Exclusive: U.S. traffic deaths fell after coronavirus lockdown, but drivers got riskier

By David Shepardson

WASHINGTON (Reuters) – U.S. traffic deaths fell during the coronavirus lockdowns but drivers engaged in riskier behavior as the fatality rate spiked to its highest level in 15 years, a government report set to be released Thursday will show.

The National Highway Traffic Safety Administration (NHTSA) found the fatality rate jumped to 1.42 deaths per 100 million vehicle miles traveled in the three months ending June 30, the highest since 2005.

At the same time, overall traffic deaths fell by 3.3% to 8,870 while U.S. driving fell by about 26%, or 302 fewer over the same period in 2019, according to the report reviewed by Reuters.

NHTSA’s study showed “drivers who remained on the roads engaged in more risky behavior, including speeding, failing to wear seat belts, and driving under the influence of drugs or alcohol.”

By contrast, the fatality rate for 2019 was just 1.10 deaths per 100 million miles, the lowest rate since 2014 as traffic deaths fell by 2% to 36,096.

Traffic data showed average speeds increased and extreme speeding became more common. Data from some states suggested that fewer people were wearing seat belts during the lockdown.

“In short, the stay-at-home orders may have led the population of drivers during the height of the health crisis to have been smaller but more willing to take risks,” NHTSA found.

NHTSA also noted that in the wake of the outbreak enforcement of some traffic laws was reduced. “It is possible that drivers’ perception that they may be caught breaking a law was reduced,” the report found.

NHTSA also said that since coronavirus risks are higher for older Americans, that could have minimized driving by more risk-averse drivers.

(Reporting by David Shepardson; Editing by Nick Zieminski)

Drug costs for COVID-19 patients plunge at U.S. hospitals, but may rise

By Chad Terhune

(Reuters) – Medication costs for COVID-19 patients hospitalized in the United States have dropped sharply since May, reflecting advances in treatment, shorter stays and use of cheaper generic drugs.

But costs may rise again as hospitals start to pay for Gilead Sciences Inc’s remdesivir.

Research by the health data firm IllumiCare and exclusively shared with Reuters found that hospitals spent $1,090 per COVID-19 patient on medication in July. That was down from $3,011 in May among more than 50 hospitals in 10 states that were analyzed.

Several factors drove down the number. The average length of stay for COVID-19 patients declined by nearly 30%, from 9.6 days in April to 6.8 days in July, the hospital data show. And the number of medications used dropped by 22%, from nearly 20 individual drugs in April to 15.4 drugs in July.

Pharmacists say some of the decrease in medications may stem from reduced use of ventilators, which require painkillers for sedation.

“We were throwing the kitchen sink at these patients and now hospitals are getting better at treating these infections,” said G.T. LaBorde, chief executive of IllumiCare, a Birmingham, Alabama-based firm that works with hospitals and analyzes their electronic medical records.

Remdesivir, which helped speed up patients’ recovery in a U.S. trial, won emergency-use authorization in May from U.S. regulators. Gilead donated early doses but has begun charging. It has said the price for commercially insured patients is $3,120 per treatment course and $2,340 for patients on Medicare.

Michael Ganio, senior director of pharmacy practice and quality at the American Society of Health-System Pharmacists, said many of the medications being used on COVID-19 patients are not “budget busters” and drug shortages have often been a bigger problem than cost.

But Ganio said pharmacy costs could increase significantly in the months ahead because of remdesivir.

Overall, many U.S. hospitals continue to face significant financial pressure from the pandemic as new infections remain high across much of the country, including in California, Florida and Texas. And health officials have warned that the upcoming flu season could further stress the healthcare system.

“As healthcare professionals, we are holding our breath for what fall will bring with flu season and COVID,” Ganio said.

In addition to remdesivir, hospital costs also may rise because of the increased use of tocilizumab, an anti-inflammatory drug widely used to treat arthritis. Hospital use jumped 29% among COVID-19 patients during July compared with the month earlier.

Tocilizumab costs more than $2,200 per patient, and is one of a class of drugs that includes Roche’s Actemra.

The most frequently prescribed drug for COVID-19 patients was the anticoagulant enoxaparin. It was given to 50% of inpatients last month at a cost of $322 per patient, the data show.

