sings, according to Dr. Marr and more than 200 other experts, who have outlined the evidence in an open letter to the World Health Organization.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
Yet the capital is hovering near its critical-care bed limit of 1,200, and Mr. Hirsch told French news media on Wednesday that he could “only see three days ahead.”Yet the capital is hovering near its critical-care bed limit of 1,200, and Mr. Hirsch told French news media on Wednesday that he could “only see three days ahead.”
Mr. Hirsch, a veteran health official, also has acknowledged the giant unknown. “How can you talk about facing up to something that we have never even known before?” he said in a telephone interview.Mr. Hirsch, a veteran health official, also has acknowledged the giant unknown. “How can you talk about facing up to something that we have never even known before?” he said in a telephone interview.
For weeks, France thought it could escape Italy’s fate even as it kept a wary eye on its neighbor. The initial measures were limited — closing schools in the rural Paris exurbs and in the northwestern region of Brittany, where some cases had been noted, and banning gatherings of more than 1,000.For weeks, France thought it could escape Italy’s fate even as it kept a wary eye on its neighbor. The initial measures were limited — closing schools in the rural Paris exurbs and in the northwestern region of Brittany, where some cases had been noted, and banning gatherings of more than 1,000.
On March 6, with nine dead already, Mr. Macron went to the theater, partly to show the French that normal life could continue. But five days later, he closed the schools, and two days after that, bars, restaurants and “nonessential” businesses.On March 6, with nine dead already, Mr. Macron went to the theater, partly to show the French that normal life could continue. But five days later, he closed the schools, and two days after that, bars, restaurants and “nonessential” businesses.
Still, he allowed the first round of Paris’s mayoral election to go ahead on March 15. On that sunny Sunday, thousands of French crowded the city’s parks and cafes.Still, he allowed the first round of Paris’s mayoral election to go ahead on March 15. On that sunny Sunday, thousands of French crowded the city’s parks and cafes.
Mr. Macron ordered them to remain in their homes the next day.Mr. Macron ordered them to remain in their homes the next day.
With this action, France put itself in a more favorable position than Italy. The confinement order began when just 148 were dead. The Italian government, by contrast, waited until the death toll was over 800 before ordering a national lockdown.With this action, France put itself in a more favorable position than Italy. The confinement order began when just 148 were dead. The Italian government, by contrast, waited until the death toll was over 800 before ordering a national lockdown.
“Sick patients who could have been saved were not, because the Italian health system was saturated,” said William Dab, a former French national health director. He added, “In France, we are still able to save patients who are in intensive care.”“Sick patients who could have been saved were not, because the Italian health system was saturated,” said William Dab, a former French national health director. He added, “In France, we are still able to save patients who are in intensive care.”
There has been resistance to the confinement in the immigrant suburbs, where restless residents are crammed into inhospitable tower blocks. Police officers have already handed out tens of thousands of fines.There has been resistance to the confinement in the immigrant suburbs, where restless residents are crammed into inhospitable tower blocks. Police officers have already handed out tens of thousands of fines.
The authorities say they have no choice but to continue. The stakes are too high.The authorities say they have no choice but to continue. The stakes are too high.
“The measures that have been adopted, they are our last chance to overcome this crisis democratically,” Mr. Dab said. “To show we can overcome this without authoritarianism, without dictatorship, that a democracy can overcome a crisis like this.“The measures that have been adopted, they are our last chance to overcome this crisis democratically,” Mr. Dab said. “To show we can overcome this without authoritarianism, without dictatorship, that a democracy can overcome a crisis like this.
“For me,” he added, “that’s what this is all about.”“For me,” he added, “that’s what this is all about.”
Constant Méheut and Eva Mbengue contributed reporting.Constant Méheut and Eva Mbengue contributed reporting.