Health stakeholders are turning their attention to limit the effects of a potential run on critical intensive care unit drugs amid a global surge in demand due to the novel coronavirus.
While significant attention has been paid to the availability of ICU beds and ventilators given a projected surge in ICU patients due to COVID-19, health stakeholders are also warning about shortages of the resources that make ICU units function, like staff and medications.
Health Canada has listed 10 Tier 3 medications on its list of critical medications that are in short supply. Hydroxychloroquine, which U.S. President Donald Trump has touted with limited evidence as a potential treatment for the coronavirus, tops the list. Studies and review on administering the drug to treat COVID-19 have not been conducted, although it is proven for people with lupus and arthritis.
Also on the list are drugs regularly used in ICUs, like Propofol, a generic drug that is used to sedate patients. Midazolam, another sedative, is also listed.
"In general most of these medications were available at normal [patient] volumes," said Christina Adams, the chief pharmacy officer for the Canadian Society of Hospital Pharmacists. But the surge in patients — rather than a disrupted supply chain — is causing problems.
Adams added that anecdotally she is hearing from health professionals that COVID-19 patients require more of these medications than is typical, further exacerbating the issue. "This is compounded by the fact that we're looking to open more ICU beds," she said.
One potential solution is to ramp up production of the drugs. However, this is not easy to do on short notice. Adams said that some of the drugs need two months lead time to significantly escalate production, while others might take closer to five months. The Ontario data modelling released last Friday projects that the first wave of coronavirus cases could peak in late April.
Other potential solutions Adams mentioned included limiting the availability of drugs like Propofol to COVID-19 patients and using other sedatives for non-coronavirus patients. Hospitals may have to pay close attention to make sure the drugs are allocated efficiently, she added. And Canada could import the drugs from other countries, although Adams noted that the global demand could make it difficult to do so.
Daniel Chiasson, the president and CEO of the Canadian Association for Pharmacy Distribution Management, said that his organization understands the urgency of the issue. "There's a higher risk to patient outcomes with these drugs." The drugs at risk are considered staples of the ICU environment.
Health Canada has also fast-tracked the approval process for drugs used in other reputable jurisdictions, Chiasson noted.
Health Canada did not respond to a request for comment in time for publication, citing unusually large volumes of media requests. The office of Ontario's health minister was also unable to get back in time for publication.
Jeff Connell, the vice-president of corporate affairs for the Canadian Generic Pharmaceutical Association, said that its members are working with the government to solve the impending problem. "Manufacturers are in contact with Health Canada, provincial governments and our partners in the pharmaceutical supply chain to monitor changes to demand for specific medicines so that production levels can be adjusted or alternative sources secured, whether they are dispensed in Canadian hospitals or in community pharmacies," he stated.
He also said that ongoing and accurate data from hospitals will be important to meet needs. "Receiving accurate and nationally co-ordinated forecasts of hospitals' supply needs is essential to meet the increasing demands posed by COVID19, including on certain classes of drugs not related to COVID-19 but essential to Canadian patients."
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