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Next Wave Of Shortages Strikes: NYC Pharmacies Run Out Of Tylenol, Hand Sanitizer, Common Drugs
In the weeks since California became the first state to order residents to shelter in place, millions of Americans have grappled with an alarming fact: That shortages of products from Tylenol to toilet paper have continued. If anything, they’ve gotten worse, even as governors like Andrew Cuomo have pleaded with the public not to hoard and buy up supplies like gloves and masks that are needed by health-care professionals.
While health officials have tried to dismiss this simply as a consequence of panicked hoarding, there are more complex dynamics at play, as CNBC explains in a recent piece exploring the shortages of basic products and common medications at pharmacies across NYC — the epicenter of the national outbreak.
In Broadway Chemists, an independent pharmacy on the Upper West Side, Tylenol, the classic over-the-counter painkiller made by JNJ, has been unavailable for weeks. Sophia Liristis, the pharmacist in charge, told CNBC that it’s on back-order until April 30.
So unless something changes, the people of the Upper West Side won’t be able to buy Tylenol until the end of April at the earliest.That’s four weeks away.
But Tylenol isn’t the only common medical item that’s in short supply.When Liristis checked her system on Tuesday while speaking to CNBC, she found that thermometers, gloves and masks were not available until May. Pulse oximeters, used to monitor blood-oxygen levels, were unavailable until May 31. Ventolin inhalers, which can ease shortness of breath, were only available two units at a time. Hydroxychloroquine, the drug used to treat malaria and lupus, and the Zithromax Z-Pak, were so limited as to be practically unavailable.
S Bros Pharmacy in Brooklyn’s Williamsburg neighborhood filled its inventory with hydroxychloroquine and Z-paks when word started to spread that the drugs could be used to treat COVID-19. But the pharmacy is now dispensing hydroxychloroquine only to patients who suffer from chronic autoimmune diseases and those enrolled in a New York study of the drugs’ efficacy, in accordance with state laws and guidelines.
However, S Bros’ shelves are also scarce, with no Tylenol, no hand sanitizer, and no cleaning supplies like alcohol and peroxide. By now, these products have been long gone. The store struggles to get a few cans of sanitizing spray to decontaminate the pharmacy.
“There’s a shortage of everything — it’s never enough,” said Evangeline Frezoulis, 37, the pharmacy manager at S Bros. “The wholesalers are not able to supply as many pharmacies as needed.”
When these small independent shops run out of items, some independent pharmacists tell customers to check with the chain pharmacies, even though it hurts their business.
“You’re just trying to help the patient get what they need,” Liristis said. “It doesn’t matter if it’s here or somewhere else — we’re just trying to work together.”
While pharmacies in NYC are probably feeling these problems most acutely, it’s occurring across the country to varying degrees. Furthermore, what’s causing these widespread shortages isn’t all that complicated:Over the past few decades, production for medical equipment from masks to plastic gloves has mostly been moved abroad, to places like China and India. With China now battling the second wave of the pandemic, and Indian factories struggling under the weight of an unprecedented lockdown, production is being constrained at a time when demand is soaring all over the world at the same time.
In other words, a “supply shock”, is meeting a different kind of “demand shock.”
If that isn’t clear enough, supply chain managers from Amerisource Bergen and CardinalHealth, two of the biggest suppliers of drugs and medical equipment in the US, explained the problems they are facing.
AmerisourceBergen, a pharmaceutical wholesaler, said the pandemic is pinching supply chains worldwide. As the company places large orders to meet surging U.S. demand, manufacturers in countries like India, which is under nationwide lockdown, are balancing those orders with obligations in regions like the European Union, which is also severely impacted.
“What we’re seeing in the supply chain today particularly from the pharmacy side is an insatiable demand for a limited amount of product,”said Heather Zenk, senior vice president of secure supply chain at AmerisourceBergen. “We are seeing manufacturers talk about things like historical inventory demands and historical product movement,” she said.
In response, AmerisourceBergen is limiting how much pharmacies receive of certain drugs to ensure they get at least some product, a policy the company calls “fair allocation.”
