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Since the pandemic began, scientific associations have warned of the risk of shortage of essential medicines to treat critical patients that the country could face.
And although there have been constant tables of work with authorities, today sedatives, analgesics, relaxants and adjuvants are scarce. Mauricio Vasco, president of the Colombian Society of Anesthesiology and Resuscitation (SCARE), explains the current crisis.
What about ICU medications?
Frontline agents and most of their alternatives have been exhausted. The fact of reactivating the health systems and the economic reopening led to an expense not only due to pathologies associated with covid-19, but also to trauma, violence, surgeries and urgent procedures and, also, to the reactivation of the surgical agendas of elective cases .
(Also read: Covid-19 patients in ICU have grown by 50 percent in December)
Is shortages a local or global problem?
Is worldwide. To the extent that the countries that produce and market these drugs and raw materials have many affected patients, it will be even more difficult for them to reach the countries affected by the pandemic that do not have good local production capacity.
What medications are they?
There are four pharmacological groups: sedatives, which allow people to be asleep and not remember (the rarest are midazolam and propofol); strong narcotic pain relievers (hydromorphone, morphine, remifentanil, and methadone); neuromuscular relaxants, which make it easier for patients to tolerate assisted ventilation therapies, and adjuvants, used to enhance the effects of the above and not to use such high doses and at the same time save. Many of the adjuncts are for managing psychiatric and neurological ailments.
How important are they?
These medications are a fundamental pillar of the management of critically ill patients, whether or not they are due to covid-19, since they facilitate all processes of ventilatory support and, by reducing pain and memory, allow the passage through intensive therapy to be associated with better outcomes in patients.
(You may be interested: WHO warns of the danger of future pandemics ‘worse’ than covid-19)
What happens if they don’t apply?
The benefit of the interventions is affected, recovery is delayed, complications are generated (due to being awake and in pain, tubes and special catheters are removed to apply medications), the ICU stay is increased, there is a greater risk of delirium, agitation and complications in the mental and wellness sphere after recovery.
Why the shortage?
The main reason is the large number of patients now for all causes and the increase in ICU beds, which generates more patients for the use of these therapies. In addition, as the countries that produce the raw material (India) and generate the commercialization and distribution (Europe and the United Kingdom) have many cases, since exports are restricted and their use is prioritized.
Who does the supply depend on?
Most imports. There is a national production that is not enough to cover the needs.
What steps have you taken and what have you been told?
The scientific associations have worked very well with the Ministry of Health’s medicine and technologies office with Invima, the Narcotics Fund and the rest of the actors. Processes have been carried out to facilitate importation, reduce barriers and local production of those that can be favored, but it is still insufficient for local demands.
(See: 10 Purposes Doctors Recommend To Maintain Health)
What alternatives exist to meet the shortage?
They have been defined in clinical guidelines carried out by scientific associations, but these are already running out as well. In addition, their use impacted the provision of services in the areas of acute and chronic pain management, palliative care, and in diagnostic, interventional and surgical procedures, which has led to the suspension of some of these services.
What do you suggest?
In addition to continuing with the measures, not stopping these actions during the holidays, the pandemic does not wait. That the Government issue administrative acts to eliminate the barriers for the prescription of the remaining alternatives, since many of them are more expensive than the agents usually used when there was no shortage. In particular, glosses to accounts for the use of these alternatives, pay previous debts and continue with subsidies or make them effective to hospital institutions should be prohibited. These must have cash flow to continue in the provision of services and payments to human talent in health.
It is also necessary to strengthen all the strategies to report and that the surveillance and control entities avoid and punish the hoarding and usury of the required medicines and supplies, promote the surveillance of the epidemiological situation throughout the national territory that if necessary allow to Territorial directorates limit the performance of non-priority surgeries in the event that the particular situation of shortage of medicines puts at risk the care of critically ill patients or the performance of urgent procedures and surgeries. It should also continue with actions at the central level to control agglomerations and prevent community transmission of covid-19.
HEALTH UNIT
