An Outpatient Pharmacist’s Perspective on the COVID-19 Pandemic

March 27, 2020

A retail pharmacist at a Florida health system provides a view of the COVID-19 pandemic from his front line and suggests ways forward.

I work for a health-system in Florida, and, as you have probably seen on the news, COVID-19 has definitely arrived in our state (and our hospitals).

It moved incredibly fast – only a couple of weeks ago we were at “We need to get ready for the outbreak,” and suddenly we are preparing for supply shortages and being overwhelmed by the crisis.

It is scary to think we are actually in times, for example, where hospitals are considering DNR orders on all COVID-19 patients due to a shortage of personal protective equipment (PPE).

Below are my thoughts on the pandemic and the response and on actions as a pharmacy community we have taken to combat the crisis:

Pharmacies are waiving home delivery and shipping fees, if they had them. Pharmacists (and technicians) have stepped in to solve problems and do our part to continue dispensing while protecting our staff and helping to control the outbreak. While many pharmacies already offered home delivery and mail order, those that didn’t are utilizing it as one tactic in this initiative.

In our pharmacy, I had (thankfully) applied for a FedEx account a while back and got my login credentials about a week ago. Perfect timing! We immediately got up and running with mail order. We of course thought we would have more time to prepare for a mail order launch, so while it has been trial by fire, we mailed our first medications out the same day the account was active.

State licensing requirements have hindered our ability to help. I’ve written about this previously, but not having a process in place for pharmacists to obtain multistate licensure is preventing us from responding quickly to the outbreak. Our health system, for example, has employees and clinics located in another state. I am wanting to ship our employee medications to their home in that state but cannot do so because of licensing.

The out-of-state permit application says to “allow 25 business days for processing.” Quite frankly, we don’t have that kind of time.

A multistate licensing process for pharmacists and pharmacies would help us improve the medication supply chain while maintaining quality control. As physicians, you’re certainly ahead of us on this one.

Self-prescribing of hydroxychloroquine is causing shortages. This one might hit home for many providers, but please don’t prescribe hydroxychloroquine for yourself, a family member, or a friend. Several state Boards of Pharmacy have stepped in and barred pharmacists from dispensing the medication without a positive COVID-19 test (or a chronic condition requiring the medication).

Let’s save any possible therapy we have for those who need it the most.

This pandemic has exposed significant weaknesses in our global health system. This virus, unfortunately, is laying shame to our global health infrastructure. It makes me ask questions like:

  • Why don’t the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC) each have their own sufficient stockpile of PPE?

WHO estimates that 89 million masks are needed each month to respond. They knew something like this was going to eventually happen; why don’t they have 400-500 million masks (at least!) somewhere in a storage unit? Or maybe multiple storage units located strategically throughout the world? With an unlimited shelf life and no temperature requirements, like medications, PPE should be a relatively easy thing for an international community to stockpile.

The US could easily do the same. In addition to being able to deploy them quickly, it would have bought manufacturers enough time to ramp up production. We do have a national stockpile, but from the perspective of a frontline clinician it’s clearly not enough. I’ve been checking our vendors’ websites every day for anything I can find and usually strike out.

We should have learned our lesson after Hurricane Maria, when disruptions to the supply chain quickly caused shortages of IV fluids for over a year.

  • Why did it take the world so long to respond?

There’s evidence that the first case of COVID-19 dates back to November. From there, it rapidly spread first throughout China, then to the rest of the world, gaining footholds on every continent. And yet,it wasn’t until March that WHO declared a pandemic.

In fact, on January 10, WHO published a statement on international travel that advised individuals to “practice usual precautions.” WHO did not recommend restrictions on international travel but noted “the risk of cases being reported [outside of Wuhan] is increased.” Within 10 days there were confirmed cases in 4 other countries.

I hope the events that have unfolded to date teach us as a global community the consequences, both in lives and in dollars, of prioritizing only what sells on the campaign trail. After all, the $2 trillion stimulus package far exceeds the combined budgets of WHO, the CDC, the FDA, and NIH. We could have even paid for the proposed infrastructure plan, too.  With all that funding, how many more lives could we have improved or even saved?

I hope, in retrospect, we won’t wait until a bridge collapses (literally or figuratively) to care about repairing bridges. Let’s start tackling problems before they happen.

*****

For more COVID-19 coverage for primary care, visit our COVID-19 Resource Page.

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