COVID-19 in inten­si­ve care units: Gene­ric medi­ci­nes save lives!

The way out of the pan­de­mic — it will only open up when as many peo­p­le as pos­si­ble have been vac­ci­na­ted. Until then, howe­ver, medi­ci­ne is rely­ing on gene­ric pro­ducts: the first aid kit used to tre­at COVID-19 pati­ents in inten­si­ve care units con­sists almost exclu­si­ve­ly them.

The COVID 19 pan­de­mic con­ti­nues to have Ger­ma­ny firm­ly in its grip. Alt­hough more and more vac­ci­nes are being appro­ved and are fuel­ling hopes for an end to the pan­de­mic. At the same time, howe­ver, thou­sands of infec­ted pati­ents are in inten­si­ve care units. Here, doc­tors and nur­ses are fight­ing for the lives of the pati­ents. Main­ly with gene­ric medicines.

Hard­ly any medi­ci­ne helps against COVID-19

The­re is still hard­ly any effec­ti­ve medi­ci­ne against the virus. The hope that indi­vi­du­al phar­maceu­ti­cals gene­ra­ted at the begin­ning of the pan­de­mic has lar­ge­ly dis­ap­peared again. Agents such as the initi­al­ly pro­mi­sing hydro­xychlo­ro­qui­ne are — accor­ding to the offi­ci­al S2k gui­de­line, which gives recom­men­da­ti­ons for the inpa­ti­ent the­ra­py of COVID-19 pati­ents — no lon­ger recom­men­ded for use in COVID-19.

Even Rem­de­si­vir, for a long time the pro­mi­sing drug of choice, no lon­ger has a clear recom­men­da­ti­on from the World Health Orga­ni­sa­ti­on (WHO). Only a the­ra­py with dexa­me­tha­so­ne — a well-known gene­ric medi­ci­nes — should be used for “pati­ents with seve­re or cri­ti­cal COVID-19 dise­a­se” accor­ding to the guideline.

Gene­rics are used for the most part in inten­si­ve care units

The inten­si­ve care staff in the hos­pi­tals the­r­e­fo­re do ever­y­thing they can to ensu­re that the pati­ents’ own body defen­ces can defeat the virus. Their tre­at­ment is pri­ma­ri­ly aimed at kee­ping the bodies of the serious­ly ill pati­ents ali­ve. In doing so, the doc­tors main­ly resort to tried-and-tes­ted medi­ci­nes — acti­ve sub­s­tances, in other words, that are almost exclu­si­ve­ly off-patent.

The “first aid kit” used in inten­si­ve care units for Covid 19 pati­ents con­ta­ins almost exclu­si­ve­ly gene­ric medi­ci­nes. This is shown by two lists com­pi­led by the Fede­ral Insti­tu­te for Drugs and Medi­cal Devices (BfArM) at the begin­ning of the pan­de­mic. They con­tai­ned all pre­pa­ra­ti­ons who­se demand, accor­ding to experts’ esti­ma­tes, could increase by 300 per­cent and 200 per­cent, respec­tively, in the months of the first wave due to the pandemic.

First of all, it deals with so-cal­led anal­ge­sics. The­se anal­ge­sics (e.g. suf­en­ta­nil, mor­phi­ne sul­pha­te, nova­mi­ne sul­pho­ne) are all pro­du­ced gene­ri­cal­ly. So-cal­led rela­xants — the­se are drugs that may be nee­ded during ven­ti­la­ti­on — are also gene­ri­cal­ly available acti­ve sub­s­tances. The same appli­es to anti-obs­truc­ti­ve drugs.

The admi­nis­tra­ti­on of oxy­gen is cen­tral to the tre­at­ment of COVID pati­ents. It can be admi­nis­te­red via a nasal tube, mask or nasal can­nu­la (high-flow the­ra­py). If the patient’s con­di­ti­on dete­rio­ra­tes, inva­si­ve ven­ti­la­ti­on may also be neces­sa­ry. This is done by means of a ven­ti­la­ti­on tube that can only be pla­ced in the tra­chea under anaes­the­sia. And the anaes­the­tics (or also: seda­tiv­es) that are indis­pensable for this are also pro­du­ced generically.

Gene­ric com­pa­nies pro­du­ce far more than the usu­al amount of acti­ve ingre­di­ents needed

Espe­ci­al­ly the acti­ve ingre­di­ents pro­po­fol and mid­azo­lam, which are cru­cial for anaes­the­tists in this situa­ti­on, were in dan­ger of beco­ming scar­ce at the begin­ning of the pan­de­mic in spring 2020. The reason for this was the sharp increase in demand, which was also due to the fact that the hos­pi­tals were pre­pa­ring for the expec­ted rush to the inten­si­ve care units.

In an unpre­ce­den­ted show of strength, gene­ric drug manu­fac­tu­r­ers ram­ped up their pro­duc­tion, rede­di­ca­ted pro­duc­tion lines and sear­ched for alter­na­ti­ve sup­pli­ers all over the world. In the mean­ti­me, they have adapt­ed pro­duc­tion to the increased demand. And this appli­es not only to the drug manu­fac­tu­r­ers, but also to the sup­pli­ers who pro­vi­de acti­ve ingre­di­ents, clo­sures or pack­a­ging. The­se are all things wit­hout which a medi­ci­ne can­not be pro­du­ced and which have to cope with exact­ly the same increase in demand in times of crisis.

Of the 71 agents that a ven­ti­la­tor pati­ent poten­ti­al­ly needs, 69 are generic

In addi­ti­on, the­re are other acti­ve sub­s­tances — such as anti­bio­tics, blood pres­su­re medi­ca­ti­on or car­diac pre­pa­ra­ti­ons — which inten­si­ve care phy­si­ci­ans use due to various sym­ptoms or pre-exis­ting con­di­ti­ons. In total, the BfArM’s list, which con­ta­ins all the acti­ve sub­s­tances in inten­si­ve care medi­ci­ne that are rele­vant for COVID-19 pati­ents and may be in short sup­p­ly, con­ta­ins 71 medi­ci­nes. And 69 of the­se are generic.

Vac­ci­nes mark the way out of the cri­sis — gene­rics save lives for so long

The sto­ry of the fight against the pan­de­mic — it can­not be told wit­hout gene­rics. Becau­se the COVID-19 pati­ents who lea­ve the inten­si­ve care units of our hos­pi­tals cured owe it lar­ge­ly to gene­rics. In other words, the drugs that make up the vast majo­ri­ty of medi­ci­nes. Not only, but also in the grea­test health cri­sis of our time.