Another treatment recently found to reduce mortality for some COVID-19 patients, the steroid dexamethasone, costs $8.78 per patient, according to IllumiCare, and it was given to 35.1% of hospitalized COVID-19 patients reviewed in July.

Overall, IllumiCare said it looked at data from March through July at health systems in 10 states, including California, Texas and Alabama. It found more than 4,000 patients who were hospitalized and under treatment primarily for a coronavirus infection, drawing on medical billing codes for respiratory infection, sepsis and related conditions.

The firm excluded some COVID-positive patients, such as pregnant women, who were hospitalized for other reasons.

(Reporting by Chad Terhune. Editing by Peter Henderson and Gerry Doyle)

Does drug touted by Trump work on COVID-19? After data debacle, we still don’t know

By Kate Kelland and Alistair Smout

LONDON (Reuters) – Scientists are resuming COVID-19 trials of the now world-famous drug hydroxychloroquine, as confusion continues to reign about the anti-malarial hailed by U.S. President Donald Trump as a potential “game-changer” in fighting the pandemic.

The renewed research push follows widespread criticism of the quality of data in a study published by The Lancet, an influential medical journal, which found high risks associated with the treatment.

The World Health Organization, which had last week paused trials when The Lancet study showed the drug was tied to an increased risk of death in hospitalized patients, said on Wednesday it was ready to resume trials.

The WHO’s change of mind is “a wise decision”, according to Martin Landray, co-lead scientist on the Recovery trial, the world’s largest research project into existing drugs that might be repurposed to treat COVID-19 patients.

“What all this episode really reflects is that without randomized trials, there is huge uncertainty,” said Landray, a professor of medicine and epidemiology at Oxford University.

Randomized studies are the gold standard in research, randomly assigning a treatment to one group of people and a dummy to another group so that the two can be compared. The Lancet study was a “retrospective observational” study, using a data set from an analytics firm, to see what effects the drug had had on some COVID-19 patients, compared to those who did not get it.

The WHO’s about-face came after nearly 150 doctors signed a letter to the Lancet outlining concerns about the study’s conclusions. The journal itself published an expression of concern about the research this week, saying “serious scientific questions have been brought to our attention”.

Some scientists said the episode had set back efforts to determine whether hydroxychloroquine was an effective or risky treatment for COVID-19, as some other trials around the world had also halted following the WHO’s initial decision to pause.

“It’s really impacted quite negatively the sort of studies that would be able to say if there is a benefit or harm,” Will Schilling told Reuters. He is co-lead on the UK COPCOV study which was paused last week, just days after its launch.

“At the moment, we don’t really know. That’s why these studies are needed, and now they’ve been slightly waylaid by all of this.”

Scientists acknowledge, though, that studies are being conducted at break-neck speed while garnering unprecedented levels of attention that could give findings unwarranted weight.

THE PRESIDENT’S TAKING IT

The drug has hit global headlines in large part because of its promotion by Trump, who said in March it could be a game-changer and last month revealed he was taking it himself, even after his own Food and Drug Administration (FDA) had advised that its efficacy and safety were unproven.

In the absence of clear scientific evidence, some authorities and consumers are buying up stocks of the drug in case it turns out to be effective. Britain, for example, is spending millions of pounds bulk-buying tablets.

Hydroxychloroquine has been shown in laboratory experiments earlier this year to be able to block the SARS-CoV-2 virus that causes COVID-19, but this effect has not been replicated in rigorous trials in people.

A separate study by University of Minnesota scientists of the potential preventative effect of hydroxychloroquine against the new coronavirus found it did not protect patients who had been given it prior to being exposed to COVID-19.

Here again, though, the waters have been muddied. The New England Journal of Medicine, which published the research on Wednesday, noted in an editorial, however, that there were limits to the scope of the study.

The University of Minnesota study also was limited in the scenario it tested, said Richard Chaisson, a Johns Hopkins researcher who is running a separate trial of the drug to determine whether it is effective in treating patients with moderate to severe versions of COVID-19.

There is still a need for robust studies looking at whether it might work in low doses before or after exposure, as well as against mild cases, moderate cases, hospitalized patients and seriously ill ones, he added.

