Tylenol shortage contributing to kids’ hospital crush: ER nurse

As hospitals in Canada struggle with an influx of children dealing with respiratory illnesses, the ongoing shortage in children’s Tylenol is only complicating the problem, one expert says.

Fevers that may have been dealt with at home with the proper over-the-counter medication appear to be progressing to the point where concerned parents end up in emergency rooms.

“It’s the Tylenol and Advil shortage that’s making them come to ERs, come to hospitals,” Eram Chhogala told CTVNews.ca in a phone interview.

“They go to the stores, pharmacies and there’s nothing there, then that’s when they come into the emergency department in hopes of obtaining (…) medication.”

Chhogala is a registered nurse in Toronto. Because she works in the emergency department, she sees a mixture of adult and pediatric patients, but she says the recent uptick in children being brought into the ER with respiratory symptoms is clear.

These patients include those with influenza, COVID-19 and a common childhood respiratory infection called RSV, she says, but one symptom appears in many children being brought to the ER.

“There’s kids having really high fevers, and it’s usually because of the lack of access to Tylenol and Advil in a lot of the stores and pharmacies and so forth,” she said.

“It’s really caused a high influx of patients coming in.”

Pharmacists and hospitals began to raise flags about a supply issue with liquid Tylenol and Advil in early summer, with Health Canada confirming that there was a national shortage. The shortage has only increased since then, with the Ontario Pharmacists Association stating in September that liquid and chewable forms were growing scarce.

While supply chain issues are believed to be a contributor to the issue, in Health Canada’s most recent update they state that “unprecedented demand” is the key source of the shortage.

In the last few weeks, children’s hospitals and health-care professionals have been sounding the alarm about children coming down with respiratory illnesses.

Some hospitals are operating at or over 100 per cent occupancy, with both RSV and influenza A being seen “above expected levels for this time of year,” according to the Public Health Agency of Canada.

TYLENOL SHORTAGE CONTRIBUTING TO CRUSH

In the summer, health professionals began to advise parents to ask their family doctors for a prescription for children’s Tylenol if they were unable to locate any on the shelves at their local drug store, in the hopes that this could help them access a supply that hadn’t yet been exhausted in regions running low.

However, many families are now ending up in the ER as avenues to find this over-the-counter medication are growing slim, Chhogala says.

“Because there’s not very much access to walk-in clinics or family doctors, they just … come to the ER, because they don’t have access to Tylenol or Advil or children’s Motrin,” Chhogala said.

Even pharmacies attached to hospitals are running out of Tylenol.

“The other day, I walked into the hospital’s pharmacy, just to grab something to drink, and I saw that the shelves were just empty. And there were families in there looking for Tylenol and there was nothing,” Chhogala said.

“So they come in [to the ER] because they’re hoping … that we can basically administer the Tylenol or Advil in the emergency department.”

Tylenol is a brand name for acetaminophen, while ibuprofen is marketed under the brand names of Advil and Motrin. It’s not necessary to get a prescription to obtain this medication, but emergency departments have their own stock that is separate from that in the pharmacy to ensure that those in emergency need can have access.

Children’s Tylenol and Advil can be used to help lower a fever, an important step in addressing the underlying infection and preventing an illness from progressing to a dangerous stage.

Chhogala said she and her colleagues have heard of patients having a fever for “more than maybe four or five days” and parents not being able to find any Tylenol or Advil over the counter to address it.

“A lot of other risks and complications happen because we’re not able to target infection, they’re not able to lower that fever, and a lot of other symptoms start arriving,” she said.

With staffing shortages still plaguing Canada’s health care system amid the COVID-19 pandemic, an increase in children in the hospital is just adding more strain to workers.

“With nursing staffing shortages, it’s quite a heavy load on our end, just because there’s so many patients and where do we put them to be seen?” Chhogala said.

“When you have a high number of patients to a low number of nurses, providing quality care is something that becomes [difficult]. And you want to be able to provide the best quality care for patients and their families out there.”

WHAT PARENTS CAN DO

Parents who are concerned that the flu could lead to their child being one of many in an overcrowded hospital should think of prevention first, Chhogala said.

They should start with the basic health measures that not only help fight COVID-19, but served to keep cold and flu levels down the past two years: wearing masks and thorough hand washing.

“That’s something that’s very, very important,” she said.

If a child does fall ill, parents should monitor their symptoms carefully.

If there is no Tylenol or Advil available over-the-counter in drug stores in their region, parents can try asking their family doctor, check in at walk-in clinics or try virtual care services that may be able to provide guidance.

If these options have been exhausted, a child who is suffering with a high fever should be brought to the ER to receive treatment, Chhogala said.

But identifying the difference between a low-grade fever and a dangerous one can help fight the numbers clogging up ERs and pediatric hospitals.

The body’s regular temperature is somewhere between 36 and 36.8 degrees Celsius, although this can vary from person to person. In general, a fever that is below 38.5 is considered to be a low-grade fever, Chhogala said, and medication such as Tylenol isn’t necessary to battle it — though she stressed that parents should confer with their doctors.

“Monitor the child’s symptoms in terms of are they looking lethargic, are they having changes in behaviour or altered mental status,” she suggested. “Increasing their fluid intake, that’s something that’s really important, because a lot of fluid intake can assist with keeping the child hydrated, and alleviating a bit of the fever symptoms.

“A low-grade fever would not require medication versus a child that’s having, say, a temp of 40.”

A fever of 40 C would be a sign that this child needs to go to the hospital, she said.

Other symptoms denoting a more serious illness include the child looking very dehydrated, with lips that are turning blue or are dry and sticky.

“I think education is very key in the communities just so that families can understand how to manage [illness], especially in this time, where we have a shortage of Tylenol,” Chhogala said. “Just because it was so readily accessible before and now … there’s pretty much nothing left.”

Tylenol shortages may make parents want to stock up, but it’s important not to take more than your fair share.

“Just be mindful that if there’s Tylenol that’s reintroduced on the shelf, not to take so much Tylenol for your own self,” Chhogala said. “You need to be considerate of other families that are out there that maybe don’t even have access to even one bottle.”

She acknowledged that it’s a “very unprecedented and scary time for a lot of people,” stressing that health-care professionals just want to help as many people as possible.

“We’re doing our very best in the emergency departments to accommodate all families, all children, we do see everybody, and we welcome anyone who really does require to come in to be seen by a doctor,” she said. “But please bear with us and please be patient, we are doing our very best to do as such, because we do genuinely care and we do genuinely want everyone to receive the care that they deserve.”