Coronavirus deaths cast a pall over France, two weeks into a national lockdown


The figures have cast a pall over a country that has already seen more than 42,000 deaths attributed to covid-19.

On Thursday, Prime Minister Jean Castex announced the full package of lockdown restrictions would continue until at least Dec. 1, and restaurants, bars and gyms would likely remain closed into December. He held out the possibility of “family celebrations” for Christmas but warned that people shouldn’t expect parties or larger gatherings.

At this point, 1 in 4 of all deaths in France are due to the coronavirus, Castex said.

The government has tracked 10,000 surplus deaths since the beginning of October, he said, and it expected deaths to rise for at least the next week.

In April, it took only a week for recorded daily deaths to rise from 401 on April 3 to the peak of 1,101 on April 10.

Although health experts had predicted a resurgence of the virus in the Northern Hemisphere this fall, for a time it looked as though death rates might stay relatively low. Health systems had had time to prepare. There was greater understanding about how to protect the most vulnerable populations. People had adapted their behavior so that those who got sick weren’t being hit with as high a “viral load.” And improved treatment strategies — including antivirals and steroids — were helping people recover.

The notion that deaths might not rise along with cases now appears to have been wishful thinking.

The story in France is the same as in much of Europe. Cases are rising exponentially, health systems are nearing capacity and more people are dying — in hospitals and in nursing homes.

“I never saw a case of covid for three months — not one,” said Philippe Fabbri, a general physician in Paris. But things changed after the summer, he said. “Now I see 12 or 15 or every week.” Given the rising caseload, it’s not a surprise that death rates would have risen, too, Fabbri said. “It’s logical.

France does not have the highest per capita death rate on the continent. Central European countries are seeing more coronavirus deaths as a proportion of their populations. But those countries largely missed the first wave of Europe’s outbreak. For France, a country with one of the best health systems in the world, which has already been through all of this once before this year, the rising death figures are particularly distressing.

Hospitals are approaching their breaking point.

“We are seeing a hospital admission every 30 seconds and to ICUs every 30 minutes,” Castex said Thursday.

The government has opened up more intensive care beds by postponing non-emergency procedures. Still, 95 percent of the country’s 7,700 ICU beds nationally are occupied, Castex said, noting that additional surge capacity may soon be necessary. Some covid-19 patients have had to be transferred to neighboring regions with more space in their intensive care units. Health Minister Olivier Véran said Thursday that 120 medical evacuations have already been carried out this fall.

For patients who end up in hospitals, case management has improved between the first and the second waves, specialists say.

“Oxygen therapy is much better regulated, and patients are intubated much less quickly than before,” Thomas Gilles, a pulmonologist at the Avicenne Hospital in the Paris suburb of Bobigny, told France’s Le Monde newspaper.

About 60 percent of critical patients are placed on ventilators, while the remaining 40 percent are treated with oxygenation instead. The net result, he said, has been to decrease intensive care stays by about five days.

But, of course, there is still no reliable cure.

Although the vast majority of the recent deaths have still been older patients, Castex noted that during the second wave, 40 percent of patients admitted to ICU wards were under age 65.

Epidemiologists say younger patients may feel less of a need to seek medical attention — and yet their can health deteriorate rapidly.

“If you are, say, 75 years old, or diabetic, the message is probably fairly clear: You understand that you are at risk,” said Marc Gastellu-Etchegorry, a Paris-based epidemiologist and deputy director of epicenter at Doctors Without Borders. “But if you’re young, there’s so much information swirling around that young people are less touched, which is true on the whole, but your understanding isn’t as good, and your tendency to seek treatment is lower.”

With such a deadly virus, the best way to lower deaths is to limit the spread, which means following public health guidelines, Gastellu-Etchegorry said. Google mobility data suggests that most people in France are abiding by the lockdown rules. But police have issued more than 72,279 fines to violators.

“The measures taken currently — they should be followed. They are effective,” Gastellu-Etchegorry said.

Those measures are more limited than the strict national lockdown in the spring. Movement outside the home is still limited to once per day with “attestation” forms, but schools remain open, as are more businesses than before.

Even if current measures are sufficient, there would be a lag before that would translate to fewer people dying. In the spring, confinement began on March 16. It wasn’t until April 11 — almost four weeks and more than 9,000 deaths later — that deaths began to decline.

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