WHO’S KNOCK-ON EFFECTS

The WHO decision to halt its trials last week had knock-on effects across the drug industry and medical profession.

French drugmaker Sanofi temporarily stopped enrolling recruits to its own study and pulled supplies of the drug for treatment. The UK COPCOV trial, aimed at establishing if hydroxychloroquine can prevent healthcare workers from contracting COVID-19, hit pause just a week after its launch.

Those studies are yet to resume.

Several European countries also have stopped using the drug for treating some COVID-19 patients.

Some trials have, however, continued despite the WHO’s move.

Novartis has not changed course with its study and the UK Recovery trial paused only briefly before moving ahead after safety checks. It is still enrolling patients and has signed up 4,500 recruits so far – 1,500 patients who are on the drug and around 3,000 who aren’t.

In short, the jury’s still out on hydroxychloroquine for COVID-19, according to Landray at Recovery.

“People can quote data, people can quote experts, but there is continuing huge uncertainty,” he said.

(Additional reporting by Michael Erman in New York; Writing by Josephine Mason and Peter Henderson; Editing by Pravin Char)

FDA identified 20 drugs with shortage risks due to coronavirus outbreak

NEW YORK (Reuters) – The U.S. Food and Drug Administration has contacted producers of about 20 drugs that either source all of their main ingredients from or are finished in China to gauge if they will face shortages due to the coronavirus outbreak.

None of the companies reported that a shortage is expected for their drugs due to the outbreak, an FDA spokeswoman said.

“We have been in contact with those firms to understand if they face any drug shortage risks due to the outbreak,” FDA spokeswoman Stephanie Caccomo said in a statement late on Monday. “None of these firms has reported any shortage to date.”

Caccomo did not identify any of the drugs or the companies.

She said the FDA has also reached out to more than 180 manufacturers to remind them of their requirement to notify the regulator of any expected supply disruptions.

U.S. officials raised concerns this week about the security of the U.S. drug supply chain in the wake of the coronavirus outbreak in China, where a significant portion of the ingredients used to make prescription drugs is manufactured.

Around 88 percent of the active pharmaceutical ingredients used in drugs for the U.S. market were manufactured overseas in 2018, according to the FDA. About 14 percent of the API for U.S. drugs in that year were produced in China, the FDA said.

(Reporting by Michael Erman; Editing by Dan Grebler)

China, U.S. to disclose details of rare cooperation against fentanyl drug scourge

China, U.S. to disclose details of rare cooperation against fentanyl drug scourge
BEIJING (Reuters) – Drug law enforcement officers from China and the United States will jointly brief the media on Thursday on a fentanyl smuggling case, in an unusual disclosure of rare Sino-U.S. cooperation in cracking down on fentanyl crimes.

China’s National Narcotics Control Commission and enforcement officers from both countries will give “detailed information” at a press conference in Xingtai city in northern Hebel province about a fentanyl smuggling case that was jointly uncovered by both sides, according to a notice circulated by the State Council Information Office.

Reporters will also be able to view a live broadcast of the trial at the Xingtai court, before the press conference.

Fentanyl is a cheap, relatively easy-to-synthesize opioid painkiller 50 times more potent than heroin that has played a major role in a devastating U.S. opioid addiction crisis.

U.S. officials say China is the main source of illicit fentanyl and fentanyl-related substances that are trafficked into the United States, much of it through international mail. China denies that most of the illicit fentanyl entering the United States originates in China.

U.S. President Donald Trump accused Chinese President Xi Jinping in August of failing to meet his promises to crack down on the deluge of fentanyl and fentanyl analogues flowing into the United States. China labeled that “blatant slander”.

The dispute over fentanyl comes with the United States in the middle of a major trade dispute with China.

China’s National Narcotics Control Commission said in September that Sino-U.S. cooperation on investigating and prosecuting fentanyl-related substances was “extremely limited”, even though counter-narcotics law enforcement departments from both sides had long maintained a good cooperative relationship.

The sudden show of cooperation announced on Tuesday coincides with intense bilateral negotiations over a phase-one trade agreement which Trump said he hoped to sign with Xi.

