RIO DE JANEIRO (AP) — Reports are emerging of Brazilian health workers forced to intubate patients without the aid of sedatives, after weeks of warnings that hospitals and state governments risked running out of critical medicines.
A 43-year-old patient suspected of having COVID-19 is transferred from an ambulance into the HRAN public hospital in Brasilia, Brazil, Wednesday, April 14, 2021. (AP Photo/Eraldo Peres)
One doctor at the Albert Schweitzer municipal hospital in Rio de Janeiro told the Associated Press that for days health workers diluted sedatives to make their stock last longer. Once it ran out, nurses and doctors had to begin using neuromuscular blockers and tying patients to their beds, the doctor said.
“You relax the muscles and do the procedure easily, but we don’t have sedation,” said the doctor, who agreed to discuss the sensitive situation only if not quoted by name. “Some try to talk, resist. They’re conscious.”
Lack of required medicines is the latest pandemic problem to befall Brazil, which is experiencing a brutal COVID-19 outbreak that has flooded the nation’s intensive care units. The daily death count is averaging about 3,000, accounting for a quarter of deaths globally and making Brazil the epicenter of the pandemic.
“Intubation kits” include anesthetics, sedatives and other medications used to put severely ill patients on ventilators. The press office of Rio city’s health secretariat said in an email that occasional shortages at the Albert Schweitzer facility are due to difficulties obtaining supplies on the global market and that “substitutions are made so that there is no damage to the assistance provided.” It didn’t comment on the need to tie patients to beds.
The newspaper O Globo on Thursday reported similar ordeals in several other hospitals in the Rio metropolitan region, with people desperately calling other facilities seeking sedatives for their loved ones.
It’s unclear whether the problem seen in Rio remains an isolated case, but others are sounding the alarm about impending shortages.
Sao Paulo state’s health secretary, Jean Carlo Gorinchteyn, said at a news conference Wednesday that the situation was dire in the hospitals of Brazil’s most-populous state. On Thursday, more than 640 hospitals were on the verge of collapse, with shortages possible within days, officials said.
“We need the federal government’s support,” Gorinchteyn said. “This is not a necessity for Sao Paulo; it is a necessity for the whole country.”
His state’s health officials sent nine requests for intubation medication to the Health Ministry over the past 40 days, according to a statement Wednesday. Its last delivery was enough to cover just 6% of monthly needs in the state’s public health network, officials told
Federal Health Minister Marcelo Queiroga, who took over the post last month, said Wednesday that a shipment of sedatives was 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 two separate efforts to acquire medications on the international market are underway “to end this day-to-day struggle.”
For many weeks, the ministry has also been facing logistical constraints on getting oxygen delivered to hospitals across the country. Queiroga said it remains “a daily concern.″
A more contagious coronavirus variant, known as P.1, has been spreading across Brazil this year. It may also be more aggressive than the original strain, and health workers have reported patients requiring far more oxygen than last year.
The private sector has stepped up to help address some of the supply shortfall. A group of seven large companies donated 3.4 million doses of intubation drugs — enough for the management of 500 beds for six weeks — to the Health Ministry.
A first batch of 2.3 million was scheduled to arrive from China late Thursday at Sao Paulo’s international airport and would be distributed to states with critical shortages, the ministry said in an emailed response to AP questions about supply bottlenecks.
Last month, the Health Ministry requisitioned intubation medications from laboratories, reportedly as a means to distribute to the neediest hospitals. That has caused others facilities’ stocks to dwindle, said Edson Rogatti, director of an association of more than 2,000 hospitals nationwide.
“If we run out, the health sector will be in chaos,” Rogatti said on Globo News TV.
Shortages aren’t limited to the public sector. Brazil’s private hospital association published a survey Thursday in which nine of 71 institutions reported having supplies for five days or less. About half said they had enough for a week.
Private facilities are looking to import medications from India, but still need regulatory approval, the association told AP.
The city of Itaiopolis in southern Santa Catarina state this week reported shortages of both sedatives and oxygen. Neighboring Rio Grande do Sul state also reported supplies running out.
“The situation is desperate,” Rio Grande do Sul’s health secretary, Arita Bergmann, said in a statement Thursday. “We urgently need the Health Ministry to replenish hospitals’ stocks, or else intubated patients can wake up without medication, and that would be terrible.”
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- Brazil ‘running out of sedatives’
The coronavirus lockdowns and restrictions that Michigan’s governor, Gretchen Whitmer, enacted in March last year were among the nation’s toughest, and the governor’s leadership is thought to have saved lives. It also drew high marks from many in the state.
The same approach proved effective last fall when the second wave hit. Now, as Michigan faces another surge of cases and hospitalizations, its worst yet, Whitmer has changed tack.
Despite past success and growing calls for another lockdown from public health experts, and doctors managing hospitals with Covid patients, the governor is resisting further restrictions, and is instead largely relying on a vaccination rollout and a voluntary suspension of in-person dining services.
Several factors are driving the new approach, experts say. Among them is a growing sense of pandemic fatigue, and sustained pressure from conservatives. Eroding support from independents and Whitmer’s looming 2022 re-election race have also played a role. Many of those bearing the economic brunt of her lockdowns are donors and influential business leaders, said Bill Ballenger, a Michigan political analyst, and the governor appears to have been “scared straight”.
“I really do think the constant pressure over the last year is catching up, not just from the right and conservatives, but there are a growing number of people in the population, including independents and business persons who are Democrats, who are really angry at Whitmer,” Ballenger said.
The pressure to remain open continues even as cases and hospitalizations rise, putting Whitmer in an exceedingly difficult position. The surge hit soon after she lifted restrictions in early March, and Michigan’s two-week per-capita caseload now leads the nation. The state reached a bleak mark on Tuesday when over 4,000 people were reported hospitalized – the highest daily total of the pandemic. A high number of cases from Covid variants is also fueling the surge.
Among supporters strongly urging the governor to once again put restrictions in place are Dr Abdul El-Sayed, the former director of the Detroit health department. He noted that an increase in deaths has followed spikes in caseloads and hospitalizations, and said a new lockdown “would have a profound impact over the next couple weeks”.
He said: “Governor Whitmer showed a tremendous level of leadership last spring and fall, and that came with a lot of political blowback from conservatives, but she did the right thing – evidence shows that she saved lives, and we need that leadership now.”
Read more of Tom Perkins’ report from Detroit: ‘Alarm is growing’: Michigan governor faces shutdown dilemma as Covid cases rise