Provinces with highest case rates hit by shortage of medication for sickest patients
Original author: Jennifer Lee
Published: May 11, 2021
As Alberta's COVID-19 ICU admissions hit an all-time high, doctors are dealing with a shortage of one of just two drugs they can use to treat the sickest patients.
The pandemic has led to a spike in global demand for tocilizumab, an anti-inflammatory medication traditionally used to treat auto-immune conditions such as rheumatoid arthritis and side-effects related to some cancer treatments.
The immune treatment is manufactured by just one company: Hoffmann-La Roche. Because it was used to treat less common conditions prior to the pandemic, it hasn't been produced on the mass scale needed to meet the global demand for its application in treating COVID-19 patients.
In February, Health Canada declared a Tier 3 shortage of tocilizumab — a designation used for shortages that "have the greatest potential impact on Canada's drug supply and health-care system."
Tocilizumab is used in addition to the go-to drug dexamethasone, which is in full supply, for people with severe COVID-19 infections.
"Frankly, it feels like we're unable to give everything we can. And that's a terrible feeling when we're trying our best to save every life, every time," said Dr. Gabriel Fabreau, internal medicine specialist at Calgary's Peter Lougheed Centre and assistant professor at the University of Calgary's O'Brien Institute for Public Health.
He said many patients on the COVID unit at the hospital would qualify for tocilizumab. But during his latest shift there last week, there was no supply.
"It's stressful.… There's evidence that it likely does help patients, and the mechanism by which it does that makes sense. And not being able to have it, not being able to offer it to the patients that would clearly qualify, it doesn't feel good."
Fabreau said some of his colleagues were able to secure some doses for patients on Monday.
Doctors in Ontario worried, too
A recent analysis led by Dr. Amol Verma, an internal medicine specialist and scientist at St. Michael's Hospital at Unity Health Toronto, estimates 40 per cent of Canadian adults hospitalized for COVID-19 might benefit from tocilizumab.
"I'm very worried about the supply issues," he said.
Verma and his colleagues estimate that for every 1,000 adults hospitalized with COVID-19, about 400 could benefit from the tocilizumab.
"And if they receive it, an important proportion of those people might not die and might not need a ventilator. And so … for every 1,000 people, you might be able to save 10 or 20 lives," he said.
Dr. Lynora Saxinger, a University of Alberta infectious disease specialist, said the drug is used in addition to the corticosteroid dexamethazone — which is plentiful — for people with severe COVID-19.
"It's not a massively game-changing drug but it looks like it's a useful drug in that subset of patients who are very ill," she said.
Other provinces with high COVID-19 rates are looking at ways to conserve the tocilizumab, she said, and that could be considered in Alberta.
"Some groups in Ontario and B.C. are looking at using a lower dose than the dose studied in the trials. And we might actually look at doing that as well if the experience of that so far has been good."
The Public Health Agency of Canada said it purchased all available supplies of tocilizumab to treat COVID (1,400 doses in March and 1,728 doses in April) and is distributing it to the provinces most in need.
Alberta Health Services is expecting a partial shipment this week with the remainder coming next week.
On Saturday, the Fraser Health Authority in British Columbia shared a shipment with Alberta, including enough tocilizumab to treat approximately 25 patients.