(Reporting by Ryan Woo; Editing by Mark Heinrich)

Several states wary of $48 billion opioid settlement proposal

Several states wary of $48 billion opioid settlement proposal
By Tom Hals and Nate Raymond

(Reuters) – Several U.S. states that have been ravaged by the opioid epidemic are pushing back on a proposed $48 billion settlement framework that would resolve thousands of lawsuits against five drug companies accused of fueling the addiction crisis.

The proposal would bring an end to all opioid litigation against AmerisourceBergen Corp<ABC.N>, Cardinal Health Inc<CAH.N> and McKesson Corp<MCK.N>, drugmaker Teva Pharmaceutical Industries Inc<TEVA.TA><TEVA.N>, and Johnson & Johnson<JNJ.J>.

The companies have proposed paying $22.25 billion cash mostly over 18 years, while services and drugs to treat addiction valued at $26 billion by the companies would be provided over the coming decade, mostly by Teva.

Officials in states such as Ohio, New Hampshire and West Virginia — all hard hit by the deadly drug addition crisis — voiced concerns about the proposal.

James Boffetti, the associate attorney general for New Hampshire, said in an interview he was troubled that payments were stretched over many years.

“The concern is, I think, the states need money now to create the infrastructure for treatment,” he said.

Small states fear the money will be divvied up by population rather than need.

“Any global opioid settlement that doesn’t reflect the unique and unprecedented damage imposed on West Virginia through the opioid epidemic should be DOA,” West Virginia Attorney General Patrick Morrisey said on Twitter on Tuesday.

Some 400,000 U.S. overdose deaths between 1997 and 2017 were linked to opioids, according to government data. Roughly 2,600 lawsuits have been brought nationwide by states, local and tribal governments.

The three distributors in a joint statement said they were committed to finalizing a global settlement and would continue working with the other parties on the details of the framework. Teva declined to comment.

J&J said in a securities filing on Wednesday the deal would lower third quarter profit by $3 billion.

The proposal, announced on Monday, was hammered out by the companies and attorneys general in North Carolina, Pennsylvania, Tennessee and Texas.

It will need broad support among state attorneys general and will have to overcome opposition from the lawyers representing local governments that sued. Those lawyers declined to sign on when presented the proposal last week.

Under the settlement framework, money for each state would be divvied up, with 15% going to the state treasury, 15% for local governments that filed lawsuits and 70% going to a proposed state fund aimed at addressing the crisis.

Boffetti predicted it would takes weeks for states to determine whether they back the settlement framework.

North Carolina’s attorney general, Josh Stein, acknowledged that a detailed term sheet needs to be developed.

“There are a lot of details and mechanics that need to be added to it,” Stein told Reuters in an interview. “That will happen in the coming weeks.”

The proposal did win a major supporter on Tuesday. Tom Miller of Iowa, the longest-serving attorney general, publicly backed the proposal, calling the framework “an important step in addressing the crisis.”

Colorado’s attorney general, Phil Weiser, called it a “very promising development.”

The lawsuits accuse distributors of failing to flag and halt a rising tide of suspicious orders and drugmakers of overstating the benefits of opioids while downplaying the risks.

The companies have denied any wrongdoing. Drugmakers say their products carried government-approved labels that warned of the addictive risks of opioids, while distributors argue their role was to make sure medicines prescribed by licensed doctors were available for patients.

The proposed deal has widened a fault line between attorneys general and local governments.

Cities and counties generally hired private attorneys to bring their cases, and attorneys general want to limit the amount of the settlement that goes to pay private lawyers. The attorneys for local governments also generally opposed Teva contributing opioid treatment drugs to the settlement, instead of cash, in part because of concerns that the framework placed an inflated value on those drugs.

Last week’s talks failed to reach a global deal, and on Monday, the three wholesale distributors and Teva struck a last-minute $260 million settlement with two Ohio counties, averting the first federal trial over opioids.

North Carolina’s Stein said he looked forward to resolving concerns about the proposal and warned that settling lawsuits individually was unsustainable.

“If we proceed on the current path and each county and city brings their case and extracts whatever amount they may be able to get from these companies, the companies will end up bankrupt,” he said. “The opioid crisis is a national problem that demands a national solution.”

