ICU Drugs Running Low as Coronavirus Cases Spike

Some fear that as the pandemic peaks, doctors may not have sedatives and other key pharmaceuticals they need

Los paramédicos ingresan a un enfermo en un hospital de Boston, el 24 de marzo de 2020.
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The shortage of ventilators and protective gear isn’t the only supply problem affecting local hospitals as they prepare for an expected surge of coronavirus patients.

Drugs necessary to intubate patients and place them on ventilators in the intensive care unit are running in short supply, prompting fears that as the pandemic peaks across the country, doctors may not have sedatives and other key pharmaceuticals.

“We are starting to see some disruption,” said Ross Thompson, chief pharmacy officer at Tufts Medical Center.

For days, Tufts has been getting its orders of several categories of ICU drugs only partially filled, or filled inconsistently, Thompson told the NBC10 Boston Investigators.

The hospital has been preparing for a potential drug shortage for about six weeks by building up its inventory and acquiring alternatives for drugs such as intravenous fentanyl, Thompson said.

“Certainly some drug is better than no drug,” he said. “And what we're looking to do is just diversify, if you will, the number of medications that we are keeping in our inventory so that if one depletes, we have alternatives that we can shift over to.”

In the worst days of the coronavirus pandemic, many doctors may be faced with unthinkable choices.

Nevertheless, Thompson and other hospital leaders fear the peak in cases of COVID-19, the disease caused by the coronavirus, predicted this month could deplete the supply of sedatives, neuromuscular blockers and other critical care drugs at some medical centers.

“I think I think it's going to be stressful,” Thompson said. “I think it's going to absolutely test our supply chain.”

Premier Inc., a group purchasing organization that represents some 4,000 hospitals around the country, warned in late March that 15 drugs essential to treating COVID-19 patients are already in short supply.

For example, pharmacy orders for fentanyl doubled in March as tens of thousands of Americans contracted the virus, leading many to seek emergency room care, the group said. At the same time, those orders went only about 60 percent filled, according to data provided to the company by its members in a survey last month.

The family of a Hingham man who has been in the ICU for more than a month says he is improving.

“What we have seen is definitely an acute shortage of these products in the past two to four weeks,” said Soumi Saha, senior director of advocacy at Premier, “and that acute shortage is worsening, and the reason here is pure sheer volume.”

In Massachusetts, the Department of Public Health said it’s monitoring ongoing shortages of three sedatives: fentanyl, morphine and midazolam. Representatives of DPH and the state’s Board of Registration in Pharmacy declined a request from NBC10 to discuss the circumstances.

The federal Drug Enforcement Administration announced Tuesday it would ease caps on manufacturers to boost the country’s supply of drugs used to treat COVID-19 patients in the hospital.

The government will also allow more foreign imports of Schedule IV and Schedule V drugs, including midazolam, which suppresses the central nervous system, allowing doctors to insert a breathing tube into a patient’s throat and keep them sedated while their breathing is assisted by a ventilator.

That’s potentially good news, although it could be weeks before supplies in local hospitals are replenished, said Michael Ganio, of the American Society of Health-System Pharmacists, a group that represents hospital pharmacies around the country.

“Manufacturing processes aren't overnight …” Ganio said. “It could be six weeks or longer before any of that actually gets to the hospitals where they're needed.”

In a statement provided to the NBC10 Boston Investigators, the Massachusetts Health & Hospital Association said it strongly supports the DEA’s move to increase its manufacturing quotas for controlled drugs.

Hospitals here are closely monitoring their inventories, the group said.

“They are being conservative with all products that may be used to care for COVID-19 patients, and are working hard to stay ahead of possible shortages,” the statement reads.

Ganio said doctors will make the best of the circumstances by tapping alternatives.

“It may not be ideal, but we'll find a way,” he said. “The health care workers that I've worked with in the past are creative. They’re resilient. They'll find a way to take care of our patients.”

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