France’s second wave of coronavirus could be worse than the first, the boss of Paris public hospital group AP-HP said on Friday as the country registered a record number of daily cases. With pressure on hospitals rising fast, France has expanded a 9:00 pm to 06:00 am curfew to cover 46 million people, more than two-thirds of its population.

“There has been a perception in recent months that a second wave does not exist, or that it is a small wave. The situation is the opposite,” AP-HP head Martin Hirsch told the RTL broadcaster. “It is possible that the second wave will be worse than the first,” he said, warning of a “daunting” challenge ahead.

On Thursday, France reported a daily record of 41,622 new cases, and the number of patients in intensive care is at its highest level since May. On Friday, President Emmanuel Macron said it was too early to say whether a new confinement was looming, after such a move was imposed nationwide for two months in the spring.

But he said that current measures were “not likely to be relaxed, they could be tightened if they don’t prove effective”.This could entail both widening the zones of a current curfew and pinpointing virus hotspots with stricter measures, he said. Thursday’s figure of 165 fatalities in 24 hours is still well below the April peak, when the death toll soared to more than 900 a day.

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Prime Minister Jean Castex conceded that hospitals were likely to come under pressure.”The new cases of today are the hospitalised patients of tomorrow. The month of November will be difficult,” he wrote on Twitter. Hirsch said the average age of intensive care patients in AP-HP’s hospitals was 62.

Many were older people who self-isolated but were infected when their children visited them. And Hirsch said the real number of cases was likely to be much higher than official tallies, as many asymptomatic carriers are never tested.”There are many positive people, infectious, in the streets without knowing it and without anyone else knowing it,” he said.

Hirsch said the leave of some hospital workers had been cancelled ahead of “this daunting month of November”. Health Minister Olivier Veran said France was now in a position to raise its capacity to treat intensive care patients by more than 2,000 beds “within 15 days”.

“We know that the curfew measures won’t have an impact before two or three weeks, which in the current period is a lifetime,” Lamine Gharbi, president of France’s private hospital federation FHP, told AFP.

Private clinics, which typically handle just under a third of all intensive care Covid cases in France at any one time, have had to cancel scheduled non-coronavirus operations to make room for virus cases, Gharbi said.

Some hospitals had to cancel leave that their staff had planned to take during the current half-term school break. The Paris region reported Friday that just under two thirds of its intensive care spots were now taken by Covid patients.”This is not getting any easier,” said one intensive care unit anaesthetist at a Paris hospital.