Has the health crisis been exaggerated? This is what one might imagine when noting that patients with Covid-19 represented only 2% of hospitalizations in France during 2020. This figure, much commented on in recent days, comes from a report by the Technical Agency for Information on Hospitalization (Atih), which analyzed all hospital activity in France during the first year of the pandemic. Yet this figure mixes all causes of hospitalizations, including scheduled surgeries, childbirth, and even dental procedures, drowning Covid patients in millions of non-emergency hospitalizations. To decipher the true scope of the hospital crisis, Sciences et Avenir has immersed itself in these data, available on the Scansanté site, where Atih groups together the figures for all hospital activities in the country.
A concentrated epidemic in a few months
The epidemic activity in France was not constant during 2020, but concentrated in two waves, in spring and autumn, which were artificially broken by containment and other social distancing measures. Thus, intensive care occupancy, which gives a first idea of hospital activity during the pandemic, was elevated mainly during the months of April and November during which Covid patients saturated the initial capacity of the intensive care units, estimated in about 5,000 beds before. the pandemic (see graph 1).
Graph 1. Daily variation in intensive care occupation of patients diagnosed with Covid-19, compared to the initial capacity of 5,000 beds. The vertical lines mark the end of each month. Click to see larger. Credit: Nicolas Gutierrez C.
This is also what we also see when we look at each month’s hospitalizations. In these figures, which, it must be remembered, include all hospital activity (including non-urgent interventions), we see a decrease in activity during the first wave, especially in April. This is due to the cancellation of most of these interventions, which may be delayed to allow healthcare workers to focus on the influx of coronavirus patients. During the month of April, these patients represented 7.6% of hospitalizations (57,000 out of 760,000). During the second wave, hospital activity was less affected, with far fewer cancellations. And Covid patients accounted for 3.7% (51,000 out of 1,400,000). But for the rest of the year, with an apparently controlled epidemic, Covid-19 hospitalizations accounted for less than 2%, or even almost 0 during the summer (see Chart 2).
Graph 2. Proportion of hospitalizations due to Covid-19. Red bars show coronavirus hospitalizations, blue bars represent all other hospitalizations. THEth digit above the bars presents the percentage represented by Covid hospitalizations in the total for the month. Click to see larger. Credit: Nicolas Gutierrez C.
And a concentrated impact on a few services
Furthermore, Covid-19 has not affected all hospital departments to the same extent. For example, the hospital activities most in demand in 2020 were digestive care and orthopedic trauma services, which together represent a quarter of all hospitalizations. While Covid-19, being a respiratory disease, mainly affected the pulmonology department, as well as the resuscitation of those with severe forms of the disease. If we look at these services, we see that the impact of Covid-19 is much greater than the total number of hospitalizations can lead us to believe. Thus, coronavirus patients accounted for 18% of hospital stays in intensive care and pulmonology services, while the impact of the epidemic was mainly concentrated in two months. Furthermore, Covid patients represent 70% of hospitalizations for respiratory infections and inflammations in adults (see graph 3).
Graph 3. Number of hospital stays by service. The red bars show hospitalizations for Covid, the blue bars show all other hospitalizations. THEth digit above the bars represents the percentage of Covid hospitalizations in the total. Click to see larger. Credit: Nicolas Gutierrez C.
This impact is also visible when we compare 2020 data with 2019 data. Due to the health crisis, the number of hospitalizations in France decreased by 11.7% in 2020 compared to the previous year. While the departments affected by the coronavirus increased their activity: + 10% for resuscitation, + 7% for pulmonology and + 412% for respiratory infections and inflammations in adults (see graph 4). Therefore, the impact of the 218,869 hospitalizations linked to Covid-19 in 2020 is clearly visible in the services in question. A real charge behind this 2% figure.
Graph 4. Evolution of hospitalizations between 2019 and 2020. The blue bar represents a decrease compared to 2019, the red bars an increase. THEth digit above the bars represents the magnitude of this decrease / increase compared to 2019. Click to see larger. Credit: Nicolas Gutierrez C.
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