COVID and the new age of medical supply scarcity

The shortage of baby formula brought on by the COVID pandemic’s global supply-chain challenges and other economic shocks has struck a chord. It’s no wonder why; what is more basic than the nourishment a baby needs to survive? After all, we’ve all either had children, or have been one.

But baby formula is hardly the only thing in short supply. We run a series of walk-in medical clinics, mostly in working-class neighborhoods in Brooklyn, Queens and the Bronx, and we are wrestling with other COVID-era shortages. One is lidocaine, a skin-numbing pain relief agent that is basic to the type of care we routinely provide.

Currently, it is on back-order for four weeks at least. We are making due by adjusting our remaining supplies from site to site.

Yes, we have learned a valuable and tough lesson about globalization, about depending on products made, for economic reasons, on the other side of the planet. But we’ve learned some other lessons too, about our profession and about the people we treat.

You’ve almost certainly been treated with lidocaine. Anytime doctors need to make an incision — to drain an abscess or remove a tooth, for example, or for countless more complicated procedures — they spread a little of this substance on the spot to numb the skin. They wait a few minutes for the drug to take effect, and then proceed.

Sometimes the patient will wince or start or just say, “ouch!” — and we know we’ve got to spread a little more. Everyone reacts differently, just as everyone reacts differently to pain and has a different threshold for it.

As we understand it, different manufacturers of different lidocaine products cite different reasons for the shortage, with Pfizer saying it is due to manufacturing delays and Fresenius Kabi citing a delay in receiving raw ingredients.

A couple of years ago, we were told by the distributor that manufacturers, most of them overseas, rotate the medical product they make, and that we should order a whole year of lidocaine in advance.

The manufacturer was “stacking up the orders” to avoid the costly and time-consuming process of switching between different products. And that’s what we did. We put in a large order. At the time, it lasted just long enough for the next cycle.

Whatever the specifics, the shortage, just like that of baby formula, shows us just how tenuous our worldwide supply lines are. And it has brought a change to the way we look at our jobs right here in our neighborhoods.

America is the land of plenty. In India, where we did some of our medical training, shortages and rationing were more common. But we’ve never experienced it here in the United States. It has made us think differently about how we provide care and be more thoughtful and conservative with our supplies, and more appreciative of the fact that, up until now, we never had to worry about it.

We know one radiologist whose technician now gives him a single vial of lidocaine each morning. That’s his limit for the day.

Maybe he explains to the patient that the supply is short and this or that procedure might sting a little more than usual. Maybe he applies a little less and waits for a possible “Ouch!” before applying or injecting more.

In a worst-case scenario, he postpones non-emergency procedures, as many others in a similar situation might be doing.

As for patients, well, we’ve seen little acts of kindness and generosity. Family members making sure that their loved ones, and not themselves, have enough cream to minimize that little sting. Others grit their teeth when a little more lidocaine might ease the situation.

We are all consumers of health care. Perhaps we as a nation need to evaluate what medicines we must make locally so we don’t get caught up in supply-chain delays and bottleneck issues.

Just the other day, we had a shortage of intravenous contrast for procedures like CT scans. Emergency rooms in New York were being cautioned to only order necessary CT scans for now. Today we don’t have enough lidocaine. Tomorrow it may be something else.

We need to look at how we can make sure that those medicines are manufactured throughout the year and not just in one or two cycles a year. At the same time, we may need to begin accepting that resources are not infinite. And we might have to say, “Ouch!”