We may run out of medicine in the hospital

This post will attempt to answer the following questions:

1. What will the impact of major surges in patients be on medication supplies?
2. Will we run out of necessary medications?

I am a part of a Whatsapp group made up of physicians from around the country that discusses various issues. As you can imagine in the past few weeks it has been extremely active. The most disturbing are reports coming out of New York and the way they are overwhelmed and running out of supplies. The news media has been focusing (rightly so) on the coming crisis of a lack of supplies but there is another looming shortage crisis that people have not been talking about.

This came to the fore last week when the following message was posted on the chat:

This list of medications may not mean much to you but to me, as a critical care physician, it was horrifying. Many of those medications are absolutely necessary to keep dying patients alive. The ones on the list that were most concerning were the sedatives and paralytic agents.

One of the main problems with COVID-19 and the lung disease it causes (called ARDS) is that there is a major problem getting oxygen from the lungs into the body. This requires us to use very advanced ventilator techniques to keep the oxygen levels at a normal level. We use the sedating and paralyzing medications for the following reasons:

1. Sometimes the ventilator settings that are necessary are uncomfortable and the patients can fight the ventilator and worsen their condition. Aside from their discomfort this can limit our ability to ventilate them. We use sedatives and opiates to make them comfortable and allow the ventilator to work better.
2. The muscles in the body use about 30% of the oxygen we breathe in. In patients who have critically low oxygen levels we will paralyze their muscles with medication so that oxygen can be shunted to vital organs.

So you can see, if we run out of these medications it could enhance the disaster. A recent New York Times article reported a recent survey of 377 hospitals and 100 long-term care, home infusion and retail pharmacies. This survey found that drug shortages were pervasive in acute care settings, where 70 percent of respondents reported at least one shortage for coronavirus drugs. Among long-term care facilities, home care settings and retail pharmacies, 48 percent reported shortages.

Drug shortages are something we have been seeing in the hospitals for the past several years for reasons I do not understand. Every few months there’s a new drug that we use on a regular basis that is in low supply and that was before COVID-19 where demand is ten times or more what it was before the outbreak.

In the hospitals, we are going to have to plan on ways to conserve these medications but there are some things you can do to help.

1. As with everything, flatten the curve. If we can spread out the influx of patients to the hospitals it will allow the drug manufacturers time to catch up and prevent shortages. This is just another example of why slowing the spread of the disease is so important.
2. Don’t hoard medications. Some of those medications are for outpatient use. As an example, some of the inhalers are in short supply. If you have enough for a month or two, don’t stockpile so they can be available for hospitals. There will be more produced over the next 2-3 months as the companies ramp up supply.
3. Write a letter to your members of congress and the White House urging them to use use the Defense Production Act to force pharmaceutical companies to produce more of the medications necessary to fight the pandemic and to temporarily lift limits on the production of controlled substances that are used in hospitals.

Just to reiterate, the idea of flattening the curve is a major issue. The isolation, social distancing, and quarantine efforts will slow the spread so the pharmaceutical companies can ramp up production before the hospitals get overwhelmed and run out. For more on how to flatten the curve with quarantine, isolation, and social distancing check out my post “What is quarantine” from last week.