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COVID-19: a lottery to determine which patients will receive rare drugs | Coronavirus: Ontario

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To treat patients with the virus, hospitals mainly use a widely available steroid, dexamethasone.

However, for the most severe forms of the disease, other drugs have been proven to work, such as tocilizumab and sarilumab, anti-inflammatories that save about 5% of patients who have access to them, explains Dr. Martin Betts, medical director of intensive care Scarborough Health Network.

With regard to these, we have trouble getting supplies, he testifies, given the extent of the needs in the various hospitals on a world scale due to the Omicron variant.

Dr. Martin Betts, in a hospital.

“We struggle every day to find a dose or two of whatever we can provide for our patients, because we know it can make a difference,” says Dr Martin Betts, Scarborough.

Photo: CBC

So, who should be preferred to prescribe the drugs capable of increasing the chances of survival? In other words, how do you triage?

Following the recommendations of Ontario’s COVID-19 Scientific Advisory Group, and to ensure that our implicit biases do not influence patient selection, Scarborough Hospitals apply a lottery.

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Each day, numbers are assigned to priority patients and then placed into a random assignment program that distributes drugs based on supplies.

When you have six patients who need life-saving medicine and you have to choose one or two, it’s a huge burden to bear. [La loterie] takes away some of that and ensures a fair system for everyone. »

A quote from Dr. Martin Betts, Medical Director of Critical Care at Scarborough Health Network

To some extent, this lottery eases the burden on our physicians, continues Dr. Betts, since they do not have to make heartbreaking choices.

Other drugs are scarce

Other drugs, such as remdesivir and sotrovimab, are also missing. However, they could save lives, recalls the emergency physician at Toronto’s St. Michael’s Hospital, Samuel Vaillancourt.

For a high-risk patient starting these drugs early [après l’apparition de] symptoms, there is a lower risk of hospitalization. Of course, it is an effective drug that can reduce hospitalizations, even in intensive care, which we should offer.

Doubts about Paxlovid supply

We had to prioritize those who receive it, says Dr. Jérôme Leis of the Sunnybrooke Health Sciences Centre. This is something that we will really have to address in the next year to have an adequate supply.

The limited access to Paxlovid, the new pill from the pharmaceutical company Pfizer which is supposed to effectively prevent serious cases, is already raising doubts among Drs Leis and Vaillancourt.

It’s an important step to have oral antiviral tablets, it’s excellent, continues Jérôme Leis. It’s the future, but the big challenge we’re going to have is the supply of these pills.

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