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, experts say.

Fevers that may have been handled at home with the proper over-the-counter medication are now driving concerned parents to take their kids into emergency rooms that are already dealing with children who are seriously ill.

“It’s the Tylenol and Advil shortage that’s making (some families) 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.”

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.

This influx in respiratory illnesses isn’t caused by the ongoing shortage in children’s Tylenol — but Chhogala, a registered nurse in Toronto, says that shortage is exacerbating the issue.

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 experiencing significant illness with influenza, COVID-19 and a common childhood respiratory infection called RSV, she says, but some of the children with fevers in the ER are there because worried parents didn’t know what to do amid “the lack of access to Tylenol and Advil in a lot of the stores and pharmacies and so forth.

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

Fever is an ordinary part of the immune response for many viruses, and isn’t something to panic over on its own. But with trusted medication vanishing from the shelves, many parents feel stranded.

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.

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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.

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 and make a sick child feel less discomfort as their body battles the virus.

“Advil and Tylenol have one role. And that's to make a child more comfortable,” Fahad Masud, a pediatric emergency doctor at the Children’s Hospital of Eastern Ontario, told CTVNews.ca on Friday.

He explained that parents shouldn’t worry that the presence of a fever alone means they have to scramble to find medication to lower it immediately — fever by itself won’t cause worse illness and many fevers will clear up as the illness improves. But it’s never pleasant for the patient.

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

With staffing shortages still plaguing Canada’s health care system amid the COVID-19 pandemic, the Tylenol shortage exacerbating the 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 appears to be very ill and has a high fever should be brought to the ER to receive treatment, Chhogala said.

However, identifying the difference between a very sick child and one with milder symptoms can help fight the numbers clogging up ERs and pediatric hospitals.

Chhogala said that she looks at the child’s symptoms as well as how high their fever is.

“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.

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

She considers a fever below 38.5 C to be a low-grade fever that likely wouldn’t require medication, while a fever of 40 C or higher would cause her to recommend the parents seek medical care.

However, Masud said that the number itself is not the point — a child who is very ill with a respiratory illness will have symptoms beyond a fever.

“[In general] the number of your temperature doesn’t tell you who’s more sick or less sick,” he said. “There’s kids who are sometimes running around with a fever 40-point-something, which I’m amazed by, but it doesn’t matter because the height of the temperature is not an indication of the height of seriousness. It's more how the child looks.”

An eight-year-old who is lethargic, won’t eat and has had a fever of 38.7 C for two days is likely sicker than an eight-year-old on day three of a fever of 39.5 who is alert, talkative and not having trouble staying hydrated, Masud said.

He also stressed that a child with flu symptoms who is struggling to breathe needs to be seen by a doctor.

The only time that a fever alone is enough to prompt an ER visit, Masad said, is if it is in a child younger than three months old.

“If it's somebody below three months with a fever of 40, I wouldn't even ask you what the next part of the scenario is because it's full stop, they need to go to [the ER],” Masud said.

Chhogala acknowledged it’s difficult for parents to know what to do at this time, “where we have a shortage of Tylenol.

“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 added 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.”