Amid the risk of hospital collapse in Minas Gerais due to the pandemic of the new coronavirus, the state’s health system is also on the alert regarding medications. Several cities in the interior and Greater BH, including the capital, are eyeing stock levels for anesthetics and relaxing muscle, which are essential for surgery in general and also for patients with COVID-19 who need the help of respirators. The substances are in short supply in the market, being sold at high prices, reaching an increase of 300%, when available. The State of Minas tried to find out about the situation in several municipalities and found that many are operating with anesthetics and muscle relaxants at critical levels. In Belo Horizonte, the Municipal Health Secretariat is following the situation of the shortage of anesthetics in the hospital network. Recently, the city government of the capital received about 10,000 vials of these substances, donated by the Lucas Machado Educational Foundation (Feluma), which will help reinforce the stock of the Unified Health System (SUS) network in BH. Despite this, the city dialogues with suppliers and with the state and federal governments to seek solutions for shortages. The warning signal was also turned on in Contagem, in Grande BH. The municipality’s Health Department does not register a lack of anesthetics and muscle relaxants, but admitted that the stock is critical. The palliative solutions found to circumvent the problem are the contingency of medications to serve, as a priority, patients who are in ICUs and those with coronaviruses who have to be intubated, in addition to the use of similar substances, if necessary. The folder also highlighted concern with the scenario and stressed that it searches daily for suppliers that have the products available. Betim also does not register a lack of anesthetics and muscle relaxants in the public network. According to the Municipal Health Department, patients who need hospitalization and mechanical ventilation continue to receive the medications, but the folder warned that they may have difficulties in acquiring the substances, depending on the market’s behavior. Another municipality in Grande BH that is on alert for the stock of sedatives, anesthetics and muscle relaxants is Nova Lima. The city informed that all efforts are being made to acquire the products, but that the demand for the substances increased due to the pandemic of the COVID-19, and that the pharmaceutical industry has failed to meet the needs of the market quickly. The purchase of substitute drugs is also being provided by the municipality. The scenario is repeated in Ibirité, which put its Field Hospital to work last week and is also struggling to buy sedatives and anesthetics. The city informed that suppliers credit the shortage to the increase in cases of COVID-19 in Minas, in addition to the low production of medicines by the manufacturer. Twenty ICU beds and 20 medical clinics started operating in the health unit. Another obstacle in the purchase of medicines is the high prices presented by the companies. Santa Luzia, for example, replaced lidocaine without a vessel, ketamine, suxamethonium, midazolam and fentanyl with Propofol, Rocuronium and Pancuronium. The city hall even opened tenders, but all were frustrated because of the high values presented by the companies for the acquisition of the main substances. Therefore, there is no provision for the purchase of medicines.
The State Department of Health (SES / MG) also faced overpricing when trying to purchase the items, a task that usually falls to hospitals. According to the folder, the values were readjusted by up to 300%. There were difficulties in purchasing the products, too, because of the general shortage of the market. Despite this, SES has been in dialogue with other state departments in the area and with the Ministry of Health to try to find solutions. Responsible for 20 health units in Minas, the Hospital Foundation of the State of Minas Gerais (Fhemig) said that there is a contingency and relocation of the stock of anesthetics and muscle relaxants. If any of the items are momentarily missing, informs Fhemig, similar drugs are used, as described in the clinical protocols. The network did not register a shortage of the substances, but admitted that it finds it difficult to deliver on time. In some health units, elective surgeries are being suspended. Case of Montes Claros, in the North of Minas Gerais, where the six SUS-affiliated hospitals are performing only emergency procedures. The Ministry of Health announced yesterday that it will strengthen the distribution of medicines for intubation of patients with coronavirus.
