Assistance Publique–Hôpitaux de Paris (AP-HP) is the largest teaching hospital trust in Europe, with 39 hospitals, 20 000 beds (10% of all public hospital beds), and an association with seven universities. AP-HP also hosts 40% of the French biomedical research. As a result of its
size and location, AP-HP has been a major player in France’s COVID-19 response, as it was in responding to terrorist attacks.(1)
AP-HP has a reputation of being an institution with a size, cumbersome operations,
and internal competition that prevent any nimble response. We are a group of health-care professionals at AP-HP who are directly involved in the management of the COVID-19 response by AP-HP. Having faced the COVID-19 pandemic, and remaining humble in facing the future, we
describe how size and coordinated management might actually have helped the organisation, speed, and consistency of the response to the COVID-19 crisis.
AP-HP initially estimated that no more than 1000 patients with COVID-19 would be simultaneously admitted to intensive care units (ICUs) in the Île-de-France region; 400 of these patients would be admitted to ICUs in the AP-HP, close to the maximum capacity. However, the situation became worse than expected (appendix). At the height of the COVID-19 pandemic, 2677 patients with COVID-19 were admitted into ICUs in the region, 41% of whom were admitted to AP-HP. A few pointsdeserve discussion.
A specific medical organisation was established, led by a central crisis medical director who was