Montreal hospitals at risk of running out of key COVID drugs

At Maisonneuve-Rosemont, the hospital has decided to tighten the control over the use of a powerful anti-inflammatory drug, Tocilizumab.

Aaron Derfel 4 minute read January 13, 2022

Maisonneuve-Rosemont Hospital is at risk of running out of a life-saving COVID medication in its intensive-care unit within the next 10 days amid a sustained high number of ICU patients suffering from the pandemic illness, the Montreal Gazette has learned.

The Omicron-driven fifth wave has not only led to some scheduled cancer and cardiac surgeries being put off in Quebec, but is beginning to deplete stocks of some COVID treatments, especially in Montreal’s overburdened adult hospital network. What’s more, Quebec’s largest pediatric hospital, Ste-Justine, is reporting a 20-per-cent drop in its surgical volumes because of a rise in COVID hospitalizations among children.

At Maisonneuve-Rosemont, just east of Olympic Stadium, the hospital has decided to tighten the control over the use of a powerful anti-inflammatory drug, Tocilizumab. This expensive medication is also administered to certain cancer patients who are at imminent risk of dying.

“Last week, we had very little, little left,” Dr. François Marquis, chief of Maisonneuve-Rosemont’s ICU, said in an interview Wednesday.

“We got more doses this week. Each and every week the allocation is given by the government, but it is absolutely a possibility that we’ll run out of this medication. Now, it’s not the only one on the market. There are a few drugs that can pretty much do the same thing. But they’re all kind of (in short supply).”

“We still have tons of Decadron,” Marquis added, “so this is another anti-inflammatory drug that we’re giving. But when you go to the next step, the next level of inflammation, especially for patients going into the ICU who are requiring very high-flow oxygen or going towards intubation, those are the kinds of patients where you want to given Tocilizumab.”

At the McGill University Health Centre, doctors are starting to run low on monoclonal antibodies for a certain group of COVID-positive immunocompromised patients. TVA Nouvelles reported Tuesday that Maisonneuve-Rosemont and two other Montreal hospitals were grappling with a COVID drug shortage that includes the medication Sarilumab, a treatment that’s also given to those suffering from severe rheumatoid arthritis.

Marquis said capacity in his ICU is “quite tight” and “we have to be very careful about who is getting admitted and who is not getting admitted. What is different from the other waves is that we have a higher turnover (of patients). During the first wave, people were pretty much dying on the spot or staying a long time.

“During the second, third waves and fourth waves, it was more like younger patients that would stay in the ICU for weeks, even months. Right now, I’m touching wood, but what we see is that patients have a shorter turnover, so they stay in the ICU for a few days and then they can go back to the ward. That’s probably thanks to vaccination.”

In contrast, Marquis noted, Maisonneuve-Rosemont’s emergency room and wards are now under “real, crazy pressure.” On Wednesday night, Maisonneuve Rosemont’s ER was filled to 133 per cent of its capacity.

“This is where most of the (COVID) patients end up piling up,” he explained of the ER. “In the ICU, it’s very tight. … We are at 100 per cent capacity, but we’re not in the same place that we were in the first and second waves” of the pandemic.

Adding to the challenges facing Quebec’s adult hospitals is that they have fewer staffed beds than at the start of the pandemic because of rising absenteeism among health workers. Health Minister Christian Dubé said on Tuesday that Quebec is scrambling to find 1,000 workers to send to hospitals to avoid reaching what he described as the “point of no return.”

Meanwhile at Ste-Justine, the pandemic is also posing challenges for the pediatric staff. In one case, a COVID-negative child is scheduled for a bone-marrow transplant, but has a parent who is COVID-positive, requiring a reorganization in that patient’s care, spokesperson Michel Dumais said.

On Tuesday, 22 patients were infected with COVID at Ste-Justine, but six were admitted solely because of the pandemic illness, while the others tested positive while in hospital for other medical reasons.


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