Race against time
With regular vacancies after the opening of a field hospital, Divinópolis, in the Midwest Region of Minas Gerais, has been running a race against time to prevent itself from fulfilling the forecast of the State Health Department (SES) that the disease will reach its peak within two weeks. The main difficulty is the acquisition of sedatives to intubate patients in the most serious condition. “Sometimes we find it in small stock, but suppliers ask from 15 days to two months (to deliver), because they are making a market reservation”, explains the coordinator of the field hospital and the Emergency Care Unit, doctor Tarcísio Teixeira de Freitas. Not even for those who propose to pay more, there is no availability in the market. While there is no short-term solution, the unit has been making replacements. “If we don’t find a relaxant, we use other medications,” he says. For now, the situation is still under control. “However, if the scenario that is about to unfold in the future will generate a decrease in assistance. There will be ventilation, the bed, but not the medication to keep the patient intubated ”, he explains. For the doctor, the alternative to avoid the impact on assistance is the joint commitment of the federal and state governments. “Measures will have to be taken as was done in the case of respirators, imports and active search in companies’ stocks,” he argues. The increase in cases in the state was reflected in the Divinópolis field hospital. Before, a reference only for eight municipalities, today, it receives patients from the macro-region, which has 54 municipalities, and from other parts of Minas Gerais, such as Betim, in the metropolitan region. Of the 30 infirmary beds, 10 were occupied until yesterday afternoon and another 10 of the 35 at the Intensive Care Center (CTI). (* Amanda Quintiliano, special for EM)
Distribution in the countryside is a challenge
The shortage of drugs for the treatment of COVID-19 comes from the beginning of June, when the red alert about the situation was brought to the attention of the Ministry of Health, points out the Federation of Santa Casas and Philanthropic Hospitals of Minas Gerais (Federassantas). According to the organization, a survey by the National Council of State Health Secretaries (Conass) was presented at a public hearing in the Chamber of Deputies, showing that 24 of the 25 state departments already suffered from the lack of muscle blockers necessary for the intubation of patients. The matter was also taken to the Ministry of Health’s crisis office, which informed Federassantas of its intention to mediate purchases abroad through the Pan American Health Organization (PAHO) and which would make a bid with national suppliers from which the states and city halls of some capitals may participate by purchasing limited quantities of these drugs. The president of Federassantas, Kátia Rocha, stressed that it is necessary that the proposal of the Ministry of Health integrate very well-defined distribution points. “The centralized purchasing model for a scenario of extremely widespread demand in hospitals spread across the national territory is a huge challenge, and such a purchase still has the potential to aggravate the scarcity”, he pointed out. On Friday, the six accredited hospitals the SUS in the North of Minas released a statement to the population, in which they announced the suspension of elective surgeries due to the lack of anesthetics and muscle relaxants used in surgical procedures. Hospital units have adopted a contingency plan, as they have stocks of medicines reserved only for emergency cases. The state and federal public ministries also distributed a note, expressing concern about the lack of medication for surgeries and for intubation procedures for critically ill patients at COVID-19. Yesterday, directors of Montes Claros hospitals again emphasized the seriousness of the lack of anesthetics and other supplies. “Consumption increased and production decreased. This caused the lack of anesthetics in Brazil as a whole, ”said Maurício Sérgio Sousa e Silva, superintendent of Santa Casa de Montes Claros, the largest hospital in the North of Minas. The direction of the University Hospital Clemente de Faria, linked to the State University of Montes Claros (Unimontes) and the only one in the city with free care, 100% by SUS, reported that the unit is highly affected by the lack of anesthetics and sedatives. “The losses can be considerable for users, including the CTI, who need surgery and sedatives in the various procedures”, informs the unit. On the other hand, the institution guarantees that, “until now, no surgery has been done” in the hospital. “HUCF put the contingency plan into practice so that, precisely, it does not fail to serve any user”, he maintains. The Hospital Universiário also informs that it has negotiated with the suppliers the regular delivery of the “minimum of inputs and materials for the surgical activity”, in addition to providing a new bid “for the purchase of medications and other inputs that had a high consumption due to the pandemic of the New Coronavirus ( COVID-19). ”Still in Montes Claros, the Hospital Aroldo Tourinho justifies that the problem of low stocks is also due to the increase in prices of pharmaceutical products in the face of high demand after the arrival of the pandemic. ”Even though we have resources, we are not able to purchase these products from suppliers. Due to the scarcity and high demand throughout the Brazilian territory, there were also significant increases in the prices of these products. As an example, a certain drug that used to cost R $ 5.30 is being offered today at R $ 60.00 ”, informs the unit’s management, linked to Fundação Hospitalar Aroldo Tourinho. (LR)[NOTICIA1609927]