COVID-19 Pandemic
Aina Abell and Rachel Balick
If you are overwhelmed by the rapid and drastic evolution of the COVID-19 global health crisis, you are not alone. In this special coronavirus issue of Pharmacy Today, we break down the key events that have occurred since the outbreak emerged, what information we knew when, and some of the ways the pandemic has touched the pharmacy world, including in the care of patients with chronic pain or opioid use disorder, in education, and in pharmacists’ well-being. Timeline sidebars, as well as entries marked “APhA coronavirus watch,” refer to APhA’s pharmacist.com coverage of the pandemic. Pharmacy Today’s coverage of COVID-19 will continue beyond the May issue as pharmacists on the front lines and the global community grapple with one of the most devastating health crises of our time.
COVID-19 timeline
12.31.19
China reported dozens of pneumonia cases with unknown causes in Wuhan.
01.01.20
Chinese officials closed the Huanan seafood market in Wuhan, suspected to be the source of the mystery illness.
01.07.20
China identified a new coronavirus as the cause of the outbreak.
01.09.20
China reported its first death linked to the new coronavirus, 2019-nCoV.
01.12.20
China shared the genetic sequence of the virus to help countries test and trace potentially infected people.
01.13.20
Thailand reported its first imported case of 2019-nCoV.
01.16.20
Japan reported its first imported case.
01.20.20
South Korea reported its first case.
01.21.20
CDC confirmed the first U.S. case, a man in his 30s from Washington State who had traveled to Wuhan. The World Health Organization (WHO) confirmed human-to-human transmission of the virus.
01.22.20
A WHO emergency committee decided that 2019-nCoV was not yet a global health emergency.
01.23.20
China placed Wuhan under quarantine, shutting down the airport, trains, and public transportation.
01.25.20
Australia, Malaysia, and Canada reported their first cases. The virus reached Europe as France confirmed its first cases.
01.29.20
The virus reached the Middle East for the first time as the United Arab Emirates reported its first cases.
01.30.20
WHO declared the outbreak a global health emergency as global cases topped 9,000, reaching 18 countries outside of China. The Philippines and India confirmed their first cases.
01.31.20
The White House announced it would ban entry for most foreign nationals who had traveled to China within the last 14 days. The United Kingdom, Russia, Sweden, Spain, and Italy reported their first cases.
02.01.20
The Diamond Princess cruise ship from Yokohoma, Japan, confirmed that a passenger had tested positive.
02.02.20
The Philippines reported the first death from the virus outside of China.
02.03.20
China launched the clinical trial of Gilead’s antiviral drug remdesivir. The Huoshenshan Hospital in Wuhan, built in 10 days to treat 2019-nCoV patients, began operations. Cases in China reached 20,438.
02.04.20
APhA coronavirus watch: Despite all the worry about the new coronavirus, the real threat to Americans right now influenza, said CDC. There are more than 19 million U.S. cases of flu this season and an estimated 10,000 flu-related deaths, including 68 children.
The Diamond Princess cruise ship was quarantined in Yokohoma, Japan.
02.06.20
APhA coronavirus watch: In a survey by the National Community Pharmacists Association (NCPA), 54% of surveyed pharmacy owners said their patients are worried about the new coronavirus, 63% said their customers are buying surgical masks as a precaution, and 96% said they’re selling masks faster than they can restock. Many pharmacists reported shortages of hand sanitizers, surface sanitizers, and gloves. On the other hand, 32% of pharmacists said the new coronavirus is a significant public threat, 42% disagree, and 26% are unsure. The news coverage is clearly affecting consumer behavior, said Brian Caswell, president of NCPA.
02.07.20
WHO told reporters there was a severe global disruption in the market for personal protective equipment (PPE), affecting access for frontline health professionals.
02.08.20
The first U.S. citizen died from the virus in Wuhan.
02.09.20
The death toll in mainland China rose to 811, surpassing that of the SARS outbreak in 2002 and 2003, which killed 774 people.
02.10.20
The death count rose to 909, surpassing that of MERS, which killed 858 people.