(Reporting by Tom Hals in Wilmington, Delaware and Nate Raymond in Boston, Massachusetts; Editing by Noeleen Walder and Sandra Maler)

Trump: looking at economic penalty for drugs coming from Mexico

U.S. President Donald Trump holds a White House Opportunity and Revitalization Council Meeting at the White House in Washington, U.S., April 4, 2019. REUTERS/Kevin Lamarque

WASHINGTON (Reuters) – President Donald Trump said on Friday he is considering an economic penalty apart from tariffs to counter the smuggling of drugs from Mexico across the southern U.S. border.

“Likewise I am looking at an economic penalty for the 500 Billion Dollars in illegal DRUGS that are shipped and smuggled through Mexico and across our Southern Border,” Trump said in a Twitter post as he prepared to leave the White House for a two-day trip that will include a visit to the border.

Praising Mexico for moving recently against drug traffickers, Trump said, “If they continue that, everything will be fine. If they don’t we’re going to tariff their cars at 25 percent.”

“Also, I’m looking at an economic penalty for all of the drugs that are coming in through the southern border and killing our people,” Trump told reporters in Washington.

(Reporting by Doina Chiacu; Editing by Chizu Nomiyama)

Trump threatens tariffs if Mexico does not help with immigration, drugs

U.S. President Donald Trump speaks during the "White House Opportunity and Revitalization Council" meeting in the Cabinet room at the White House in Washington, U.S., April 4, 2019. REUTERS/Kevin Lamarque

WASHINGTON (Reuters) – President Donald Trump threatened on Thursday to put tariffs on cars coming from Mexico into the United States if Mexico does not continue to help Washington deal with the immigration and drug situation along the southern U.S. border.

Trump told reporters at the White House he would put tariffs on cars or close the border, but he said he may start with the tariffs. He also said he would give Mexico a year to try to stop the flow of drugs before putting tariffs in place.

“A lot of good things are happening with Mexico. Mexico understands that we’re going to close the border, or I’m going to tariff the cars,” Trump told reporters at the White House.

Trump said he would “probably start off with the tariffs – that will be a very powerful incentive.”

Trump warned last Friday that he would close the U.S. border with Mexico this week unless Mexico took action to help stop the flow of illegal migrants across the frontier.

Trump said on Thursday that media coverage in recent days has prompted Mexico to take action to curb the flow of immigrants to the United States and take other action to ease the pressure on U.S. ports of entry.

(Reporting by Jeff Mason; Writing by David Alexander; Editing by David Gregorio)

The rise and fall of ‘El Chapo,’ Mexico’s most wanted kingpin

FILE PHOTO: FILE PHOTO: Recaptured drug lord Joaquin "El Chapo" Guzman is escorted by soldiers at the hangar belonging to the office of the Attorney General in Mexico City, Mexico January 8, 2016. REUTERS/Henry Romero/File Photo

By Dave Graham

MEXICO CITY (Reuters) – Joaquin “El Chapo” Guzman is Mexico’s most notorious kingpin who shipped tonnes of drugs around the world, escaped two maximum-security jails and became one of the world’s most-wanted fugitives.

He now faces the prospect of life in prison.

Jurors on Monday will begin deliberations on 10 criminal counts facing Guzman, 61, in the trial that began in November in New York.

The audacious exploits of El Chapo, or Shorty, captured the world’s imagination and turned him into a folk hero for some in Mexico, despite the thousands of people killed by his brutal Sinaloa cartel.

Beyond putting Guzman’s personal life and drug dealings on public display, the case has also highlighted Mexico’s long-time fight to bring down its chief adversary in the bloody war on drug trafficking.

In January 2016, after some three decades running drugs, Guzman was caught in his native northwestern state of Sinaloa.

Six months earlier, he had humiliated Mexico’s then-president, Enrique Pena Nieto, by escaping from prison through a mile-long tunnel dug straight into his cell – his second time escaping a Mexican jail.

Just days after his 2016 capture, Guzman’s larger-than-life reputation was sealed when U.S. movie star Sean Penn published a lengthy account of an interview he conducted with the drug lord, which the Mexican government said was “essential” to his capture a few months later.

