Responding to shortages of medicines used to treat Covid-19 patients in hospital intensive care units, Direct Relief is sending the initial 500 “push packs,” each containing enough ICU critical medications and supplies for at least 100 hospitalized patients.

The pre-packaged modules containing 14 different medications were developed in partnership with critical care specialists and healthcare companies as the Covid-19 pandemic arose so they could be rapidly deployed in the event of drug scarcity. Direct Relief last week began delivering the packs to hospitals in some of the states hardest hit by Covid-19, including New York, New Jersey, Connecticut, and California.

Direct Relief coordinated with the Society of Critical Care Medicine (SCCM) to prioritize hospitals for distribution of the ICU medication modules.

“SCCM was very pleased to partner with Direct Relief on the distribution of these valuable medications and equipment for intensive care professionals on the front lines of this pandemic,” said David J. Martin, CAE, CEO/Executive Vice-President of the Society of Critical Care Medicine. “Direct Relief was there when our hospitals and ICUs were overwhelmed with critically ill Covid-19 patients, and we can’t thank the organization enough for their dedication and commitment to supporting the critical care community during these unprecedented times.”

Shipments of ICU medications began in early April, and have since arrived at hospitals across the world, including in Spain and Italy, that are dealing with surges of ICU patients due to Covid-19.
With no vaccine or proven treatment available yet for Covid-19, hospitals treating severely ill ICU patients—including those on ventilators—need medication for sedation and to address some of the secondary complications that may arise, including bacterial pneumonia and septic shock.

Until the Covid-19 pandemic struck, Direct Relief had focused its U.S. efforts on nonprofit safety-net clinics rather than on hospitals. But by March, Direct Relief had established relationships with dozens of U.S. hospitals that needed personal protective equipment and other supplies that had become unavailable through their usual supply chains.

Lessons from China

Direct Relief’s January work supplying N95 respirators and other PPE to hospitals in and around Wuhan, China, as they attempted to stop the initial Covid-19 outbreak prompted the development of the ICU medication modules and stocking of other items, such as oxygen concentrators, which had become keenly needed for recovering patients to be safely discharged and free up ICU beds for new patients as infections spiked. Direct Relief subsequently purchased 3000 portable oxygen concentrator units, which also have started being distributed.

Direct Relief Pharmacist Alycia Clark, anticipating a surge in US hospitalizations and the potential for medication shortages to arise similar to the severe shortages of PPE that occurred, led the development of the ICU Medication push pack that could be assembled, stockpiled, and rapidly deployed.

Clark used a medication-estimating tool she had developed for Direct Relief to determine how much medicine an ICU would need to treat each Covid-19 patient per day, and began working with critical care specialists to confirm specific items and volumes, as well as with pharmaceutical manufacturers to secure the supplies.

“We were asking for products for ICUs when the first cases were just hitting the U.S., and we had to take a risk,” Clark said. “Now hospitals are stocked out, pharmacies are stocked out, and manufacturers are stocked out.”

Direct Relief has received products from Pfizer, Mylan, Sandoz, Teva, Merck, and others.

“Amid this global health crisis, we understand the need for immediate and significant philanthropic and private sector contributions to help sustain partners who are working on the front lines to save lives,” said Caroline Roan, President of the Pfizer Foundation and Vice President, Global Health & Patient Access, of Pfizer Inc. “At Pfizer, we believe it is our responsibility to help protect the most vulnerable from this disease and are putting the full weight of our resources behind our comprehensive Covid-19 response.”

“Mylan has a long-standing history of partnering with Direct Relief that is driven by our shared passion to provide access to medicines, especially in moments of crisis. Direct Relief’s urgent and comprehensive response to fighting COVID-19 is inspiring, and we are proud to contribute to their efforts,” said Mylan Chief Commercial Officer Tony Mauro.

“Sandoz is very proud to be a contributor in support of this unprecedented outreach, in collaboration with other pharmaceutical manufacturers and Direct Relief. We are proud of the industry response, and thankful for organizations like Direct Relief who help facilitate these donations for the most urgent needs for the most critical patients,” said Carol Lynch, President of Sandoz, Inc.

The ICU Critical Supply Modules include antibiotics such as azithromycin and ceftriaxone, vasopressors such as norepinephrine, and respiratory medications like albuterol inhalers. Some of the medicines in the Modules have become scarce in U.S. hospitals, including dexmedetomidine and norepinephrine, as well as inhalers and, at times, even acetaminophen.

Hospitals that have already received the ICU Modules include Zuckerberg San Francisco General Hospital, Elmhurst Hospital, Bellevue Hospital, and SUNY Downstate—as well as the 17-bed Mammoth Hospital on the remote Eastern slope of California’s Sierra Nevada Mountains.

“The extra meds are a big deal for us,” said Dr. Chris Hummel, emergency department director at Mammoth Hospital, in an email to Direct Relief. “The ICUs at many of our receiving hospitals are filling up, and the day could come very soon when we are unable to transfer anyone out. With your help, we feel that we’re now in a much better position to care for our community.