by Jeff Lewis
As one of the nation’s most accessible healthcare professionals – drop by anytime, no appointment necessary – I’m grateful for the individual and collective commitment that pharmacists have in supporting the well-being of our communities during such troubling times. In times of uncertainty, fear, and confusion, it is also encouraging to witness the sincere collaboration of the entire healthcare team – setting aside self and, collectively, ministering to the health needs of others.
People are scared. They’re attempting to interpret the ever-changing information being funneled to them via the media. They’re looking for a sense of control over the elusive…peace within the chaos. Unfortunately, the early stages of a pandemic are filled with more questions than answers. And, yesterday’s answers are often invalidated today. The accessibility of pharmacists – especially those serving in community pharmacies – puts them on the front line of answering questions, triaging care, and infusing a measure of security into the lives of others.
A pandemic drastically changes the manner of a community pharmacist’s daily business. Here’s a little glimpse ‘behind the counter’.
One challenge of the community pharmacy is changing workflow in an effort to reduce community spread of the coronavirus. In an environment that is regularly visited by individuals with illness and/or risk factors making them more vulnerable to the most serious effects of the coronavirus, it is of critical importance for the environment to become more orderly and respectful of social distancing recommendations. With cautions leading to a slower workflow, patience – on the part of everyone – is required more than ever. Other strategies being employed to limit community spread include such things as telemedicine communication and ‘parking lot’/home delivery of medications to an extent never before seen.
Although the pandemic consumes the conversations, meeting the ongoing needs of patients in the management of chronic medical conditions requires extra attention. Pharmacists around the country have been quick to engage state agencies aimed at easing prescription refill regulations – ensuring that self-isolation doesn’t overly disrupt ongoing treatment plans.
The present pandemic is caused by a virus for which there is neither a treatment nor a vaccine. Yet, there are emerging medications in both categories and it is incumbent on the pharmacist to maintain a keen awareness of both the scientific data and the potential ramifications of community awareness.
Of note, a medication that has been used for many years in the treatment of malaria – hydroxychloroquine – has been identified as a potential treatment for coronavirus. It is also used to treat symptoms of rheumatoid arthritis (RA) and systemic lupus erythematosus (aka, lupus), diseases of the immune system. Usually, this medication is in limited supply in a community pharmacy because of the rather small patient population that uses it. However, the purported potential of the medication to effectively treat coronavirus has created a number of unexpected, and very concerning dynamics. Chief among them, prescribers have been prescribing the medication for themselves, family, and friends to have ‘just in case’ any of the individuals become infected. This has created a shortage of the medication in pharmacies, such that individuals who regularly use it for the treatment of RA or lupus are unable to get it.
Further, should the medication prove useful for the treatment of coronavirus, those individuals who are sick will be unable to receive it. From a healthcare ethics perspective, the principle of ‘distributive justice’ would stand in strong opposition to such hoarding of medications. In response, pharmacists are implementing strategies to help ensure that the supply of hydroxychloroquine (along with its “cousin” chloroquine) are reserved for those who presently, or urgently, need it.
Pharmacists are using their expertise in medication compounding to meet unexpected needs. Only weeks ago, nobody would have imagined that the nation’s supply of alcohol-based hand sanitizer would have been, effectively, exhausted. This was less related to hoarding, and more related to the fact that everyone needed some, and the on-hand supplies were insufficient to meet the needs. In response, pharmacists are employing their expertise in the compounding of hand sanitizer.