“I supply more heroin, methamphetamine, cocaine and marijuana than anybody else in the world. I have a fleet of submarines, airplanes, trucks and boats,” Penn said Guzman told him at the drug lord’s mountain hideout.

Mexico’s government extradited Guzman in January 2017, a day before Donald Trump took office as U.S. president on vows to tighten border security to halt immigration and drug smuggling.

Guzman’s legendary reputation in the Mexican underworld began to take shape when he staged his first jailbreak in 2001 by bribing prison guards, before going on to dominate drug trafficking along much of the Rio Grande.

However, many in towns across Mexico remember Guzman better for his squads of hitmen who committed thousands of murders, kidnappings and decapitations.

Violence began to surge in 2006 as the government launched a war on drug trafficking that caused criminal groups to splinter and killings to spiral.

Guzman’s Sinaloa Cartel went on smuggling hundreds of tons of cocaine, marijuana, and crystal meth across Mexico’s border with the United States.

In February 2013, the Chicago Crime Commission dubbed him the city’s first Public Enemy No.1 since Al Capone.

ELUSIVE KINGPIN

Security experts concede the 5 foot 6 inch gangster was exceptional at what he did, managing to outmaneuver, outfight or outbribe his rivals to stay at the top of the drug trade for over a decade.

Rising through the ranks of the drug world, Guzman carefully observed his mentors’ tactics and mistakes, forging alliances that kept him one step ahead of the law for years.

Mexican soldiers and U.S. agents came close to Guzman on several occasions but his layers of body guards and spies always tipped him off before they stormed his safe houses.

In preparing for a raid in 2014, U.S. officers restricted information to a small group for fear of corruption among Mexican law enforcement, DEA agent Victor Vasquez testified in Guzman’s trial.

SINALOA ROOTS

Guzman was born in La Tuna, a village in the Sierra Madre mountains in Sinaloa state where smugglers have been growing opium and marijuana since the early twentieth century.

He ascended in the 1980s working with Miguel Angel Felix Gallardo, alias “The Boss of Bosses,” who pioneered cocaine smuggling routes into the United States.

The aspiring capo came to prominence in 1993 when assassins who shot dead Roman Catholic Cardinal Juan Jesus Posadas claimed they had actually been aiming at Guzman.

Two weeks later, police arrested him in Guatemala and extradited him to Mexico. During his eight-year prison stay, Guzman smuggled in lovers, prostitutes and Viagra, according to accounts published in the Mexican media.

After escaping, Guzman expanded his turf by sending in assassin squads with names such as “The Ghosts” and “The Zeta Killers,” in reference to the rival Zetas gang.

Guzman hid near his childhood home, agents said, but rumors abounded of him visiting expensive restaurants and paying for all the diners.

In 2007, Guzman married an 18-year-old beauty queen in an ostentatious ceremony in a village in Durango state.

The state’s archbishop subsequently caused a media storm when he said that “everyone, except the authorities,” knew Guzman was living there. Guzman’s bride, Emma Coronel, gave birth to twins in Los Angeles in 2011. She attended nearly every day of her husband’s trial, at one point donning a red blazer that matched his own.

WAGING WAR

Between 2004 and 2013, Guzman’s gangs fought in all major Mexican cities on the U.S. border, turning Ciudad Juarez and Nuevo Laredo into some of the world’s most dangerous places.

In one such attack, 14 bodies were left mutilated under a note that read, “Don’t forget that I am your real daddy,” signed by “El Chapo.”

Guzman’s Sinaloa cartel often clashed with the Zetas, a gang founded by former Mexican soldiers, arming its crew with rocket-propelled grenades and heavy machine guns.

In 2008, hitmen working for a rival murdered Guzman’s son Edgar, a 22-year-old student. Guzman reportedly left 50,000 flowers at his son’s grave.

In the 1990s, Guzman became infamous for hiding seven tons of cocaine in cans of chili peppers. In the following decade, his crew took drugs in tractor trailers to major U.S. cities including Phoenix, Los Angeles and Chicago, indictments say.

Forbes magazine put the kingpin’s wealth at $1 billion, though investigators say it is impossible to know exactly how much he was worth.