Cardinal Health, another major wholesaler, said it’s managing the distribution of more than 100,000 products considered critical inventory which are in unprecedented demand since the pandemic started to spread. “We are experiencing backorders and declining inventory levels at rates never experienced before,” the company said, in a website statement, warning that customers may only receive partial deliveries while other products are out of stock altogether.
It’s impossible to say when inventories for thousands of products like Tylenol and hand sanitizer will stabilize. And as Americans in certain hot spots around the country continue to struggle to find toilet paper, we suspect widespread hoarding will continue.
Some pharmacies are even home-brewing their own hand sanitizer, just like the inmates in New York’s state prisons. City Drug & Surgical in Manhattan’s Washington Heights neighborhood has been making hand sanitizer since the brand names sold out about three weeks ago. The pharmacy’s owner told CNBC that a batch of the stuff typically takes about 40 minutes to make a batch of 24 bottles. They sell out almost immediately.
How long before pharmacies start making their own reusable face masks — like the kind that the CDC are recommending — out of old T-shirts and rags?
The Fight Against COVID-19: “Bending The Curve” & Then What?
Eradicate the virus — without a vaccine? Manage infection rates to let the population “build immunity through suffering” until a vaccine is available? How can we revive the economy without risking thousands of deaths in fresh outbreaks?
I think we’re now at the turning point in the fight against COVID-19. Everyone’s now acting to stop the spread, and the early hotspots in Europe, North America, and Australia are seeing signs of progress, just as the Asian nations did earlier. There is a long road ahead, and we have to decide which route to take, but Western societies are showing they can handle this too. In this post I’m going to show updated versions of my three favorite graphs, which tell the story and lead to the single biggest public policy-making challenge many nations may face this decade.
Bending the Curve in California: Just-in-Time Deliverance?
The graph below shows confirmed cases in Los Angeles, the San Francisco Bay Area, and California as a whole, with South Korea and Italy as contrasting examples. The vertical axis is a log scale, so exponential growth shows up as a straight line. Data sourced from the Johns Hopkins database and the California state and individual county reports.
Los Angeles lost to the Bay Area on April 2 and became California’s new COVID-19 hot spot. Shelter in place has begun working for the Bay Area, but confirmed cases have still doubled in the past week. So on March 31, our local public health officials released what I call “Shelter-in-Place 2.0,” a tighter set of rules, to try to avoid the hospital-overload scenario which hit Wuhan, Milan, Madrid, and now New York. Face masks are also becoming trendy outside the home! Will the Bay Area get a “just-in-time deliverance”, or is the worst still yet to come?
Locally, Santa Clara County – the heart of Silicon Valley – reports 30% of ICU space in use by COVID patients, 38% used by other patients, and 32% available. So they can take a doubling in COVIDICU cases without overloading, and other Bay Area hospitals have headroom too.
I used this info to estimate a Bay Area ICU limit on the graph, but I must caution that there’s not a direct relationship between “confirmed cases” and “ICU cases,” so it’s only an estimate. An outbreak in a major nursing home, or a worsening of cases-in-progress without improvement in current ICU cases, could lead to a surge in ICU demand.
Best in the US – Minnesota Holds the Line:
The next graph takes a fresh look at the US data (again from Johns Hopkins), using the 91-DIVOC.com graphing tool. Instead of confirmed cases, this graph shows daily new cases per million population, but still with a log scale.
Last week I noted “Minnesota Bends it Best,” and here we see the result — when an outbreak stalls out, it looks like the flat curve for Minnesota. And not only is it flat, but it’s the lowest sustained level in the US. There’s other good news — Washington has stabilized (albeit at a higher case rate), and even New York (top right) might be flattening out. But Connecticut, New Jersey, Louisiana, Massachusetts, and Michigan have more work to do (click on the chart to enlarge).
Worldwide: What Kind of Ending Can We Write?
The third graph this week shows the global situation for the 50 most populous nations, with focus on the US. Using the same tool and data as the state-by-state graph above, this one also shows daily new cases per million people on a log scale. The US is third behind Spain and now Belgium, and in the same cluster with Italy, France, Germany, the UK and the Netherlands. Growth in the US has started to slow, but it looks like we might still catch the same pain as Spain.
