Covid-19: Today... and tomorrow?

Who would have thought a few months ago that we would be facing such a situation and such uncertain times? With this coronavirus epidemic, we are living through a health crisis that is unparalleled in the 21st century: more than 100,000 deaths have been recorded worldwide to date, and the epidemic has not yet been brought under control.

This is an unprecedented situation, particularly for the healthcare sector, which is in the front line, and for our Group, which plays an important role in all the countries where it is present. 

In France, we have exceeded 15,000 deaths, and 2 regions in particular are hard hit: Ile de France and the Grand Est.

Since our country's official passage to the "epidemic" stage in mid-March, the hospitals and clinics of Medecine – Surgery - Obstetrics (MSO) have cancelled all non-emergency surgeries. The teams have reorganized the facilities to create Covid-19 zones and have constantly increased the capacity of the intensive care units, even going so far as to create them from scratch. 

To date, 46 of our MSO facilities have admitted up to 1,250 Covid+ patients, including 350 patients in resuscitation units. These patients arrive directly, via the emergency services of our own facilities, or from public hospitals. 

In the Ile de France region, our facilities have received up to 900 Covid+ patients, including 250 in intensive care. 

To cope with the unprecedented influx of patients, we almost tripled our resuscitation admission capacity.

In addition, the lack of caregivers has been offset by a tremendous outpouring of solidarity from volunteer employees from our facilities in less affected regions. This solidarity is also illustrated through the care of patients transferred to less impacted regions, such as the Toulouse center, which receives patients from the eastern part of France, and the Caen center, which receives patients from the Ile-de-France region.

Today, as patients begin to leave the Resuscitation Units (ICU) or Critical Care Unit (CCU), the new challenge that hospital teams are beginning to face is to urgently organize our Aftercare and Rehabilitation facilities (FCR) as well as the training of caregivers in the specific recovery needs of people leaving intensive care or resuscitation. 

At this stage of the epidemic, a sharply increasing number of transfers in the coming days and weeks is expected.

In the Group's Scandinavian countries, although the health crisis seems to be better contained with less alarming figures, all our facilities are also highly mobilized and work closely with public hospitals as well as regional and national health departments.

In Sweden, almost half of the Covid+ patients are in the Stockholm area where our Capio St Göran hospital receives a significant proportion of the infected patients in the region with more than 100 Covid+ cases and 11 in intensive care out of a total capacity of 16 places. Our non-emergency care activities, such as the ophthalmology and orthopaedic clinics, are operating at a slower pace due to the decreasing number of patients and the support provided by staff for the care of Covid+ patients, especially at St Göran Hospital. Geriatric institutions in Stockholm have converted most of their capacity to Covid-19 patient care and have increased their support for advanced home care. And our 105 primary care centres have largely turned to virtual patient contact, with a significant increase in chat and video contact.

In Norway, clinics are still open but all major surgery has been cancelled, all physiotherapy activities have been suspended, non-emergency activity has been reduced and the duration of consultations has been limited to a maximum of 15 minutes. We actively support the public sector by providing primary care in Oslo, Bergen and other cities. And, very positive news, as the epidemic is considered to be under control, we are expected to reopen surgery from 20 April. 

In Denmark, the government has requisitioned all anaesthesia personnel and equipment to be deployed according to the needs of each region. In the meantime, the private sector can continue activities that do not require general anaesthesia (examinations, surgeries with local anaesthesia, MRIs). And now, as announced by the government, a gradual easing of restrictions is beginning.

In Germany, our hospitals have postponed all unnecessary surgery and hospitalization, and are working alongside public hospitals to care for Covid patients.

Italy is the country in the group most affected by the epidemic to date. The only Ramsay Santé clinic in this country, the Centro Ortopedico di Quadrante in Omegna in Omegna (Piedmont region, north-western Italy), which specializes in orthopaedics, has treated up to 83 Covid+ patients while lacking protective equipment and medical supplies. In this context, the group mobilized to help him by supplying him with various drugs and equipment from France and Denmark (notably curare and non-depolarizing neuromuscular blockers). 

The mobilization of our teams, both medical and administrative, is simply extraordinary. I would like to express my deepest respect to the courageous and dedicated caregivers at Ramsay Santé.

Now, in parallel with managing the epidemic, we need to think about all the other patients. The cessation of elective surgery may lead in the more or less short term to a worsening of patients with non-Covid pathologies, particularly in oncology where consultations and detection tests are stopped. Beyond the surgical interventions themselves, the cessation of certain types of consultations and examinations could represent a "loss of chance" for many patients. I would like to see a certain resumption of care activities to limit this risk of loss of luck as much as possible.

These are very difficult times. And even if "that's what we're here for", the exceptional mobilization of the Ramsay Santé teams, and more broadly of the entire hospital sector, will mean that many lessons will be learned once the epidemic is behind us. We are experimenting with organizations and creating new solutions all the time as well. All the experience acquired in France and in the other European countries of the group will have to serve as a basis for major changes in the organisation and financing of healthcare in France: capitalise on public/private/urban medicine coordination, have a long-term vision of investment and financing (compared with the ONDAM's accounting and annual management), promote digital solutions, stop managing our sector in a just-in-time manner. And, more than ever, strengthen the place of prevention in our health system. We will have to discuss these initial avenues together and, above all, take action.