(Reporting by Dave Graham and Mexico City Newsroom; Editing by Daina Beth Solomon and Alistair Bell)

A matter of life and death? UK stockpiles drugs as no-deal Brexit feared

Jo Elgarf is seen with her daughter Nora and the child's prescription medicine at their home in London, Britain, January 30, 2019. REUTERS/Henry Nicholls

By Edward Baran

LONDON (Reuters) – With just 56 days until Britain leaves the EU, Jo Elgarf has begun stockpiling food in case politicians fail to strike an exit deal, but she says she cannot do the same with vital drugs her disabled daughter needs.

Four-year-old Nora has cerebral palsy and epilepsy and relies on imported Epilim and Keppra daily to stop her suffering seizures. Elgarf wants to stock up on the drugs in case supplies are hit but she can’t because they are only available on a monthly prescription.

For Nora, “this could be matter of life and death,” Elgarf told Reuters at her home in southwest London.

“It could mean being sent off in an ambulance to hospital with a massive seizure that lasts five minutes plus. She cannot miss those medicines. There’s no ifs and buts about it and we cannot use alternatives either.”

With the clock ticking, British lawmakers are still struggling to agree a withdrawal treaty with the European Union, having comprehensively rejected Prime Minister Theresa May’s agreement last month.

The default position means Britain will leave on March 29 without a deal in place unless something can be agreed beforehand. That has led to fears that supply chains will be severely disrupted leading to shortages of food and medicines.

According to the British government, about three-quarters of medicines used by the state-run National Health Service (NHS) come via the EU. May, a Type 1 diabetic, has said she herself relies on insulin produced in another EU country.

WORLD’S BIGGEST FRIDGE BUYER

Last August, Health Secretary Matt Hancock outlined plans to ensure Britain had an extra six weeks of supplies in the event of a no-deal Brexit.

In January, he said Britain had bought 5,000 fridges to hold medicines, making him the biggest buyer of fridges in the world, and secured warehouse space.

Jo Elgarf sits with her daughter Nora at their home in London, Britain, January 30, 2019. REUTERS/Henry Nicholls

Jo Elgarf sits with her daughter Nora at their home in London, Britain, January 30, 2019. REUTERS/Henry Nicholls

“Making sure patients continue to have access to the medicines they need is paramount…,” said health minister responsible for Brexit planning Stephen Hammond.

“We are working extremely closely with industry to make sure there are significant supplies of these drugs in the UK,” Hammond wrote in an article last week.

But some Britons do not share that confidence, and anecdotal evidence from newspaper readers suggests people are stockpiling everything from children’s painkillers to medicines for serious conditions.

For Elgarf, a member of anti-Brexit Facebook group “48 percent Preppers” – a reference to the percentage that voted to remain in the EU in the 2016 referendum – that is not an option, and that has left her fearful.

“It doesn’t matter even if I had all the money in the world, I can’t go and buy these medicines because they are prescription-only. I have no way of securing my child’s future,” she said.

It is not just patients and their families who are concerned.

The chief executive of a body running hospitals in Birmingham, England’s second-biggest city, warned last week there was a risk operations could be canceled because of a drug shortage.

“In the event of a chaotic, no-deal exit, many NHS trusts could quickly run out of vital medical supplies,” Dr Dave Rosser wrote in a memo to his board of directors.

He said “well-informed and non-political NHS sources” had estimated goods from Europe across the English Channel “could be reduced to between one-third and one-fifth of current daily volumes for a period of at least some months.”

According to the Brexit Health Alliance, an industry body, 45 million patient packs go to the EU from the UK every month, and 37 million packs go the other way.

“Any divergence from these harmonized standards by the UK in the future, and a lack of agreement on cooperation with the EU on medicines and medical devices, would mean that supply chains are at risk,” it said.

One unintended consequence of the concern is that patients stocking up on medicines might bring about problems themselves.

“Hospitals, pharmacies, (family doctor) surgeries and patients should not stockpile medicines at any point during this process,” health minister Hammond said.

“Doing so risks shortages for other patients. If everyone does what they are supposed to, we are confident the supply of medicines will continue uninterrupted whatever the Brexit outcome.”

(Writing by Michael Holden; editing by John Stonestreet)