Shortage of curares in France during the COVID-19 crisis. What were the findings?

P. Odou (Lille, France)

In February 2020, the Sars-COV2 pandemic was falling on Europe and France. This pandemic led to a large number of people being admitted to intensive care with the need for long sedation. This sedation was induced by the administration of a narcotic, propofol and a curare. Very quickly, given the number of people being cared for, tensions in supply chain were observed and led to shortages or even breaks in some establishments. Very quickly, the Lille CHRU pharmacy set up a whole arsenal of procedures to avoid any breaks. One of these procedures consisted of restarting the operation of a batch curare compounding unit. This was done, but what can we learn from it today? It was necessary to:
1) Settle with the French drug agency, the regulatory problem that prohibited us from copying an existing formulation on the market.
2) Restarting the production machines and/or manual production, i.e. setting up a requalification of the machines and staff trained in these techniques.
3) To also set up a risk analysis in order to prove our capacity to produce in complete safety.
4) Find the API. For this, we had to go to the international markets to find pharmaceutical grade API which were bought by the French state at a high price.
5) Train the staff, the youngest, to manufacture an injectable form from powders.
6) Find the primary containers allowing the packaging adapted to the clinical use in order to modify as little as possible the habits of the resuscitation services.

In conclusion, some hospitals have started to recover specialized pharmaceutical technologies. But for France to be independent in the future for its care, it is essential that a few hospitals reappropriate production from API, train specialists, maintain the machines and human skills in non-crisis periods. Finally, the state must acquire a chemical library of basic products to enable trained hospitals to react quickly.

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