Even before the arrival of the mysterious coronavirus, hospitals had been experiencing drug shortages for decades. However, the supply of medications has dried up even further with the increased number of critically ill COVID-19 patients and the scramble to try off-label treatments for the disease.
The pandemic has worsened some drug shortages and created many others. One of the drugs affected by this is dexamethasone. The recovery trial about dexamethasone found that: "The effect of dexamethasone was striking among critically ill patients on ventilators." However, the steroid had no effect on outcomes among those with mild cases of the virus.
Based on this preliminary result, the drug's supply started to wane fast, with many not even waiting for the full data analysis to come.
Treatment guidelines from the World Health Organization and many countries have cautioned against treating coronavirus patients with steroids. Dexamethasone represses the immune response of a patient, which could provide some relief to those whose lungs are destroyed by an over-active immune response, which sometimes manifests in severe cases of COVID-19. However, such patients may still need a fully functioning immune system to fend off the virus itself. The treatment requires taking dexamethasone for ten days, and the drug is readily available to the public.
However, it is clearly stated that people should not go out and buy dexamethasone to take at home. Dexamethasone has not proven to be beneficial for people with milder symptoms of coronavirus who do not need help with their breathing. Regardless, people started stocking up so they could get the maximum benefit out of the drug. Suppliers have increased prices, so the drug's price climbed 50% higher than the original cost. Pharmacies were prepared for the increased demand, but these unexpected extra charges could cause substantial cash flow problems for some.
Medicine scarcity causes several issues related to patient care and safety, and may result in inefficiency in medical care, medication errors, and harmful side effects. Furthermore, patients may suffer due to delayed treatment or no treatment at all. Shortages may even increase the workload of physicians and pharmacists and raise the cost of medical care.
Dexamethasone is a drug with a complex mechanism. It should not be taken without a doctor's prescription and should not be stopped without asking a doctor either as it can worsen the patient’s condition if suddenly stopped. The dosage of medication and length of treatment are based on the patient’s state and response to therapy. Doctors usually reduce the dose gradually to minimize the drug’s harmful effects.
Long term use of high doses of any steroid can lead to thinning of the dermis, easy bruising and bleeding, changes in body fat (especially in your face, neck, back, and waist), increased skin inflammation and facial hair, menstrual problems, or impotence. Over time, steroid overdose can cause severe irreversible health problems, such as liver damage, kidney damage, high cholesterol levels in the body, heart disease, cancer, and anaphylactic and septic shock. Yet people are still concerned about stocking this drug up so they can use it whenever they want.
Shortages of some critical medicines will likely continue to be a problem during this pandemic. Participants in a meeting recognized that scarcity of drugs and technologies are of concern to all countries and that a coordinated, back-to-back approach across the health system is needed to reduce their impact on public health. Higher authorities will be required to proceed on priority issues to improve access to needed medicines in health systems.