Supplies of both prescription and nonprescription medications are running short. (Credit: Marc Fayad)
BEIRUT — As hospitals treat the largest number of COVID-19 patients since the start of the pandemic, staff are overworked, intensive care units are understaffed, and beds are full. And now health care workers are faced with another challenge — shortages of drugs with which to treat those patients.
“While no drug has been proved to cure COVID-19, there are several studies that have shown certain benefits for certain drugs,” Lise Abi Rafeh, medical director at Haykel Hospital, told L’Orient Today.
“But we are struggling to get everything we need to offer the best care we can.”
Though there is no definitive cure for the illness caused by the novel coronavirus, doctors have a range of options for medications they can prescribe in the hope of improving a patient’s chances of recovery.
Among these are antiviral medication remdesivir (sold under the brand name Veklury), rheumatoid arthritis medication baricitinib (Olumiant) and arthritis medicine tocilizumab (Actemra), which is used to treat COVID-19 patients who are in critical condition.
Their effectiveness in fighting the disease is not universally recognized, however. While the US Food and Drug Administration has issued emergency-use authorization for remdesivir and baricitinib in hospitalized patients, the World Health Organization has recommended against the former’s use.
Tocilizumab, meanwhile, has been approved for use in the UK’s National Health Service, though studies on its effectiveness have been inconclusive and it has not been FDA-approved.
At the American University of Beirut Medical Center, all three of these medications are in short supply, according to critical care doctor Pierre Bou Khalil.
When L’Orient Today spoke with Bou Khalil on Tuesday, remdesivir was out of stock, despite having been available last week, and supplies of Actemra were running low. While baricitinib was out of stock a few days ago, it was now available again.
“It’s in flux, but not a single day goes by without us facing shortages of something,” Bou Khalil said. “It’s very worrying, as we might not be able to replenish stocks in time and patients will miss doses.”
Remdesivir and baricitinib are also missing at Nabih Berri Governmental University Hospital in Nabatieh, according to director Hassan Wazni. Rafik Hariri University Hospital, however, has not experienced a shortage of remdesivir, according to hospital manager Firass Abiad. But this is likely connected to lack of confidence in the drug’s efficacy at Lebanon’s main COVID-19 treatment center.
“We use it extremely rarely,” Abiad said, explaining that the hospital took part in a WHO study that showed that remdesivir “is really not that effective.”
Jalal Abdou, an infectious disease specialist and the head of the COVID-19 department at Elias Hrawi Governmental Hospital in Zahle, says doctors are still administering remdesivir and tocilizumab despite the lack of consensus on their effectiveness.
“This is a new disease; there is no cure and no universal protocol,” he said. “We are using all our weapons to fight this disease.”
Global and local demand
According to Karim Gebara, the head of the Lebanese Pharmaceuticals Importers Association, the primary cause of the shortages is unprecedented demand, both globally and locally.
“The supplying companies can’t provide the quantities we need anymore, particularly as critical cases increase,” he said.
As of Tuesday evening, there were 799 people in intensive care with COVID-19, 246 of whom were on mechanical ventilation, according to the Health Ministry. This is nearly twice the figure from a month ago, when 420 were in the ICU and 145 were on mechanical ventilation.
Gebara explained that rather than Lebanese importing companies placing orders for a certain number of boxes or pills, foreign suppliers are simply sending whatever they have available.
“We get what we can get,” Gebara said. “It’s really hard to say, but we simply don’t have sufficient supplies to cover the demand.”
In some cases, if hospitals are unable to find the drug they need from suppliers, they ask patients to source it themselves.
“The family then goes around asking wherever they can,” Bou Khalil said. “But they often find it at a much higher cost.”
As is the case for oxygen machines and intensive care beds, people have been taking to social media to find the medicine their loved ones need.
Many of these requests reach Diana Franjieh, a pharmacist and a founder of Capsule of Hope, a pharmacist-led initiative that tries to source and distribute medications to people in need.
“Both at the pharmacy I work in and at Capsule of Hope, we have seen a huge surge in demand,” Franjieh said. “But suppliers are barely able to provide us with the quantities we ask for.”
“If we order 10 boxes of a certain drug, we might only get three.”
One of many crises
It is not only prescription medication ordered by doctors to treat the most severe cases of COVID-19 that are hard to come by.
Even paracetamol (Panadol), which is often recommended as the first line of treatment for mild cases of COVID-19, and supplements such as zinc and calcium are in short supply, according to Ghassan Al-Amin, the head of the pharmacists’ syndicate.
“There is a huge demand for these products,” he said. “No matter how often we import them, they are always sold quickly.”
According to Amin, a major reason behind the disappearance of over-the-counter products is people stockpiling them at home amid uncertainty over the fate of state subsidies on medications.
“We are in a crisis, one of the many crises facing the country,” he said.
Despite a dedicated parliamentary session and an Economy Ministry proposal, the future of subsidies on medical supplies, wheat and fuel is unclear.
The central bank governor, Riad Salameh, has suggested there are only enough US dollars in the bank’s reserves to continue subsidies until the end of January.
“People need to know on what basis and at what price they will be able to buy medicine in the future,” Gebara said.
“At the moment,” he continued, “people just don’t trust the capacity of the health system in Lebanon to protect them.”