Canadian Hospitals' Dire Need for Respirators, PPE, Anesthetics

"Some hospitals have reported they're essentially using a 30-day supply of certain medications in just one day."
"Overall, our consumption of these drugs could increase by an order of magnitude." 
"The drugs that we're using are so fundamental to the care we provide to critically ill patients that we cannot ever conceive of them not being available."
"If someone told me, 'Sorry, we're out of Propofol', I would say 'What the hell are you talking about'?"
"We haven't run out of any of these drugs but the burn rate is such that we're having to employ conservation strategies actively."
Dr.Michael Warner, ICU head, Michael Garron Hospital, Toronto

Propofol, to sedate COVID patients on ventilators. (Richard Vogel/The Associated Press)

"I've been on numerous calls in the last couple of weeks to see where is the supply at, what is the supply chain looking like."
"We're seeing more patients who need ventilators, and we're also seeing them needing more of these anesthetics than the average ventilated ICU patient. So it's kind of a double whammy right now with these COVID patients." 
"Ventilators are great, but they only work if you have the drugs to run them."
Christina Adams, chief pharmacy officer, Canadian Society of Hospital Pharmacists

"People are recognizing that it is more than just ventilators that are needed to look after COVID-19 patients if there's a major surge."
"We need ventilators, we need intensive-care doctors and nurses, we need PPE [personal protective equipment]  -- and we need drugs."
Dr.Niall Ferguson, head, critical care, University Health Network, Toronto

According to chief pharmacy officer Christina Adams, the supply of anesthetics -- for use with respirators during the novel coronavirus epidemic -- currently available, is sufficient to cope with one to one-and-a-half times "business as usual" demand from hospitals. A new reality has arisen however, with the advent of critically ill COVID-19 patients in rising numbers so critically ill they must be placed for prolonged periods on respirators during which time hospitals need two to three times the drugs they would normally require.

But these are anything but normal times. The public is aware of the dire need for greater numbers of ventilators to be able to cope with an anticipated influx of of COVID patients, and the related need for personal protective equipment for the safety of health professionals looking after those patients. Now, however, another prospect of a dire shortage has been realized because the growing number of coronavirus patients placed in ventilators have begun to drain drugs known for their use in the operating theatre during surgeries.

Hooked up to breathing machines, many coronavirus sufferers are constantly kept on sedatives and medication to paralyze them for the purpose of protecting health-care workers during intubation, and to prevent damage to patients' lungs during that procedure. ICUs are still awaiting the dreaded surge of coronavirus patients, but in serving the needs of the steady trickle of those who are presenting at hospital in need of critical care, drugs are being used at a greater rate than usual, while not yet in shortage nationally.


Health Canada is working alongside the Canadian Society of Hospital Pharmacists in an effort to source and secure more of the needed drugs from overseas sources along with a supply of active ingredients that Canadian manufacturers use in producing the drugs. Most of the two or three percent of total COVID-19 cases who require critical medical attention in intensive care units are being hooked up to a ventilator and sedatives along with paralyzing drugs, similar to general anesthetic combinations in use during surgery are given to most of these patients.

Their use is mandated in the interests of cough prevention and other physical reactions to their illness that might cause the virus to be aerosolized, creating a major infection risk for the health-care workers while inserting breathing tubes, while at the same time creating a safer environment during ventilation for the patients themselves. In the interests of preventing damage breathing machines can cause to lungs, hospitals are attentive to the prevention of intubated patients coughing or drawing in air naturally. The sedative Ropofol is of critical use in these circumstances.

While the drugs are also utilized in regular bacterial pneumonia patients who develop acute respiratory distress syndrome, (ARDS), more COVID-19 patients have a need for the treatment for a longer period of time on average, leading to the drugs being consumed at a far greater rate than under normal circumstances. It takes Canadian manufacturers two or three months to raise production levels. They must first, however, access the needed ingredients produced in other countries, which are now in great demand worldwide.