The shortage of medical sample tubes that Quebec — and the rest of the world — have been dealing with since August 2021 shows no signs of abating. And it might get worse with the advent of a sixth wave of COVID-19.
A survey by the Presse Canadienne of suppliers, the Quebec Health Ministry, regional health authorities and private laboratories found that the rationing of testing equipment is severe and has led to the postponement and cancellations of blood tests throughout the health-care network.
The Health Ministry said its supplier is unable to meet more than 50 per cent of demand, including that of the ministry itself. The situation has led to delays in appointments in the public health network and cancellations at some private labs.
The situation worsened during the fifth pandemic wave and attempts to make up for the shortfall have been slowed not only by COVID-19 but also attempts by hospitals to catch up on tests.
“It is a persistent global supply issue for materials used in large quantities and on a large scale. According to the information we have, the demand exists because of an unexpected convergence of an increased COVID-19 infection rate and the resumption of medical activities,” Health Ministry spokesperson Marjorie Larouche said.
The situation has led to major problems over the past few months. The Eastern Townships regional health authority had to cancel 6,000 non-urgent test appointments between Jan. 4-7 and then cancel non-urgent appointments between Jan. 10-14.
At the end of January, private laboratories were closed down in the Montérégie and at the beginning of March testing centres in the Centre-du-Québec region such as pharmacies and labs had to refer patients to the regional health authority.
In the Montreal area over the past few days, some labs have stopped offering appointments for blood tests. One of them is Services Phleb, a private lab serving Montreal, Laval and the western Montérégie. Not only has Phleb stopped taking appointments, the lab recently had to cancel many appointments made prior to its decision to stop testing.
Other private labs have made colossal efforts to adjust, as did Biron, one of the largest laboratory chains in Quebec.
“For the moment it’s working. We’ve optimized our procedures to try to preserve our supply, but it’s a fragile balance because we, like all laboratories in all fields in all countries, have to deal with this shortage, this incapacity of suppliers to produce at the same rate they did before,” company spokesperson Annie Gauthier said.
The biggest sample tube supplier in the country, BD Canada, operates a factory in Quebec. Company spokesperson Ozgur Uzun said the pandemic has led to “unprecedented challenges.”
BD Canada said it produced an additional half billion tubes in 2021 compared with a year earlier after “investments of more than $300 million in the manufacture of tubes over the past four years” at its factories around the world. Uzun said the company transferred part of its manufacturing capacity away from lower-demand products to try to meet demand.
“The ever-changing needs for the types and quantities of tests required has led to the highest and most unpredictable demand in BD’s history,” said Uzun.
Uzun said clients of other suppliers have turned to them, but that BD is facing the same supply problems as the rest of the industry: limited access to raw materials, delays in shipping and transportation caused by a lack of personnel and an absenteeism rate increased by employees contracting COVID-19.
The company is meeting weekly with the Health Ministry to monitor inventory levels at each medical establishment to determine its needs.
People responsible for supplying health-care establishments have been directed to watch inventories and keep CLSCs and testing centres up to date on the situation, Larouche said.
“In certain regions, there have been meetings with prescribing physicians to confirm the pertinence of test requisitions and avoid breakdowns in service,” she said.
Meanwhile, sources within the regional health authority for the Centre-Sud de l’Île de Montréal, one of the biggest in the province, confirmed that the use of sample tubes has become extremely controlled and supervised, to maintain an adequate if fragile testing system.
Annie Gauthier of Biron said the company has to make do with what it has because the Health Ministry is a priority when it comes to supply. “We can’t order as much as we could in the past because we have to prioritize the public health network. We are aware of that, respect that and agree with this way of doing things. Our public network has a particular mission in the province and it is important above and beyond anything else that that it have access to the quantities it needs.”
Biron changed the manner in which it operated at the start of the pandemic.
“What we did first of all was try to optimize the materials we already had,” Gauthier said. “We tried — while remaining within industry norms and respecting the parameters that determine the process of drawing and testing blood — to use fewer tubes. We also tried drawing a little less blood without compromising the quality of testing.”
Gauthier said the company also invested in expansion. “During the pandemic, we expanded our laboratory installations and acquired new equipment. What helps us the most these days, without its being a panacea, is the optimization of our equipment, which is now more efficient and allows us to conduct more analyses — a bit more with less, if you will — but still producing a high-quality result.”
Another factor that allowed the company to weather the supply issue was a drop in demand for its services “especially during the first year (of the pandemic). Many people had fears about going out and either cancelled or postponed their testing for diagnostic services.”
As in the public sector, surveillance of supply has been increased, Gauthier said. “Can we have exactly the same quantities as before? No. Things have changed. That’s why we have to watch our supplies more closely than we did in the past.”
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