Instant Pots, duct tape, and tracheostomy tubes from people who didn’t survive COVID-19: These are the tools patients and families are using to navigate persistent tracheostomy supply shortages exacerbated by the pandemic.
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November 2022Jenny McLelland started sterilizing her son James’ trach tubes in her Instant Pot in late 2019 after reading a 2018 PLOS One paper that concluded that self-contained electric pressure cookers “are a viable alternative for steam sterilizing laboratory items when an autoclave is unavailable” (PLOS One. 2018;13:e0208769). Her son’s supply was impacted by the 2019 closure of an oxide sterilization facility in Illinois that triggered a shortage of pediatric Bivona tubes. Three years later, McLelland, a California resident, is still sterilizing and reusing trach supplies—the family currently receives just four trach tubes per year, down from their allotted 50—and her social media posts outlining her sterilization technique have been shared hundreds of times by other desperate families.
Crystal Evans, a Massachusetts-based adult who has been ventilator dependent since 2016, is using a UV baby bottle sterilizer to maintain her stash of limited supplies. Evans started stockpiling equipment almost as soon as COVID-19 began circulating, but her foresight wasn’t enough to forestall harm. Unable to obtain adequate numbers of ventilator circuits and trach tubes, Evans developed tracheitis and bacteremia. When her ventilator circuit ripped in December 2020, Evans patched it with duct tape, as new supplies hadn’t been delivered. By January 2021, she was struggling to breathe against an inflamed airway. Her durable medical equipment (DME) provider, health insurance company, Congressman, and Senator provided little help; Evans is still getting only one ventilator circuit per month instead of the five she needs and is using trach supplies shipped to her “from friends who have lost their kids.”
To say the COVID-19 pandemic interrupted the supply chain, creating shortages of necessary tracheostomy supplies, is not entirely accurate. Yes, years of COVID-related shutdowns (not to mention COVID-related deaths and disability) have led to a global shortage of medical-grade silicone, shipping delays, and workforce shortages. But those who rely on tracheostomy tubes say the supply chain has always been precarious, with few factories manufacturing the necessary equipment and their personal supply dependent on Medicaid rules that vary from state to state and DME providers who have little financial incentive to deliver the proper number of supplies.
Unfortunately, tracheostomy supply shortages are likely to continue for a while. “This isn’t going to be over until the end of 2023,” said Andrew Georgilis, president and CEO of Bryan Medical, a Cincinnati-based manufacturer of tracheostomy tubes and speaking valves, noting that his company currently receives only about 25% of the raw material they order, while demand has increased nearly 50%. “It’ll get better and better as we go forward, but this isn’t going away anytime soon.”