02.11.20
WHO assigned an official name to the disease caused by the novel coronavirus: COVID-19. The global death toll reached more than 1,000.
02.14.20
Egypt reported its first case, becoming the first African country touched by the outbreak. The first COVID-19 death outside of Asia was recorded in France.
02.19.20
Iran reported its first two cases. Hours later, officials confirmed both patients died.
02.24.20
Italy’s outbreak has become the largest outside of Asia. The Dow Jones experienced its worst day in 2 years.
02.25.20
CDC warned about the likely spread of the virus in the United States, saying “it’s not a matter of if, but when.”
02.26.20
California announced the first U.S. cases with no clear source of exposure. The virus reached South America as Brazil confirmed its first case. The virus had now touched every continent except Antarctica.
02.27.20
APhA coronavirus watch: FDA reported the first drug shortage brought on by the COVID-19 outbreak. The agency said it is closely monitoring the drug supply chain.
02.29.20
A man in his 50s in Washington State became the first recorded death from the virus in the United States. President Trump announced travel restrictions involving Iran and increased warnings about travel to South Korea and Italy.
03.02.20 A virus expert’s perspective
(Editor’s note: This interview was conducted on February 28.)
For more than 15 years, Timothy Sheahan, PhD, has studied the molecular mechanisms of viral pathogenesis in the hope of discovering viral and/or host proteins to target for antiviral therapy. Pharmacy Today recently caught up with him to learn more about the new coronavirus, called SARS-CoV-2, which causes a respiratory disease—known as COVID-19—that’s causing fear around the world.
Pharmacy Today: Given that many pharmacists have a hard time convincing people to get their flu shots, what advice would you give a pharmacist who is talking to a patient concerned about the coronavirus while underestimating flu risk?
Sheahan: When I try to talk to the general population about vaccinations, especially about flu vaccination, I tell them I consider my flu vaccine like wearing a seatbelt in a car. It’s a perfectly safe thing, so why wouldn’t you get it if it could save your life?
As far as coronavirus, [pharmacists should tell patients] the usual stuff—if you’ve been out, handwashing is really important and is the most overlooked, simple thing you can do to protect yourself. Whenever I’m out on a town bus, I’m always washing my hands afterward.
At this point in time, people don’t need to be worrying about wearing masks—not in this country, anyway—unless you’re sick. Masks come in all [types], and the flimsy surgical masks don’t really offer much protection from getting sick but might stop you from [touching your nose or mouth]. People tend to think of masks as protecting them from acquiring an infectious disease, but it may be better if you are sick with some respiratory [illness] to wear one to protect the people around you, like in your house.
Pharmacists may get questions about medication. Unfortun-ately, there’s nothing a pharmacist can do to help out with at this point, until a coronavirus antiviral is approved.
Pharmacy Today: Based on what we know today, even as developments continue to emerge, how do you think the risk in the United States will increase?
Sheahan: The global COVID-19 situation is fluid and evolving daily. Last week, I thought there was a low risk for rampant COVID-19 in the United States and would have thought influenza posed more of a public health risk in this country. Now, I think the risk is moderate. As testing for the new coronavirus is now under way in the United States, we have seen a few cases pop up in California, which is suggestive of community spread in the past few days. That means that these are cases acquired from the community and are not linked to international travel or exposure to people known to have COVID-19.
Just like influenza, the new coronavirus causes more severe disease in the elderly. So, we need to make sure this demographic is prepared and has an adequate supply of medication, nonperishable food, and supplies in the event that we see continued community spread here and are advised to stay home.
Pharmacy Today: There are a lot of theories about whether this is going to become a pandemic or if it’s going to be something that just kind of dies out like SARS did. What’s your feeling about it?
Sheahan: It’s hard to know. One thing about this, though, is that there are so many cases—and probably a lot of cases that we don’t yet know about—and there seems to be an increase in the number of cases outside China. The numbers of new cases outside of China—South Korea, Japan, Italy, Iran, et cetera—now exceed the new cases in China. So, even if those places can contain the virus in their country, everyone else must be able to do the same thing to prevent it from becoming a pandemic.
