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.