2. Ensuring sufficient physical infrastructure and workforce capacity
ENSURING SUFFICIENT PHYSICAL INFRASTRUCTURE AND WORKFORCE CAPACITY is crucial for dealing with the COVID-19 outbreak, as there may be both a surge in demand and a decreased availability of health workers. The section considers the physical infrastructure available in a country and where there are shortages, it describes any measures being implemented or planned to address them. It also considers the health workforce, including what countries are doing to maintain or enhance capacity, the responsibilities and skill-mix of the workforce, and any initiatives to train or otherwise support health workers.
2.1 Physical infrastructure
The Covid-19 epidemic arrived in France on an already difficult hospital context. Many hospital workers, including emergency specialists and nurses, were on strike last November/December demanding additional resources for public hospitals.
Also, very quickly in the early days of the epidemic, there were issues regarding sufficient availability of protective masks, solutions for hand hygiene, and diagnostic tests. It turns out that, since the H1N1 epidemic crisis in 2009 where the government (and the WHO) had been accused of over reacting with regard to the acquisition of masks and vaccines, there has been a slight change in the doctrine or attitude of scientific and public authorities towards the continued preparation for the risk of a pandemic linked to an emerging virus with respiratory tropism. Consequently, there was a change in the state policy towards its stocks, in particular, regarding masks. Since 2011, the policy of consecutive governments was to reduce the national reserve of masks, and to pass the responsibility of stocking to individual facilities and healthcare centers, or physicians. In particular, it seems that there was a lack of higher quality masks (FFP2) which are necessary for healthcare professionals at high risk, that is, those dealing with infected people. There were several primary care doctors who have been infected and died in the past week (week 12). On April 9, in response to the issues previously encountered, a national online platform dedicated to help managing the stock of masks available in pharmacies has been opened. On April 13, the president minimized the issue of the shortage of protective gears in France, reporting that it had been experienced by all countries around the world, while maybe not to a similar extent. He also announced that the easing of the lock-down policy by May 11 would be accompanied by a general distribution of masks for all in coordination with local authorities. The priority distribution of masks to health professionals will be extended from now and until May 11, to ambulance drivers, pharmaceutical assistants, radiology technicians and domestic helps. But for the moment, many health professionals such as physiotherapists, dentists or orthodontists cannot work since they do not have the protection material. It is not clear yet when/if they will be served.
The government announced that an "air bridge" was set up for the transportation and long-term supply of medical equipment, especially of masks. France awaits full delivery of 1 billion masks over the next 14 weeks at the rate of 2 deliveries per week, some of them coming from China. In addition, the private sector has placed an order for 5 million masks, delivered by March 30.
Concerning hand hygiene, ambulatory and hospital pharmacies are allowed to prepare hydro- alcoholic solutions intended for human hygiene by a new decree (2020/107/F). The government also set by this decree fixed priced for disinfectant care products. Therefore, by week 12 there were no more problems concerning these solutions. On April 17, the value-added tax on hydro-alcoholic solutions and protective masks was reduced from 20% to 5.5% to increase their financial accessibility for all.
There were about 5,000 "resuscitation" beds in France before the epidemic. These are beds in dedicated units intended to take care of patients suffering from deficiencies of major vital functions (e.g. respiratory, cardiovascular, renal, hepatic…), where strict standards in terms of staff and equipment are applied: 24h presence of a specialist, nurses with prior specific training, as well as particular monitoring devices, respirators and intravenous perfusion systems. But this capacity can be increased significantly by using resources in intensive care and other operative units which also have monitors, respirators and qualified personnel (nurses) to carry out similar functions for patients affected by the failure of a specific vital function.
The resuscitation bed capacity has been increased from 5,000 to 8,000 beds by March 24. Hospitals and private clinics have been given authorization to increase their intensive care capacity across the country. On April 19, the Minister of Health however declared that there were persistent strains on resuscitation drugs with potential risks of shortage. Specific dispositions to facilitate the delivery in nursing homes of drugs used to treat pain in end-of-life care were also taken to limit shortages in these specific settings.
There was a mobilization to help the most affected regions. A medical train (called health TGV) is set up to move patients from hospitals under tension to less affected regions. In the eastern border areas, some patients are also transferred to hospitals in Luxembourg, Switzerland, Germany and Austria. The medical aircraft of the Army and the Military Field Hospital have also been supporting hospitals in need. All in all, 644 cases were transferred by April 19.