So, it’s hard to know if it’s going to die out like SARS did or if it will go pandemic. Some people are even saying it might become endemic and just be something that happens seasonally, like the coronaviruses causing the common cold. But right now, it’s hard to know how that’s going to go.
03.02.20
APhA coronavirus watch: APhA created a resource center for pharmacists at www.pharmacist.com/coronavirus. The web page includes the latest from federal agencies and a decision tree document that helps pharmacists talk to patients with various levels of exposure to COVID-19.
03.05.20
U.S. Congress approved an $8.3 billion emergency spending package to combat the coronavirus.
03.06.20
President Trump signed the $8.3 billion emergency spending package. Vice President Mike Pence announced that 21 people aboard the Grand Princess cruise ship tested positive for the virus.
03.07.20
Cases worldwide surpassed 100,000.
03.10.20
APhA coronavirus watch: Kentucky Gov. Andy Beshear announced an executive order allowing pharmacists to fill prescriptions for noncontrolled medications for 30 days, including an emergency refill, so patients can stock up and avoid going out to stores.
CMS reminded Medicare Advantage Organizations and Part D sponsors that they have the flexibility to remove prior authorization requirements, waive prescription refill limits, and relax restrictions on home or mail delivery of prescription drugs.
Italy issued a nationwide quarantine.
03.11.20
WHO declared the global COVID-19 outbreak a pandemic.
APhA coronavirus watch: Florida Gov. Ron DeSantis signed into law a bill that allows pharmacists to test and treat patients with illnesses such as influenza and strep throat and patients with chronic illnesses. The order also allows pharmacists to set up mobile stations in locations not designated as a pharmacy to ensure homebound older adults and others in need have access to necessary medication.
President Trump announced travel restrictions on foreign travelers from 26 European countries. APhA canceled its 2020 Annual Meeting & Exposition.
03.13.20
President Trump declared a national state of emergency.
APhA coronavirus watch: CVS Health, Target, Walgreens, and Walmart joined President Trump at the Rose Garden to announce plans to provide COVID-19 testing across the country. APhA sent a letter to the President’s Coronavirus Task Force urging it to maximize the use of pharmacists to prevent, treat, and respond to the virus. APhA released a statement calling on the nation’s health insurers and PBMs to immediately remove administrative barriers to pharmacists and patients filling prescriptions early.
03.14.20
FDA announced a temporary policy allowing pharmacists in state or federally licensed facilities to compound alcohol-based hand sanitizer. Spain enacted a partial lockdown.
03.15.20
U.S. cases surpassed 3,000, with 61 deaths. CDC recommended to cancel or postpone events with 50 or more people.
03.16.20
CMS approved Florida’s request for a Section 1135 waiver, the first to be granted, giving the state flexibility in its Medicaid program. The Dow Jones Industrial Average sank by 3,000 points, and the S&P 500 and NASDAQ were down by around 12% by the closing bell. San Francisco became the first U.S. city to impose a stay-at-home order, except for essential needs. President Trump advised all Americans to avoid gatherings of 10 or more people, outings to bars and restaurants, and discretionary travel.
03.17.20
APhA coronavirus watch: APhA released a statement on the importance of precautions to protect pharmacy personnel from exposure to COVID-19 as they care for patients and communities.
West Virginia, the last U.S. state without a confirmed case, recorded its first.
03.18.20
Canada and the United States agreed to close their borders to all “nonessential traffic.” The Trump Administration suspended refugee admissions, citing coronavirus concerns. President Trump signed the Families First Coronavirus Response Act, which would provide free coronavirus testing and ensure paid emergency leave for people infected or caring for a family member with the illness. It would also provide additional Medicaid funding, food assistance, and unemployment benefits.
03.19.20
APhA coronavirus watch: APhA coronavirus watch: APhA released guidance for patients and caregivers on how to ensure adequate supplies of medication if they become unable to get to the pharmacy.