This graph makes it clear that most nations are at “the end of the beginning” — the daily new cases have stopped growing and are stabilizing. But other than China, no one is claiming to have driven case growth back to zero. And dissident reports from China suggest it’s in a bureaucratically-induced state of denial, not entirely in control.
So what’s the endgame here?
Do we try to eradicate the virus — without a vaccine? Do we try to manage infection rates, to let the population “build immunity through suffering” until a vaccine is available? How can we revive the economy without risking thousands of deaths in fresh outbreaks?
Some things are clear: The recovered cases can get back to normal. The infirm elderly need to be protected as much as possible. Everyone else is in between, and without a treatment or vaccine, every economic or social activity comes with some level of infection and mortality risk.
I can see two limiting-case scenarios. Both require that right now, everyone work together to suppress the virus, in every way we can. But we need to start the discussion of “what’s next” since it’s a tough policy choice, perhaps the biggest of the decade.
The first scenario, “put out the fire,” is modeled on Korea. Use shelter-in-place and face masks to suppress the growth of the virus, then use rapidly-growing testing capacity to trace and isolate the infected. With a return to “containment,” everyone else can get back to work. South Korea is doing well, and only has 100 new cases per day nationwide. But even South Korea hasn’t been able to put out the fire completely. And “get back to work” involves major changes in how work is done, to reduce infection risks every minute, every day.
The second scenario, “controlled burn,” envisions an “infection risk budget,” with a goal to keep caseloads at a level that hospitals can sustainably support, while allowing as much economic output as possible. If we risk too many infections, hospitals overflow and thousands die – reruns of New York, Milan and Wuhan. But if we can minimize the risk throughout daily life, and keep our homes safe, then that frees up room in the budget.
With that extra room, more people could get back to work and get the economy going. Even if those activities might cause a bit of spreading, it might be worth the risk (for arena sports, cruise ships and other mass social gatherings, it might not). A “controlled burn” would take a long time, but eventually everyone who needs to work will have immunity or received a vaccine, and we’ll have normal life again (provided the virus doesn’t mutate too fast). But in the absence of an effective treatment or vaccine, it will cost thousands of lives to build herd immunity this way. Is there a better way?
No matter which path is taken, policymakers will have to decide how to balance lives vs. livelihoods. And the rest of us need to learn how to prevent spread at every level, both to preserve lives and to revive jobs.
Biden Says Democrats May Need To Hold Virtual Convention
Joe Biden says that the Democratic National Convention may need to be held virtually.
In a Friday interview with ABC’s “This Week,” the 2020 Democratic frontrunner said that the convention is “necessary,” but may not be feasible as it would require bringing thousands of people together in one location during a pandemic, according toThe Hill.
“Well, we’re gonna have to do a convention,” said Biden. “We may have to do a virtual convention. I know I think we should be thinking about that right now.”
“What we do between now and then is gonna dictate a lot of that as well,” he added.
BREAKING: Joe Biden tells @GStephanopoulos that Democrats “may have to do a virtual convention. I think we should be thinking about that right now. The idea of holding the convention is going to be necessary.“
Biden, dispensing well-worn advice, has encouraged DNC decision makers to “follow the science” and “listen to the experts.”
The Democratic National Committeeannounced Thursday that its national convention would be delayed by a month until August because of the coronavirus crisis.
The convention was originally scheduled to start July 13 but will now commence on Aug. 17.
A source close to the Biden campaign told The Hill last week that the former vice president had advocated for the convention to be delayed with the same format. The convention committee said on Thursday that it was trying to figure out the “most appropriate structure for this historic event.”
Meanwhile, the Republican National Convention is scheduled to occur Aug. 24 to 27 in Charlotte, N.C. -The Hill
Biden also repeated advice from Dr. Anthony Fauci, the nation’s top expert in infectious diseases, when he said that what the country needs “most of all” is a vaccine — but that in the meantime “we have to take all the efforts we can to make sure we prevent the spread.”
He also suggested that we would need “at least two more iterations” of coronavirus stimulus.