Actualités

Covid-19 : la saturation des hôpitaux, des chiffres imparfaits mais un problème réel

Les hôpitaux de France voient arriver, depuis plusieurs semaines, une nouvelle vague de patients atteints du Covid-19, qui inquiète les autorités sanitaires car elle pèse sur le système hospitalier. Le premier ministre, Jean Castex, l’a répété à plusieurs reprises lors de son allocution du 18 mars pour justifier un nouveau durcissement de la lutte contre l’épidémie. Mais ce diagnostic est contesté par certaines voix qui critiquent les indicateurs de suivi de l’épidémie et relativisent au passage la pression de l’épidémie sur le système de santé.

Ce qu’on entend

Le très médiatique avocat Fabrice Di Vizio, qui défend notamment l’infectiologue marseillais Didier Raoult, a soutenu cette thèse dans l’émission « Touche pas à mon poste ! » de C8, lundi 22 mars. Opposé aux nouvelles restrictions sanitaires, le juriste a pointé du doigt les chiffres de l’organisme Santé publique France (SPF) sur le nombre de personnes en réanimation.

Avant la crise sanitaire, « le mot réanimation, cela voulait dire [des] lits pour accueillir des patients avec des défaillances multi-organiques, nécessitant une assistance respiratoire. » Mais l’avocat estime que les chiffres des patients en réanimation communiqués depuis la crise du Covid-19 ne relèvent pas de la même logique, puisqu’ils incluent des patients placés en soins intensifs ou en surveillance continue.

Cette nuance relativise donc, selon lui, la portée de l’épidémie : « Si j’ai bien 5 000 lits de réanimation en France, j’ai 13 000 lits de soins intensifs et surveillance continue. (…) En réanimation je n’ai pas 5 000 patients, j’en ai 2 500. Et donc je m’interroge… »

POURQUOI C’EST TROMPEUR

La limite du décompte des malades et des lits en réanimation

Il y avait un peu plus de 4 600 malades du Covid-19 en « réanimation » au 23 mars, selon SPF. Cela représente un troisième pic déjà comparable à celui de novembre 2020.

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A partir de ce chiffre, le gouvernement français met en avant, par exemple dans l’application #TousAntiCovid, un indicateur intitulé « tension en réanimation », qui s’établissait à 91,6 % au 23 mars. Mais, Fabrice Di Vizio a raison sur ce point, on ne peut pas réellement dire que 91,6 % des lits de réanimation sont actuellement occupés en France, pour plusieurs raisons, que nous détaillions en novembre 2020.

D’abord, ce calcul est réalisé à partir de la capacité initiale de lits de réanimation (avant la pandémie), qui était d’environ 5 000 places. Or, le nombre de lits peut fluctuer en fonction des besoins. Jusqu’à 10 500 places avaient été dégagées au printemps 2020, selon le gouvernement.

Ensuite, et c’est le plus important, sont comptés en « réanimation » des patients qui sont « en unités de soins intensifs et en unité de surveillance continue », comme le précise SPF dans la notice de ses points épidémiologiques hebdomadaires.

L’organisme a récemment fait évoluer sa nomenclature et évoque désormais des patients en « soins critiques ». Il donne aussi des précisions sur l’endroit où se trouvent ces malades du Covid-19. Au 16 mars, « parmi les 4 260 patients en services de soins critiques, 3 256 étaient en services de réanimation et 1 004 dans d’autres services de soins critiques (soins intensifs ou soins continus) », détaille le point épidémiologique de SPF du 18 mars. Plus des trois quarts des patients se trouvent tout de même en réanimation au sens strict.

Lire aussi Covid-19 : les limites du calcul du taux d’occupation des lits en réanimation

Les 13 000 lits supplémentaires ne sont pas tous mobilisables

Si le calcul de la « tension des réanimations » est effectivement imparfait, le raisonnement de Fabrice Di Vizio l’est également à d’autres niveaux. Tout d’abord, il laisse entendre que les « 13 000 lits de soins intensifs et surveillance continue » que comptent les hôpitaux français sont aisément mobilisables pour accueillir les patients atteints de forme grave du Covid-19. Or, c’est faux, pour des raisons médicales et logistiques. Les malades du Covid-19 font l’objet d’une surveillance particulière et sont souvent regroupés dans les hôpitaux, pour limiter les risques de diffusion du virus. Il n’est donc pas possible de les répartir au sein de différents services.

L’article à lire : « Un monde à part » : comment fonctionnent les services de réanimation

Ensuite, le raisonnement laisse penser que la situation serait soutenable tant qu’il reste des lits pour des patients contaminés par le SARS-CoV-2. Or, des personnes atteintes d’autres pathologies doivent pouvoir être admis en réanimation. Il peut aussi être utile de disposer de places libres en cas de catastrophe impliquant des dizaines de blessés graves (accident, attentat, etc.). Un service entièrement rempli constitue donc un risque.

De même, la transformation ponctuelle de lits en places de réanimation face aux pics de Covid-19 se décide au détriment d’autres interventions médicales, ce qui a un coût humain que l’on peut évaluer en « pertes de chances » pour d’autres patients. Pour toutes ces raisons, la plupart des médecins en première ligne dans l’épidémie s’alarment de la situation actuelle.

Enquête : Cancers, infarctus, AVC… la double peine des dégâts collatéraux du Covid-19

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