To ensure that substance use disorder treatment services are uninterrupted, the Substance Abuse and Mental Health Services Administration (SAMHSA) eased prohibitions on use and disclosure of patient identifying information under 42 C.F.R. Part 2 would not apply in these situations to the extent that, as determined by the provider(s), a medical emergency exists.
Cases worldwide surpassed 200,000. Italy overtook China as the country with the highest death toll, with 3,405 fatalities. California issued a stay-at-home order.
03.20.20
APhA coronavirus watch: APhA coronavirus watch: APhA, along with other pharmacy organizations, released a joint set of policy recommendations to enhance patient care during the ongoing health crisis.
The APhA House of Delegates held its first virtual session. The body voted on protecting pharmaceuticals as a strategic asset, the protection of pharmacy personnel during public health emergencies, classification of pharmacy personnel as frontline providers, enforcement of laws and regulations against adulterated products and false and misleading claims by entities offering to sell pharmaceutical and medical products to health care providers and consumers, and inappropriate and unethical prescribing and ordering of medications and medical supplies for personal use or for use by colleagues or family members.
DEA eased restrictions on early refills of prescriptions for controlled substances as long as conditions specified by the Controlled Substances Act are met. Prescriptions must be signed and dated by the prescriber and indicate the earliest date the refill can be dispensed.
The United States announced plans to close the border with Mexico. New York City Mayor Bill de Blasio said the city is now the country’s epicenter, with 5,151 coronavirus cases and 29 deaths. The Dow Jones experienced its worst weekly performance since the 2008 financial crisis.
03.21.20
Confirmed cases in New York State surpassed 10,000. In a tweet, President Trump promoted the use of hydroxychloroquine and azithromycin, taken together, as a potential treatment for COVID-19, despite lack of sufficient evidence for its effectiveness.
03.22.20 FDA issues new guidance on patient access to REMS drugs
FDA issued new guidance on required testing for the Risk Evaluation and Mitigation Strategy (REMS) program. Although all REMS requirements remain in effect, the agency said it will not take enforcement action against health care providers or sponsors for failing to adhere to REMS requirements for certain laboratory testing or imaging studies during the COVID-19 public health emergency.
“The completion of some REMS-required laboratory testing or imaging studies may be difficult because patients suspected of having COVID-19 may be self-isolating and/or subject to quarantine,” stated FDA Principal Deputy Commissioner Amy Abernethy, MD, PhD, in a press release. “Under these circumstances, undergoing testing or imaging studies in order to obtain a drug that is subject to a REMS can put patients and others at risk for transmission of the coronavirus. We will continue to work with sponsors to ensure that patients have appropriate access to the medications they need.”
Providers who prescribe or dispense drugs that are subject to REMS with laboratory testing or imaging requirements should consider whether there are compelling reasons not to complete these tests or studies, FDA said. They should use their best medical judgment in weighing the benefits and risks of continuing treatment in the absence of testing or studies and communicate with their patients about these judgments.
The guidance, available at www.fda.gov/media/136317/download, will be in effect for the duration of the COVID-19 public health emergency.
03.22.20
Global cases surpassed 300,000. President Trump announced he would activate the federal National Guard to assist Washington, California, and New York, the three states hit hardest by the pandemic.
03.24.20
Global cases surpassed 400,000. India announced a nationwide lockdown. The Tokyo 2020 Olympics was postponed. U.S. cases reached more than 50,000.
03.25.20 Senate passes coronavirus legislation without provider status
Despite intense lobbying by a coalition of pharmacy stakeholders, the U.S. Senate on Wednesday, March 25, 2020, passed a coronavirus legislative package that did not include pharmacist provider status language. The Coronavirus Aid, Relief, and Economic Security Act (CARES Act), the third legislative package in response to COVID-19, is aimed at mitigating the economic effects of the pandemic. The pharmacy stakeholder coalition will continue working toward inclusion of language that recognizes pharmacists and their services in Medicare Part B in future coronavirus legislation and ultimately makes that recognition permanent.
The $2 trillion economic stimulus legislation passed 96–0.
