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The Latest Research and Information on COVID-19: Critical Care Supply Shortages


​COVID-19 Critical Care Supply Shortages

Canada Snapshot

US Snapshot

  • Early signs hospitals may face shortages of pharmaceuticals (sedatives and painkillers) needed to care for COVID-19 patients, particularly in critical care and for those requiring ventilators.
    • These drugs include bronchodilators (e.g., albuterol) for keeping airways open, as well as sedatives (e.g., fentanyl, midazolam, propofol) and neuromuscular blockers (e.g., cisatracurium, rocuronium) used to intubate patients being placed on ventilators.
    • Demand for antivirals, antimalarials (e.g., chloroquine), and painkillers is also likely to increase.
  • At least two purchasing groups for US hospitals have recently indicated that demand for some pharmaceuticals is exceeding supply.
    • For example, Premier Inc., notes that national demand for a number of COVID-19 drugs have increased by more that 50% and fill rates are falling. In New York, demand has increased exponentially (e.g., demand for midazolam increased by 4100% in Marcg.).
    • Vizient reports that demand for pharmaceuticals necessary for ventilation are up by 58%.
  • The US Food and Drug Administration has recently changed the status of a number of drugs to "currently in shortage" as a result of increased demand. These drugs include midazolam, alfentanil, hydromorphone and lidocaine.
  • The Drug Enforcement Administration has increased Aggregate Production Quotas for controlled substance medications (e.g., fentanyl, morphine derivatives) that are in high demand due to COVID-19.

Global Snapshot

  • The two largest global producers of active pharmaceutical ingredients (APIs) are China and India, followed by Italy.
    • The lockdowns in China following the initial outbreak in Hubei province reduced supply, but as China eases restrictions large-scale manufacturing is showing signs of improvement.
    • Faced with reduced Chinese API imports, India has put restrictions on the export of some ingredients, including antimalarial hydroxychloroquine (used in some COVID cases), to maintain domestic supply.

Oxygen Supply Shortages

  • Media reports out of Italy, the UK and New York have indicated some hospitals are facing oxygen supply shortages because of heavy demand.
  • The problem may have less to do with the actual supply of medical oxygen and more to do with the ability of companies to deliver oxygen to hospitals (i.e., lack of cylinders).
  • Hospitals face the additional challenge of oxygen delivery systems that may not be built to support the required high-flow oxygen necessary to keep increased numbers of COVID-19 patients on ventilators and non-invasive ventilation (NIV).
    • On March 31, the NHS sent a memo to hospitals with actions to mitigate the risk of oxygen supply failure.
    • The NHS is addressing the "surge" capacity challenging by providing hospital trusts with engineering support.
  • The WHO has released guidance on oxygen sources and distribution strategies for COVID-19 treatment that includes an estimation of oxygen needs for COVID-19 patients and surge capacity plans.