COVID-19: Drug and medical supply impacts

Updated on May 22, 2020

Drug and medical supply shortages

The COVID-19 outbreak has raised concern about the availability of medical supplies, including disinfectants, hand sanitizer, drugs, medical devices, and food/feed additives. In addition, throughout the pandemic, veterinarians have been asked to assist healthcare providers with equipment and services, including PPE, ventilators, laboratory support, and trained volunteers.

The AVMA is in close communication with federal and state agencies and is supporting these efforts to gather information from independent practices, practice groups, and veterinary distributors about shortages of disinfectants, drugs (including both animal and human drugs used in veterinary medicine), medical devices, food/feed additives, and other products needed by veterinarians. Veterinarians are encouraged to utilize AVMA Direct Connect to determine what vendors may have products or alternatives available and to continue to share shortage information and concerns with the AVMA via coronavirusatavma [dot] org. Products reported to the AVMA to be in short supply are summarized below.

Disinfectants: EPA registered antimicrobial products

Products with activity against antimicrobials on inanimate objects are regulated by the Environmental Protection Agency (EPA). The AVMA has received information about shortages, including allocation based on prior orders and backorders, for the EPA antimicrobial classes of wipes (sold out), building disinfectants (allocation to prior orders), and sprays (backordered).

The EPA regularly updates its List N: Disinfectants for Use Against SARS-CoV-2, which is searchable by EPA registration number, active ingredient, site of use (e.g., health care, institutional, residential), contact time, and keyword. When using an EPA-registered disinfectant, label directions should be followed for safe, effective use. See AVMA Direct Connect for distributors of these products.

On March 30, in an effort to respond to supply chain disruptions, EPA published a Temporary Amendment to Pesticide Registration Notice 98-10 (followed by additional amendments on April 14 and May 11) that allows registrants of currently registered pesticide disinfectant products on EPA’s List N containing certain active ingredients to use any similar source of those active ingredients without having to first apply for and receive EPA approval of an amendment to their pesticide registration identifying the new source of their ingredient.

Hand sanitizer

Occasional shortages of hand sanitizer have also occurred. The United States Pharmacopeia (USP) has recently posted guidance on compounding hand sanitizer during the COVID-19 public health emergency. These include: Compounding Alcohol-based Hand Sanitizer During COVID-19 Pandemic, FAQs – Alcohol-based Hand Sanitizer During COVID-19 Pandemic, Compounding Alcohol-based Hand Sanitizer During COVID-19 Pandemic Infographic, USP Hand Sanitizer Toolkit During COVID-19 Pandemic 2020, and FAQs – COVID-19 Compounding Resources.

Drugs

The following drugs have been reported to the AVMA as being on backorder:

Drug Type
Specific Drug

Antimicrobials

Amoxicillin 500 mg capsules (100 ct)

 

Amoxicillin/clavulanate potassium 28.5 mg/5ml (50 ml bottle)

 

Amoxicillin/clavulanate potassium 500 mg/125mg tablets

 

Cephalexin 250 mg capsules

 

Cephalexin 500 mg capsules

 

Clindamycin

 

Doxycycline 20 mg tablets (100 ct)

 

Doxycycline 50 mg capsules (50 ct)

 

Doxycycline 100 mg tablets (500 ct)

 

Erythromycin

 

Metronidazole

Chemotherapy agents

Pamidronate

Human pharmaceuticals

Alprazolam (Xanax) tablets

Ophthalmic Preparations

Atropine 1% ophthalmic ointment

 

Ketorolac ophthalmic solution

 

Neopolydex ophthalmic ointment

 

Neopolydex ophthalmic suspension

Ulcer medications

Famotidine injection

FDA Center for Veterinary Medicine (CVM)-approved drug applications—No current shortages are reported by any of the 32 animal drug companies that make finished drugs or source active pharmaceutical ingredients for the Unites States market, according to the FDA. However, six firms have indicated that they see supply chain disruptions that could soon lead to shortages. The FDA is working with these firms to identify interventions to mitigate potential shortages; this has also been done for human medical products. The agency is sharing information on its website about the availability of drugs and medical supplies. Animal Drug Shortage Information, including current and resolved shortages are posted on CVM’s website. FDA-CVM has also posted Guidance for Industry #271 on Reporting and Mitigating Animal Drug Shortages During the COVID-19 Public Health Emergency. Reporting of potential shortages by animal drug sponsors can help mitigate the impact on practitioners and patients of shortages that may develop.

FDA Center for Drug Evaluation and Research (CDER)-approved drug applications—FDA is also working with sponsors of drugs approved for humans to identify interventions to mitigate potential shortages. Shortage of drugs for humans are also published on the FDA website.

Medical devices

The FDA notes that no statute or regulations currently exist requiring medical device manufacturers to notify the FDA when they become aware of circumstances, including discontinuation of products, that could lead to potential shortages. In addition, manufacturers are not required to respond when FDA requests information about potential supply chain disruptions. As during prior emergencies, the FDA has taken steps to establish and remain in contact with medical device manufacturers and others in the supply chain, including hospitals and group purchasing organizations to assist in identifying existing and potential shortages of medical devices.

To assist, the AVMA has reached out to practitioners and distributors asking them to share information about shortages they may be experiencing. Shortages or limits on filling orders for the medical devices listed below have been reported to the AVMA. For mitigation, please see the AVMA’s information on conserving personal protective equipment (PPE).

Product
Status

Bouffant caps

Allocation – prior orders                       

Examination gloves – Vetone aloe                                   

Short supply/inventory                                           

Shoe covers

Allocation – prior orders

Surgical gloves

Short supply/inventory

Surgical gowns

Shortage

Surgical masks

Short supply/inventory

Dust masks (N95, other similar)

Shortage

Food/feed additives

Fortunately, the AVMA has been notified of only one instance of a potential supply chain impact on a vitamin food additive.

Volunteering equipment and services

Federal, state, and local officials and our human medical colleagues have reached out for donations of both equipment and services. In collaboration with the Association of American Veterinary Medical Colleges, veterinary teaching hospital staff have collaborated with human medical colleagues to help fill gaps in equipment, sharing available PPE, needles, syringes, and medication, as well as sharing ventilators and repurposing anesthetic machines that might be used as ventilators. Veterinary teaching hospitals (large and small animal) have oxygen supplies and can be converted into facilities for human health care if needed.

The American College of Veterinary Emergency and Critical Care, in collaboration with the American College of Veterinary Anesthesia and Analgesia, has spearheaded collection of information regarding ventilator availability from veterinary emergency and critical care facilities around the country and some specialty hospitals pledged access to these ventilators to human healthcare facilities in their communities. On March 24 FDA issued an Emergency Use Authorization for ventilators, anesthesia gas machines modified for use as ventilators, and positive pressure breathing devices modified for use as ventilators, ventilator tubing connectors and ventilator accessories during the COVID-19 pandemic.

Veterinary practitioners wanting to donate PPE, other medical supplies, or wanting to volunteer with other healthcare personnel, are encouraged to contact their local and state veterinary medical associations to see if current local or state orders to do so exist and/or if the veterinary associations have established a system to coordinate such donations or volunteer participation. Direct collaboration between local and state veterinary medical associations and local and state emergency management operation centers and agencies facilitates identification and fulfillment of needs, helps to ensure appropriate resource allocations, and allows more direct coordination with federal emergency management efforts as needed. More information on federal efforts is available through the FEMA. When seeking to volunteer, veterinarians should keep in mind that volunteering to assist in the human medical response carries increased risk for their own health and may also impact when/how they are able to return to veterinary practice (mandated isolation/quarantines).