The CARES Act did include provisions that APhA has supported. One provision strengthens drug shortage reporting requirements from manufacturers and response during public health emergencies—a concept that aligns with recently adopted policy by the APhA House of Delegates. It will also restore consumers’ ability to use tax-preferred account funds to pay for OTC medicines without requiring a prescription.
Other provisions in the bill also affect pharmacists. One allows pharmacists to administer the coronavirus vaccine or vaccines when available, either under current Medicare rules categorized as “suppliers,” when Part B compensates pharmacists as mass immunizers, or both. Another gives the Secretary of the U.S. Department of Health and Human Services (HHS) the authority to consider waiving all Medicare telehealth restrictions to treat COVID-19 in the future, such as restrictions on pharmacists offering these services or even on telepharmacy.
The CARES Act also provides for possible inclusion of pharmacists in the U.S. Public Health Service’s Ready Reserve Corps to respond to a public health or national emergency and offers federal liability protection to health professionals, including pharmacists, who volunteer to provide COVID-19 health care services.
03.25.20
The U.S. Senate passed the CARES Act. WHO warned that the United States could become the “global epicenter” of the pandemic. FDA issued an emergency use authorization for ventilators, ventilator tubing connectors, and ventilator accessories. Britain’s Prince Charles tested positive for the virus. Britain’s parliament closed to slow the virus’s spread.
03.26.20
The United States became the new epicenter of the pandemic, with 82,474 cases and more than 1,100 deaths. The U.S. Department of Labor reported that 3.28 million people filed for unemployment insurance the week before.
03.27.20
Cases worldwide topped 500,000, with 24,082 deaths. U.K. Prime Minister Boris Johnson tested positive for COVID-19. U.S. cases topped 100,000, the most in the world, with more than 1,500 deaths. President Trump signed the CARES Act into law.
03.28.20
Cases worldwide surpassed 600,000. Italy’s death toll reached 10,000. South Korea recorded more recoveries than active cases for the first time. FDA authorized the emergency use of a new, rapid coronavirus test that could give patients results in less than 15 minutes. The first known U.S. infant death was reported in Illinois.
03.30.20
APhA coronavirus watch: DEA allowed oral prescriptions of Schedule II controlled substances when they are needed for proper treatment, there are no appropriate treatment alternatives, and submitting an electronic or paper prescription to the pharmacy prior to dispensing is not possible.
03.31.20
The United States halted USAID’s global shipments of PPE, asking them to be sent to the United States instead. Deaths in New York City topped 1,000, as confirmed cases climbed to 41,771. FDA established the Coronavirus Treatment Acceleration Program to expedite the development of treatments. President Trump announced that the country could be facing a bestcase scenario of 100,000 to 240,000 deaths. Hydroxychloroquine sulfate tablets and chloroquine phosphate tablets were added to FDA’s Drug Shortages list. Italy said its cases were reaching a plateau.
03.31.20 Inappropriate prescribing poses dilemma for pharmacists
There is scant evidence that chloroquine/hydroxychloroquine, alone or in combination with azithromycin, are effective treatments for COVID-19—but in the face of uncertainty and encouragement from President Trump, many health professionals have seized on their use. As pharmacies across the country have been flooded with fill requests for the drugs—troubling pharmacists and potentially contributing to shortages—pharmacy, medical groups, and state boards have taken a stand against the phenomenon.
Boards and associations speak out
State governments and boards of pharmacy in Idaho, Kentucky, Nevada, North Carolina, Ohio, Oklahoma, and Texas, with more considering policy, have taken action against inappropriate prescribing and hoarding, specifying that prescriptions must meet certain requirements to be filled.
In addition, APhA, the American Medical Association, and the American Society of Health-System Pharmacists released a joint statement on March 25, emphasizing ‘strong opposition’ of physicians’ and others’ prophylactic prescribing of medications currently identified as potential treatments for COVID-19—mainly chloroquine/hydroxychloroquine and azithromycin—for themselves, their families, or their colleagues; and some pharmacies’ and hospitals’ excessive purchasing of the medications in anticipation of potentially using them for COVID-19 prevention and treatment. Read the statement at https://apha.us/AMAJointStatement.
