When Ruth Krukar, 90, went to Longs Drugs last week to pick up a prescription refill of the antibiotic she takes to prevent lung infection, a pharmacist informed her that her $20 copay could soon jump to $200. 

That’s because demand for the medication azithromycin, best known by the brand name Zithromax Z-Pak, is increasing in response to preliminary findings that the drug may help treat coronavirus patients.

Commonly prescribed to treat respiratory infections, Z-Pak could potentially also help reduce the duration of the COVID-19 virus when taken in tandem with an anti-malarial drug, according to a French study published last week. 

“I emailed my five kids and said, ‘Yippee-yay, I’ve been on the right medication for a change!'” said Krukar, a retired research librarian who lives in Hawaii Kai with her husband.

The COVID-19 outbreak is disrupting the global drug supply chain. Experts predict that factory shutdowns and worker quarantines at drugmaking facilities in China, a key producer of medications prescribed to Americans, will decrease the availability of common pharmaceuticals that millions of Americans rely on. 

The U.S. Food and Drug Administration announced that one drug is already in short supply due to manufacturing issues brought about by the coronavirus pandemic. It’s tracking another 20 drugs that could soon fall into shortage. 

The agency did not disclose the name of the nation’s first coronavirus-related drug shortage, but said the drug was recently added to its drug shortages database.

Drug price increases, like the one Krukar’s pharmacist predicted and prepped her for, could arise as a result of supply issues.

“If the generic form of a medication gets used up due to high demand or there’s a supply shortage and it’s just not available, then people are left to use the brand name medication and the pricing jumps up significantly,” said Dr. Roy Goo, associate professor and chairman of the Department of Pharmacy Practice at University of Hawaii Hilo. 

“It’s kind of like if you needed a T-shirt and Walmart closed down and the only place that’s still open is Armani,” he said. “You’re going to pay a lot more for that T-shirt.” 

Hoarding of drugs with unproven abilities to treat coronavirus is expected to be another major contributor to the predicted drug shortages that the FDA is bracing for.

There is some preliminary evidence, for example, that the antimalarial drugs chloroquine phosphate and hydroxychloroquine can reduce the symptoms of COVID-19 in patients infected with the virus.

Although the FDA issued a statement affirming that the drug hydroxychloroquine is not approved for coronavirus treatment, President Trump last week publicly overstated the drug’s potential to treat coronavirus patients, claiming that there’s been “very, very encouraging results.”  As a result, the drug’s supply suddenly faltered for American patients who depend on it to treat other diagnoses.

A ProPublica report found that Lupus patients who use the same medication to combat the effects of their illness have been faced with shortages.

“A lot of the things that we need for daily life are going to be hard to come by.” — Dr. Roy Goo, chair of the Department of Pharmacy Practice at UH Hilo

Doctors are also stockpiling these unproven drugs for themselves and their family members, and they’re prescribing them to patients who do not have any of the diagnoses that the drugs are FDA-approved to treat.

States including Nevada, Texas, North Carolina, Kentucky, Idaho and Ohio are issuing new restrictions and guidelines for the doctors who prescribe them and the pharmacists who dispense them in an effort to combat stockpiling. 

“I think there are some people out there who are probably prescribing these drugs to patients with COVID-19,” Goo said.

“It definitely is not what the general medical population recommends as the standard of care,” he said. “But there’s always people who see those preliminary results and jump on it.”

Shortages of pharmaceutical drugs and medical equipment are not without precedent. Hospitals experienced a severe shortage of saline, the IV solution commonly used to rehydrate patients and dilute medications, after Hurricane Maria battered Puerto Rico in 2017. 

But the coronavirus pandemic could threaten access to hundreds of medications, including common antibiotics like penicillin and amoxicillin. China is home to 13% of manufacturers who make the active ingredients used in drugs prescribed to American patients.

The FDA has asked drug manufacturers in China to evaluate their entire supply chain. Drugmakers are required to notify the FDA of any anticipated supply disruptions.

“This is what the experts have always been afraid of during a pandemic like this,” Goo said. “It’s not about the impact of the disease but the impact that it has on our supply chains for a lot of necessary products. If we’re shutting down factories and people are getting sick and unable to work, then a lot of the things that we need for daily life are going to be hard to come by.

“We’re not at the point yet where we’re unable to get lifesaving medications,” Goo added. “But the supply stocks are definitely getting limited.”