Coronavirus Continues to Disrupt Prescription Drug Supplies

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For Michelle Weaver, hydroxychloroquine has been a miracle drug.

Her daughter Kaitlyn, 13, suffers from juvenile inflammatory arthritis and an immune deficiency, which cause excruciating joint pain that often leaves her bedridden or reliant on a wheelchair to get around. But when Kaitlyn started using hydroxychloroquine in January, her debilitating pain went away and she was able to walk again. “This drug is the difference between Kaitlyn getting up every day and having a somewhat normal childhood and her being in the hospital,” said Ms. Weaver, who lives in Alabaster, Ala.

But when Ms. Weaver went to renew her daughter’s prescription in March, her pharmacist told her the drug was no longer available. Demand for hydroxychloroquine had soared following reports that the drug, also taken to treat malaria, could treat coronavirus patients, a claim President Trump had promoted at a White House briefing on March 19. Ms. Weaver called a dozen pharmacies to no avail, at one point cutting her daughter’s daily dose in half to ration their supplies, before finally locating a bottle more than 100 miles away.

Now she lives in fear that she will not be able to find the drug when they need to refill the prescription. “I really worry this is going to be a strain on our family trying to keep her on this medication,” said Ms. Weaver.

A new study published in JAMA on Thursday underscores the challenges that families like Ms. Weaver’s have faced since hydroxychloroquine and a related drug, chloroquine, were widely touted as breakthrough treatments for coronavirus patients. The drugs have long been used to treat autoimmune diseases like lupus and rheumatoid arthritis. But now many patients have been scrambling to find them because of shortages.

The new study analyzed nationwide prescribing patterns across the country from mid-February through April using data from 58,000 pharmacies. It found that in mid-March, prescriptions for a short-term supply of the drugs soared to 45,858, up from 2,208 during the same period in 2019, a nearly 2,000 percent increase. “This was a really stunning finding,” said Dr. Haider Warraich, the lead author of the study and a cardiologist and researcher at Brigham and Women’s Hospital and Harvard Medical School.

While the surge began to decline somewhat the following week, the heavily increased demand continued through April. All told there were almost a half-million more prescriptions for hydroxychloroquine and chloroquine filled between mid-February and late April compared to the same period in 2019. The New York Times reported the intense demand for the drugs last month, which appeared to be driven in part by doctors writing prescriptions for themselves and their families.

Several studies have shown that people with Covid-19 who were given the drugs were at higher risk of heart rhythm problems and were more likely to die, and last month the Food and Drug Administration issued new safety warnings cautioning that they should be used only in clinical trials or in hospitals where patients can be closely monitored. “We have a system in which it’s very easy to prescribe a medication off label,” or for a medical condition for which a drug has not been specifically approved, Dr. Warraich said. “It’s much harder to enroll a patient in a clinical trial. But in the end that is what’s going to help us fill this data-free zone with the data that can guide us.”

As part of the new study, Dr. Warraich and his co-authors looked at whether the pandemic also affected prescribing patterns for 10 of the most widely used drugs in America, which revealed some striking trends. Prescriptions for chronic conditions such as high blood pressure, high cholesterol, heart disease, acid reflux, thyroid disorders and depression spiked in early to mid-March and then fell sharply from late March through April. Prescriptions for the cholesterol-lowering medication Atorvastatin, for example, rose 30 percent in mid-March and then by late April were down almost 10 percent compared to the same period in 2019.

Dr. Warraich said that the trend likely reflected doctors and patients preparing for the pandemic by stockpiling medications that are routinely use for chronic conditions. But the number of people starting on these medications for the first time likely fell once hospitals and clinics shifted their focus to coronavirus patients, as evidenced by the sudden drop in prescriptions in late March and April.

Two drugs that showed a very different trend were amoxicillin, an antibiotic used to treat bacterial infections, and hydrocodone-acetaminophen, an opioid-containing painkiller that is commonly sold under the brand name Vicodin. Prescriptions for both declined in March and then plummeted in April. Dr. Warraich speculated that fewer painkillers were prescribed because of drops in elective medical procedures and visits to the dentist. Antibiotic use may have fallen in the past few months as doctors became more likely to suspect coronavirus, rather than bacterial infections, among people with cold and flu symptoms, Dr. Warraich said, or fewer people with symptoms may have been visiting their doctors because of concerns about catching the virus.

Dr. Warraich said the most encouraging finding was that compared to other medications there were no substantial drops in prescriptions for the two most popular groups of blood pressure medications, known as ACE inhibitors and ARBs. When the pandemic began, some scientists theorized that these classes of drugs could make people more susceptible to contracting the coronavirus or developing severe symptoms. Those concerns have since been dispelled by recent studies. But experts still worried that many patients might have been scared into stopping their blood pressure medications. The new study suggests that did not happen.

  • Frequently Asked Questions and Advice

    Updated May 28, 2020

    • What’s the risk of catching coronavirus from a surface?

      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • How many people have lost their jobs due to coronavirus in the U.S.?

      More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.

    • Is ‘Covid toe’ a symptom of the disease?

      There is an uptick in people reporting symptoms of chilblains, which are painful red or purple lesions that typically appear in the winter on fingers or toes. The lesions are emerging as yet another symptom of infection with the new coronavirus. Chilblains are caused by inflammation in small blood vessels in reaction to cold or damp conditions, but they are usually common in the coldest winter months. Federal health officials do not include toe lesions in the list of coronavirus symptoms, but some dermatologists are pushing for a change, saying so-called Covid toe should be sufficient grounds for testing.

    • Should I wear a mask?

      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

    • How can I help?

      Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.

“That was probably the most reassuring part of this analysis, which was that there was no major drop off in people having these medications prescribed,” Dr. Warraich said.

After peaking in mid-March, prescriptions for hydroxychloroquine and chloroquine declined substantially but mostly remained elevated above their normal levels throughout April. To help ease the demand, some states issued strict new rules, such as requiring that doctors prescribe the drugs only for conditions that they have been proven to treat. Patient advocacy groups like the Arthritis Foundation and the Lupus Foundation of America sent letters to state pharmacy boards, the White House, Congress, the F.D.A. and other agencies asking them to help ensure that patients with chronic conditions could access the drugs.

“We have a lot of heartache in our patient population over the barriers they had in filling their prescriptions,” said Guy Eakin, the senior vice president of scientific strategy at the Arthritis Foundation.

Maureen Stewart has used hydroxychloroquine since 2005 to treat lupus. Her local pharmacy in Pittsburgh told her they were having trouble with their supply chain and needed to use two different manufacturers to fill her last prescription in late March. Without the drug, her joints become inflamed, especially her knees and her ankles, causing pain and swelling that make it difficult for her to walk. She is scheduled to get her next prescription in June and is anxious about it.

“I’m concerned about going for my next refill because of all the publicity,” she said. “I worry what’s going to happen if I can’t get it.”