"We're digging the trenches": France's intensive care medics brace for coronavirus war

Intensive care nurse Emmanuelle Dubourg Davy feels that war has been declared and knows that her hospital in the western French city of Angers will soon be inundated with critically ill coronavirus patients. The teaching hospital has stockpiled surgical blouses, face masks and disinfectant gels, and rotas have been rewritten to increase working hours. So far, only three of 24 intensive care beds are occupied by coronavirus patients, but few among her colleagues doubt that a wave will hit.

"We're on a war footing, as if we were digging trenches," she said. Across Europe, the pandemic is putting public healthcare systems under unprecedented strain, bringing Italy's hospital network to its knees and stretching Spain's to breaking point.

As infections spiral higher and fatalities surge, France is next in line, and Britain seems only a few days behind. France now has nearly 20,000 confirmed cases of coronavirus and the death toll stands at around 860. Two in every five of the country's 5,000 intensive car beds are already occupied by coronavirus patients.

In eastern France, around Strasbourg and Mulhouse, home to the country's second biggest outbreak after the Paris region, intensive care units (ICUs) are already overwhelmed. The army is setting up a field hospital and transferring patients to other cities. One 24-year-old nurse in the region said it felt like being in a never-ending tunnel, with no spare beds for patients and a desperate shortage of masks and equipment.

"It's like death is around the corner," said Sandrine, who withheld her surname as she is not authorised to talk publicly. Like other countries around the world, France has imposed an unprecedented lockdown to get people off the streets and to slow the virus' spread, hoping to win time for medics.

HEROES CRACKING UP Hospitals with limited intensive care facilities are re-tooling recovery or emergency rooms by installing ventilators sometimes stripped from operating theatres. Larger hospitals are scrambling to order new machines.

All but essential operations are being cancelled to free up personnel and beds. "We've reorganised everything to create something that will hold up, but every two days, we're told we need 10 more beds here, 10 more beds there," said Anne Geffroy-Wernet, an anaesthetist-intensive care doctor at Perpignan's main hospital.

"We're now a region that is becoming endemic and we're trying to build ICU beds in parts of the hospital where there weren't any, under difficult circumstances." If creating ICU beds is difficult, adding personnel is harder, doctors said. In each intensive care unit, there should be one doctor for every six patients, two nurses for every five and one caregiver for every four.

Those ratios will not be sustainable as the number of patients keeps rising, so hospitals are recruiting staff from other departments, such as paediatrics, as well as student medics to bolster intensive care wards. Geffroy-Wernet, a union leader, said as many as 40% of frontline health workers could fall sick. Five hospital staff have already died in France.

"We know we're going to hit a wall, we just hope that the airbag that we're trying to prepare will allow us to limit the damage," said Jerome Larche, a trainee intensive care doctor at a private clinic in Montpellier, after an 18-hour shift. French law says doctors can be on duty for up to 24 hours consecutively, followed by 24 hours rest. Nobody expects to keep those hours.

"Sometimes it's a question of life or death, so you won't go home," said another ICU doctor in southeastern France. "The consequence is that people start thinking they're heroes. But they're not, so they are going to start cracking up mentally." (Additional reporting by Tangi Salaun in Paris; editing by Richard Lough and Gareth Jones)

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