"There's fewer flights, so it's creating longer routes."

"It's been really challenging trying to get our product around."

Karin Stephenson, manager, commercial operations, McMaster Nuclear Reactor, Ontario

An unidentified man sits in the waiting area at the nuclear medicine department at Toronto General Hospital on Friday, May 22, 2009. (THE CANADIAN PRESS / Chris Young)

More inevitable but unforeseen fallout from the global pandemic is now being recognized, and critical express deliveries with medical companies and shippers in Canada striving to transport time-sensitive radio-chemical materials for the treatment of cancer face rising shipping costs and delivery delays of time-sensitive materials. A drop in passenger flights has had the additional effect of crimping options for transport of critical medical equipment with cargo delays. 

"Now you go with whatever option you get", remarked Gabriel Feitas, an executive at isoSolutions in Vancouver specializing in sourcing and distributing nuclear medicine products whose company has encountered shipping price increases ranging from 20 to 30 percent. Lower prices were available through searching out competing flights before the entry of COVID-19, but that situation has turned completely inside-out.

Canada, with its limited domestic market and COVID-imposed restrictions on international travel, made more complex by the necessity of imposing a 14-day quarantine period for arrivals, has seen air passenger traffic hard-hit. A situation almost unique to Canada where travel volumes have dropped at Canadian airports some 90 percent on an annual basis. No such situation is being seen in the United States and other international travel spots.

Fifty percent of air cargo that normally transits in the belly of passenger jets has become a problem which likely wouldn't have arisen had dedicated freighters been routinely used. Now, with flight cancellations resulting in plummeting air traffic during the pandemic, some companies have been left to scramble in a bid to ship treatments known to decay over time, leading as well to an increase in the costs of transport.

Deliveries of radio isotopes used in the treatment of around 70,000 patients a year in Canada through a procedure called brachythrapy, have faced delays of up to ten days' duration. Prior to the current situation the McMaster Nuclear Reactor was able to ship out its iodine-125 isotope in a few days to just about anywhere. In the United States, cancer specialists and the American College of Radiology have not heard of any such concerns over the shipment of isotopes there.

Since medical isotopes decay over time, moving them expeditiously to sites where they are needed and used as critical therapies, the situation is reaching emergency status for the broader industry. Iodine-125 loses roughly 20 percent of its radioactivity in the span of ten days. Holmium-155, another product shipped by McMaster is the key raw ingredient in liver cancer therapy used in Europe, called QuiremSpheres, with a half-life of 27 hours. Speed in delivery is absolutely critical.

Quirem Medical based in the Netherlands, stated through its supply chain manager that some patients' treatments were rescheduled because of delayed shipments. "Timing is extremely critical", commented Jan Sigger, chief executive of Quirem Medical. Airlines in distress are moving to smaller planes with less cargo capacity. "Shipments get bumped all the time because of aircraft capacity". noted Mike Stopay, director of Pacer Air Freight, a cargo specialist in Toronto.

Transport of COVID-19 vaccines equivalent to about 0.3 percent of global air freight, despite its recent introduction, is unlikely to displace time-sensitive medical products in cargo planes, Marco Bloemen, managing director of Seabury Consulting noted. A rise in e-commerce resulting from the pandemic is also fuelling a boom in converting passenger planes to freighters with their greater freight capacity. However, they fly less frequently, offering yet another headache in express delivery.

Recently an upside in the situation was discovered when delivery delays caused researchers at Yale University to set aside the brains of dead pigs for their research because too long a delay in delivery had taken place. ON another occasion, they had experienced a delay in the shipping of human brain tissue from the Wellcome Trust in London. Their research involved growing stem cells from fetal brain tissue for studies into Zika virus in 2016.

Frozen samples were generally shipped to the United States within a day from Britain. And then on one occasion the tissue shipment was delayed in the post and it took two days after clinical death for the experiments to proceed. Amazing the scientists involved when the tissue could still be 'woken up' to produce stem cells. A discovery that led the researchers to an experiment to determine whether entire pig brains after slaughter could be restarted several hours following death.

"They were trying to get brain tissue to do experiments on and there wasn't a proper brain bank in t he U.S. so they were getting it from the Wellcome Trust in London, who was shipping it with DHL. And then one time DHL was delayed by 48 hours, and one of the post-docs said to the lead scientist: 'Look we can't use it, it's been sitting around for too long', so the scientist gave it to him to practise techniques on, and then the guy shows up with all these data, and they found it was the same as the fresh brains, except this brain was 48 hours old."

When the researchers restated dead pigs' brains from four hours after slaughter the animals never regained consciousness, but many basic cellular functions, including blood circulation and metabolism switched back on for 10 hours. So much for long-held assumptions that brain death is irreversible And possibly opening up an entire new front in brain research and the potential for functional resurrection.

 

According to Nenad Sestan, a professor of neuroscience at Yale who carried out the pig experiments, the research team had considered the possibility that brain cells remain "alive" days following death, but he postal delay gave them greater hope of validation. "We had already started working on the project, but this event gave us more confidence for our hypothesis."

 

Pigs’ brains restarted basic cellular functions hours after death, with support from a system that pumped oxygen and nutrients into the organs. Credit: Michael Staudt/VISUM/eyevine