Drug Shortages Exacerbated by the COVID-19 Pandemic

Globalization and overseas outsourcing of manufacturing has resulted in periodic drug and medical supply shortages since 2001. This issue has been brought to the attention of US authorities multiple times with no action on the part of several administrations.

On this blog I have written about the defunding of the FDA so that many of the drug producing factories in China and India have not been inspected by FDA inspectors for quality in decades. Within the last five years the only major producer of intravenous fluids for the United States and Canada, located in Puerto Rico, was shut down after hurricane damage and electrical grid damage. The US Military was impacted by this factory shutdown and tried to purchase fluids from overseas producers, but they were at top capacity and could not meet the demand. There have been critical shortages of morphine for pain control.

The pandemic has further exacerbated this issue. CIDRAP, the Center for Infectious Disease Research and Policy at the University of Minnesota reported on its website that there is a shortage of 29 of 40 drugs crucial for treating COVID-19 patients. The shortage includes the short term anesthetic propofol, the bronchodilator albuterol, hydroxychloroquine (used for rheumatoid arthritis and certain lupus patients), fentanyl and morphine. The Food and Drug Administration has its own critical list of shortages and lists 18 of 40 on their drug shortage list. An additional 67 out of 165 critical acute drugs are listed as in short supply. This list includes acetaminophen (Tylenol), lidocaine, diazepam (valium) and phenobarbital among the most noteworthy.

As the election for President concludes, it is far overdue for whomever prevails to dedicate one department to evaluate, plan for and prevent critical drug and supply shortages. It is also long past due that the production and distribution of these key pharmaceuticals and medical supplies return to the United States so we are not subject to the whims of a foreign government or find ourselves trying to outbid our allies for supplies.

Michael Osterholm, MD, the director of CIDRAP, sees the coming increase of COVID-19 cases further challenging the existing supply of medications available to the American public.

Life’s New Reality with Coronavirus aka COVID-19

We are bombarded daily with news about the spreading infections with CoronaVirus or Covid-19. With television, the Internet and other news mediums; the quantity, quality and accuracy of information can be overwhelming.

This single stranded RNA virus has managed to invade most of our populated continents and is now moving into communities. There is more we do not know about this pathogen than we do know.

Public health officials which include the Trump Administration, the CDC, the NIH and local health departments have been extremely tight-lipped on the clinical course of the hundreds of US citizens evacuated from infected areas and quarantined for 14 days.

We do not know if there are any telltale historical or clinical markers to tip us off as to whether the patient in front of us with a cough and low grade fever might have a run of the mill seasonal viral infection or Covid-19.

And, it is still unclear,

  • How long the virus stays alive on a surface and remains infective.
  • How long the incubation period is and how long in advance of demonstrating signs of infection asymptomatic patients can transmit the disease.
  • What role, if any, children, who seem to be less vulnerable to the disease, play in the transmission of the disease as asymptomatic carriers?
  • How a relatively healthy nonsmoking adult in their 30’s to 50’s will do if they catch the disease?

The recommendations on testing from the administration and CDC have been unrealistic based on the lack of availability of the testing labs and kits in affected states. This will improve with time, but will it improve to the level of the “quick, never get out of your car, drive-through testing” being done in South Korea? That story, covered by CNN, was both enlightening and disheartening. Enlightening by illustrating how government can institute a plan quickly and efficiently.   Disheartening realizing that with all our wealth and expertise in the United States we are not doing something similar.

The recommendations about prevention are commonsense. Do I really need to log onto the CDC website to learn that I need to wash my hands, avoid touching my face and stay home if ill?

The selfishness and entitlement of the American public make even asking these minimal changes in our pattern to be a major inconvenience and intrusion into our privacy. I see the Ultra Rock Festival in Miami and the Calle Ocho street festival have been cancelled smartly to prevent infection. At the same time restaurants are jammed, servers and food preparation individuals without sick leave and health insurance still show up at work ill, to serve and prepare food, and many chronological adults balk at giving up their restaurants, bars, clubs and shows to prevent the spread of disease.

Posters suggesting we stay six feet away from others are plastered on buses and train platforms of mass transit systems where if you can stay 6 microns away from another transit passenger it’s as if you are travelling in the First Class section.

If we are all fortunate, Covid-19 will ultimately be an annoyance in the low risk population. We will develop fast and effective ways to detect it and then, with knowledge of how it spreads, we will be able to provide advice on how to protect others.

I am just not sure today’s American public has the will, the determination or the sense of community, altruism and sacrifice of lifestyle needed to prevent a major health and economic crisis.

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