France in a state of health emergency: what consequences for health systems?

If some still believed in confinement for two weeks, they risk falling from above. France is officially in a state of health emergency for two months. Parliament adopted this text on Sunday March 22 “emergency to deal with the Covid-19 epidemic”. The latter can be stated as “in the event of a health disaster endangering, by its nature and gravity, health and its population”. It was released on March 24 at Official newspaper. What are the consequences in terms of mobilization of health services?

With this text, the government can order the “requisition of all goods and services necessary to put an end to the health disaster”. It can, for example, use taxis and hotels for healthcare personnel, requisition medical equipment or even protective masks for healthcare professionals or certain populations at risk.

“Hydro-alcoholic solutions intended for human hygiene can be prepared, in the event of a break in their supply, until April 15, 2020, by the dispensary pharmacies and pharmacies for internal use mentioned in the articles”is it especially written in the text.

Regarding protective masks from the national stock, they can be distributed free of charge, on presentation of proof, until April 15 also by pharmacies to professionals in the following categories: “general practitioners and doctors of other specialties; nurses; pharmacists; massage therapists; dental surgeons; midwives; service providers (…); social, educational and medico-social support services which intervene at home in favor of the elderly, children and adults with disabilities (…) as well as home helpers employed directly by the beneficiaries”.

“Tipping point”

At the health facility level,the directors general of the regional health agencies are authorized to authorize until April 15, establishments to carry out a care activity other than that for which they have been authorized”. The health personnel intervening within these structures “can use any material, health product and blood product and carry out any act and examination necessary to carry out this mission”. “Operational medical structures may be supplied with materials, health products and blood products by any means, in particular by any pharmacy, any pharmacy for internal use, any blood transfusion establishment or pharmaceutical establishment. One or more structures not reporting to the Minister of Defense and designated by the competent Regional Health Agency can carry out or contribute to carrying out, for the purposes of this mission, any administrative, logistical, technical or medico-technical activity.it is specified.

This Wednesday, March 25, the director general of the Assistance Publique-Hôpitaux de Paris, Martin Hirsch, also launched on franceinfo a call for the requisition of nursing staff and for “recognition”, possibly in the form of bonuses, for the “superhuman” effort of the staff. As the group’s hospitals passed the threshold of 1,600 inpatients, he asked “four strong assurances”. “The first is that I can, in the face of each seriously ill person, put on a respirator. I don’t want us to know about the difficulties we have had with masks on respirators that save lives. The second thing: we need all the staff, whether they are volunteers or whether we use requisitions, and my third point, I rarely talk about it, but today we have carers who make efforts that can simply be described as superhuman, we must have the assurance that they will have recognition. I don’t know if these are bonuses, it’s moral, and it’s for the morale of the troops. And then fourth thing: it’s the drugs. It is necessary that between the industrialists, the public authorities and us, we have the assurances that we are not in lack of drugs (…) We are in a pivotal moment ”, he warned.

Monday, March 23, Professor Philippe Juvin, head of the emergency department at the Georges-Pompidou hospital in Paris announced that “a few hundred” caregivers in Ile-de-France had tested positive for Covid-19. For them, “the coronavirus will be recognized as an occupational disease”. “There will be no debate on it,” assured the Minister of Health.

As for the peak of the epidemic which risks saturating the health system, Philippe Juvin predicted it Monday within “about a week”. “I am not convinced that it is necessary to harden” confinement, he added, specifying that the watchword “stay at home” was “enough”.

Tougher penalties

In addition to mobilizing health systems, the establishment of a state of health emergency allows the limitation of individual freedoms, set by the Prime Minister. Among them, “the freedom to come and go, the freedom to undertake and the freedom of assembly”. “Many of our fellow citizens would like to find the time before, normal time, but it is not for tomorrowsaid Edouard Philippe earlier this week. Going out for a walk with your children or playing sports is within a radius of 1 km from your home, maximum for an hour, alone and once a day”he added.

Sanctions have been tightened for French people who do not respect these instructions. The fixed fine of €135 will increase to €1,500 in the event of a repeat offense “within 15 days”. “Four violations within thirty days” could be worth up to “€3,700 in fines and six months in prison.”

The new text also provides for the introduction of measures to support businesses, the postponement of the second round of municipal elections, “no later than June 2020” or the prescription by decree of all other general individual measures aimed at combating the catastrophe. These must, however, beproportionate to the risks involved and appropriate to the circumstances of time and place.”