The COVID-19 coronavirus is straining the U.S. healthcare system's resources, and in particular, ventilators are in short supply. This is problematic, as the virus targets the respiratory system.
But it isn't just the ventilators themselves that are scarce. So are the drugs that need to be administered to patients who are placed on these machines.
Data recently released by Vizient shows that there are potential shortages of 13 drugs found in three distinct drug classes that are crucial to the use of ventilators. Sedatives and anesthetics, for example, saw a 51% increase in demand during March, while the fill rate has dropped to 63%.
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Meanwhile, there's been a 67% increase in demand for analgesics, with the fill rate dropping to 73%; and neuromuscular blockers saw a 39% increase in demand, with fill rates dropping to 70%.
These medications are needed to keep people sedated, manage their pain, alleviate their stress and in some cases effectively paralyze them so they don't pull out a tube or hurt themselves in other ways as they receive ventilator treatment. But if the current pandemic continues much longer, acquiring these medications will present long-term challenges for patient care.
"It's a very big concern right now, especially in areas where you have the peaks," said Steven Lucio, vice president of pharmacy solutions at Vizient. "We have seen demand skyrocket up. That's one of the things we're trying to clarify with the COVID crisis. There was a lot of concern given to a lot of raw materials coming from foreign locations – like China and India – and that we would have shortages due to supply. We haven't seen that manifest itself. We still have the supply, but the demand is so great that the supply can't keep up with it."
The challenge is that hospitals and health systems are trying to get their hands on as much drug supply as they can, and with everyone competing for supply, they're receiving a much smaller percentage of the medications than they're used to. If the coming weeks get worse – and statistics indicate they might – the healthcare system could reach the point at which the supply is no longer there.
"Everyone is working very hard to acquire products and avoid the threshold where we don't have enough supply," said Lucio.
This impacts the sickest patients the most because they require larger doses of these drugs, and the larger doses are what healthcare organizations are all trying to acquire. Some hospitals have taken to using smaller doses for the sickest patients, but that sometimes means not using the most viable product to treat them.
There are alternatives to some of these medicines, Lucio said, but each drug has a different profile of side effects. If a patient is put on one drug one week and another drug the next, and then back to the first drug, that creates complications for caregivers and can result in suboptimal care.
The current coronavirus hot spots in the U.S. – such as New York, Washington state and Louisiana – will likely see maximum ventilator usage in the next couple of weeks, said Lucio. But as the virus subsides in those locations, other hot spots could emerge.
"That's another challenge in terms of the supply chain," said Luccio. "The same product is shipped to New Orleans, New York and Washington state. When (coronavirus) crops up in other areas, how quickly can we get the medicines there? It can be difficult to change that method of distribution."
One bright spot in all of this, he said, is that the U.S. Food and Drug Administration has been open and accessible. Even now, the agency is working to find additional suppliers and alternate sources of raw materials, and is prioritizing drug approvals. There are limitations to what the FDA can do, but they've been receptive to insight and feedback, as in changing the enforcement thresholds for opioids – which have seen an increased need despite the negative attention they've garnered for their addictive qualities and long-term adverse health effects.
"You can make more product, but there are tests to make sure the product is stable, so it could easily be a month or more before the product is available," Lucio said. "We can't snap our fingers and immediately products are available. But going forward, the FDA and DEA are working overtime and trying to adjust their processes to the fullest extent."
Historically, the most recent development that significantly disrupted the pharmacy supply chain was Hurricane Maria, which interrupted the flow of IV fluids to Puerto Rico. The supply chain didn't suffer to the extent that it has currently, but there are some lessons to draw.
The big one is that there needs to be more transparency regarding the supply channel. The information that's publicly available to providers is very limited and difficult to come by.
"Healthcare-wise, if we can identify how much manufacturing capacity there needs to be, and ensure there are local places the products can be sourced from, we can avoid widespread disruption of supply chain issues in the future," said Lucio. "It can't be just, 'Drugs are extremely important.' We've got to think more strategically about how they're manufactured and sourced. Transparency really is key here."