Widespread critical-medication shortages are the next big crisis of the coronavirus pandemic. Some hospitals, including in New York, are running low on paralytic agents that are needed to safely intubate patients. Steve Corwin, the president and CEO of New York–Presbyterian, recently noted on MSNBC that his hospital is even running short on solutions needed for dialysis. I am fortunate to work in the emergency department of one of the best-resourced hospitals in the country, Brigham and Women’s Hospital in Massachusetts. But already, when I order intravenous fentanyl, which doctors use to minimize pain and keep patients breathing safely and comfortably while on mechanical ventilators, an alert pops up reminding me that there’s a national shortage. Am I sure I want to use this medication? Of course I’m sure. The frequency of alerts and the number of drugs in undersupply are shocking developments in a rich country.
Throughout the pandemic, the United States has been playing catch-up. We’re still not testing enough, even though public-health officials saw that problem coming from miles away. Hospitals continue to run low on personal protective equipment. It is too soon to know whether 11th-hour attempts to increase those supplies will succeed. Too many lives hang in the balance to play wait-and-see with our medications too.
In addition to drugs for patients on mechanical ventilators, including sedatives such as etomidate, paralytics, and pain meds, we also need to fast-track the production of antibiotics such as azithromycin, cefepime, and others that we use to treat pneumonia. We need a steady supply of hydroxychloroquine, although not for patients with COVID-19—no compelling evidence shows that it actually benefits those with the virus. Yet because many are using it for the coronavirus, we are now low on the drug for patients with conditions it’s known to help, such as lupus and rheumatoid arthritis.
Here are steps the federal government can take now to make sure that hospitals are well stocked during the pandemic and after it passes, when doctors turn to operations delayed by the COVID-19 surge. First, it needs to improve data collection to track how manufacturing capacity is stacking up against medical demand. Then, it needs to compel pharmaceutical companies and their suppliers to accelerate the production of needed drugs.
The data infrastructure is already in place. For some 20 years, the FDA has run a drug-shortage tracking program. In 2011, in response to a deficit of cancer treatments, anesthesia, and other critical-care medications, President Barack Obama issued an executive order urging drug manufacturers to report supply issues early so that any bottlenecks in production could be addressed in a timely way.