Drug used to treat COVID-19 in short supply at Hamilton hospitals

A Hamilton infectious disease specialist says the city’s hospitals have been rationing doses of a drug used to treat COVID-19 due to low supply during the current wave of the pandemic.

St Joseph’s Healthcare Dr. Zain Chagla says Tocilizumab — an anti-inflammatory medication — is one of few drugs physicians can give to people when they get moderately or critically ill with COVID-19 to protect them from getting ventilated or dying.

Chagla says Hamilton’s hospitals have “been very strict” in recent times since supply shortages have led to limiting doses and turning to alternative medications.

“We look at patients to see whether or not there is an expected survival just for the sake of making sure that we give the drug to people where we think it’s going to derive the most benefit,” Chagla told 900 CHML’s Good Morning Hamilton.

“We’ve had to bring in alternative medications which have similar efficacy, which is good, but … are expensive and have more drug interactions associated.”

Ontario’s COVID Science Advisory Table recommended rationing the drug as far back as April 2021 as supply shortages coincided with the third wave of infections that sent more patients into intensive care than the first two.

The agency suggested use be restricted for critically- and moderately-ill patients and that a second doses  — usually considered after 24 hours — be scrapped.

Dr. Peter Juni, the group’s scientific director, said the dosing change is unlikely to impact patients’ treatment but rationing the drug was recommended so the maximum number of people can benefit.

“It’s basically the best trade-off we can make to treat this population of patients in the hospital who would require the drug,” he said in an interview in April.

Chagla says Pfizer’s new COVID-19 treatment, Paxlovid, could help if the drug is administered early for people who are high risk.

Clinical trial data submitted to Health Canada revealed the drug reduced the risk of hospitalization and death by 89 per cent.

Doses can be given to adults, 18 years of age and older, who have tested positive for COVID-19 and are experiencing mild or moderate illness, and who are at high risk of becoming more seriously ill.

“It’s a little trickier; patients need to get tested early,” Chagla said.

“There’s a lot of drug interactions that we have to deal with, so not every patient is going to be eligible. But certainly there’s a lot of hope for outpatient therapy, particularly.”

Dr. Dominik Mertz, medical director of infection control at Hamilton Health Sciences (HHS), says the potential caveat with the drug is its effectiveness with people who are vaccinated since the trial data was primarily done in high risk individuals not vaccinated.

“Less than one per cent of those highest risk individuals required hospital admissions with treatment. So that’s a huge fact and great to see,” said Mertz.

“But what we’ve seen in the already vaccinated individuals will be low, so you will see less of an impact.”

Ontario is set to receive approximately 10,000 courses of Pfizer’s anti-viral COVID-19 pill in January from the federal government, according to the province’s ministry of health.

Last week, Canada’s Health Minister Jean-Yves Duclos said the country has already received its first shipment of 30,000 treatment courses of the drug, with another 120,000 expected through March.

Hamilton’s hospitals reported close to 300 COVID patients in their care as of Friday, with about 90 of those having been specifically hospitalized for COVID.

The city’s intensive care units (ICUs) recorded just over 40 people who are critically ill.

Ontario had 4,114 people in hospital with COVID on Jan. 21 with 590 in ICUs.

The number of institutional COVID-19 outbreaks in Hamilton were at 85 as of Friday connected to close to 1,400 total cases, according to public health data.

More than 800 of those are tied to 40 surges in homes containing seniors, including 609 at 24 long-term care homes (LTCH) and 215 in 16 retirement homes. Just over half of the estimated 824 cases are with health care workers.

Two long-term care homes are reporting connections with about 150 of the infections — 95 at Heritage Green Nursing Home in Stoney Creek and 64 with The Wellington on the Mountain.

The outbreak in the city’s primary jail, the Hamilton-Wentworth Detention Centre, has been steady over the past couple of days with reported cases at 81 as of Jan. 21.

Just over 50 of the cases are tied to inmates.

The outbreak numbers potentially represent only part of the picture in the city since public health stopped reporting COVID-19 outbreaks in workplaces not tied to high-risk settings like hospitals and congregate settings.

There are seven surges tied to about 170 cases in the city’s shelter system while about 117 are connected with 19 support homes.

As of Jan. 18, the city has put about 1.16 million COVID vaccine doses into arms with about 455,000 second visits and 254,000 third shots.

Over 81.1 per cent of eligible Hamiltonians aged five and up have had a pair of doses, while 86.3 per cent have gotten at least one shot.

About 87 per cent of residents aged 12-plus have had at least two shots, while about 89.6 per cent have had a first dose.

The city is still behind the provincial average, which has 88.9 per cent of those 12-plus with two doses and 91.6 per cent with a single dose.

Third-dose immunization is at 45.4 per cent, meaning more than 5.8 million Ontarians have received a booster shot.

Excluding kids aged five to 11, Hamiltonians in the 12-to-17 age group represent the lowest vaccination rates of those eligible in the community at just over 80 per cent having had a pair of doses

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