RIO DE JANEIRO (AP) – Reports are coming in of Brazilian health workers being forced to intubate patients without the help of sedatives, after weeks of warnings that hospitals and state governments were at risk of getting out of critical drugs.
A doctor at Albert Schweitzer Municipal Hospital in Rio de Janeiro told the Associated Press that health workers dilute sedatives for days to make their supplies last longer. When it ran out, nurses and doctors had to start using neuromuscular blockers and tie patients to their beds, the doctor said.
“You relax the muscles and perform the procedure easily, but we don’t have sedation,” said the doctor, who agreed to discuss the sensitive situation only if he was not mentioned by name. Some try to talk, but resist. They are conscious. “
Lack of needed drugs is Brazil’s latest pandemic problem, experiencing a brutal COVID-19 outbreak that has flooded the country’s intensive care units. The daily death toll averages about 3,000, accounting for a quarter of deaths worldwide, making Brazil the epicenter of the pandemic.
“Intubation kits” include anesthetics, sedatives, and other medications used to put critically ill patients on ventilators. The press office of the Rio Health Secretariat said in an email that occasional shortages at the Albert Schweitzer facility are due to difficulties in obtaining supplies from the world market and that “replacements are being made so that the assistance provided is not harmed”. It did not comment on the need to restrain patients to beds.
The O Globo newspaper reported similar ordeals at several other hospitals in the Rio metropolitan region on Thursday, with people desperately calling other facilities looking for sedatives for their loved ones.
It is unclear whether the problem in Rio remains an isolated case, but others are ringing the alarm about impending shortages.
The Secretary of State of the State of Sao Paulo, Jean Carlo Gorinchteyn, said at a press conference on Wednesday that the situation is dire in the hospitals of Brazil’s most densely populated state. On Thursday, more than 640 hospitals were on the verge of collapse, with possible shortages within days, officials said.
“We need the support of the federal government,” said Gorinchteyn. “This is not a necessity for Sao Paulo; it is a necessity for the whole country. “
According to a statement Wednesday, his state’s health officials have sent nine requests for intubation medications to the Department of Health in the past 40 days. The latest supply was enough to cover just 6% of the monthly needs in the state’s public health network, officials told AP.
Federal Health Minister Marcelo Queiroga, who took over the post last month, said on Wednesday that a shipment of sedatives is expected to arrive in Brazil “in the next ten days.” It is the result of a contract signed with the Pan American Health Organization.
He said there are two separate efforts underway to bring drugs to the international market “to end this day-to-day struggle.”
For weeks, the ministry has faced logistical limitations to deliver oxygen to hospitals across the country. Queiroga said it remains “a daily concern.”
A more contagious variant of coronavirus known as P.1 is spreading across Brazil this year. It can also be more aggressive than the original strain, and health professionals have reported that patients require a lot more oxygen than last year.
The private sector has worked to help address some of the supply shortage. A group of seven large companies donated 3.4 million doses of intubation drugs – enough to manage 500 beds for six weeks – to the Ministry of Health.
An initial batch of 2.3 million would arrive from China at Sao Paulo International Airport late Thursday and would be distributed to critical deficit states, the ministry said in an email response to AP questions about bottlenecks in the U.S. supplies.
Last month, the Department of Health demanded intubation drugs from laboratories, reportedly as a means of distribution to the most needy hospitals. That has led to stocks of other facilities diminishing, said Edson Rogatti, director of an association of more than 2,000 rural hospitals.
“If we run out, the health sector will be in chaos,” Rogatti told Globo News TV.
Shortages are not limited to the public sector. The Brazilian private hospital association published a survey on Thursday in which nine of the 71 institutions reported having supplies for five days or less. About half said they had enough for a week.
Private facilities want to import drugs from India but still need regulatory approval, the association told AP.
The city of Itaiopolis in the southern state of Santa Catarina reported a shortage of both tranquilizers and oxygen this week. The neighboring state of Rio Grande do Sul also reported running out of supplies.
“The situation is desperate,” Arita Bergmann, Rio Grande do Sul’s health secretary, said in a statement Thursday. “We urgently need the Department of Health to replenish hospital supplies, otherwise intubated patients could wake up without medication, and that would be awful.”