The groups strongly agree that pharmacists should use their professional responsibility to “make reasonable inquiries to a prescriber to resolve any questions about a prescription” and balance the needs of patients taking these medications on a regular basis for an existing condition.
Steady level of diligence
Former federal prosecutors Steven Block, JD, and Sarah Hall, JD—now partner and senior counsel, respectively, at the law firm Thompson Hine LLP—agree that pharmacists should rely on their professional judgment about suspicious prescriptions for drugs thought to be useful for treating COVID-19.
“A lot of pharmacists that I’ve talked to are really questioning what their ethical and their legal responsibilities are if they get requests that just don’t seem right,” Block said.
He has heard stories of pharmacists asked to fill chloroquine prescriptions called in by veterinarians and out-of-state doctors they’ve never worked with before. When questioned, some prescribers have claimed the prescription was for a relative with rheumatoid arthritis (RA) or a patient recently diagnosed with RA. “When they drill further, it doesn’t seem like the physician’s specialty would even treat RA,” Block said.
“The best way for pharmacists to handle [suspicious orders] is to do some amount of diligence now [so they don’t] have to explain why they filled scripts with serious warning signs to a government regulator or a criminal prosecutor 2 years from now,” Block said.
Pharmacists are gatekeepers
Decisions of whether to dispense these medications also has professional implications.
The pandemic will eventually subside, Hall said. “But fill records are going to last forever, and they need to be cognizant of being able to defend how they filled the scripts.”
The U.S. Department of Justice (DOJ) and other regulators have a history of investigating data after crises. “When DOJ looks at individuals to target for prosecution, there is always a higher standard applied to individuals who hold licenses—doctors, lawyers, nurses, pharmacists, anyone who uses special skill and training in what they do,” Hall said.
Prescribers will be at the top of the pyramid. “But the pharmacist is a gatekeeper, so they’ll be held to high standards.”
Preparing for the worst
DOJ has already directed every U.S. Attorney’s office in the country to prioritize the detection and investigation of any criminal conduct related to the pandemic. Pharmacists don’t necessarily have to be scared, but they do have to be careful. “The government tends to have a very low threshold to investigate cases in the wake of disasters such as this one,” Block said.
“They’re not going to only be concerned about the pharmacist who filled a bogus order for 25,000 doses. They may also look at the possibly bogus order of 500 doses,” he said. In the context of a fast-moving public health crisis, “where people are going to be tired and overworked and scared, [pharmacists] simply need to be reminded to still take the steps they would normally take.”
04.02.20
Cases worldwide surpassed 1 million, with more than 51,000 deaths. Spain’s death toll topped 10,000. Iran’s confirmed cases surpassed 50,000, with 3,160 deaths. The U.S. Department of Labor reported that a record 6.6 million Americans filed for unemployment benefits the previous week. The U.S. death toll rose to more than 5,000, with at least 2,000 in New York.
04.03.20
APhA coronavirus watch: Pharmacists will be included in legislation creating a tax holiday for health professionals and first responders who continue to serve during the COVID-19 pandemic. The legislation, the Helping Emergency Responders Overcome Emergency Situations (HEROES) Act of 2020, initially did not include pharmacists as beneficiaries, but after a request from the APhA Government Affairs team, bill sponsor Rep. Bill Huizenga (R-MI) added pharmacists to the list.
FDA said it will coordinate development of convalescent plasma and hyperimmune globulin to treat patients with COVID-19. The products are derived from human blood donated by people who have recovered from the virus. The U.S. Supreme Court announced it will scrap the oral argument schedule for the rest of the term. The White House and CDC recommended Americans wear cloth face coverings in public to prevent the spread of the virus.
04.04.20
U.S. cases reached more than 300,000, with more than 8,000 deaths. New York State’s total cases reached 113,704, with 3,565 deaths. Italy reported more than 15,000 deaths but stated that new infections were leveling off.
04.05.20
Britain’s Queen Elizabeth II gave a rare address to the nation about the pandemic. Spain’s daily death toll fell for the third day in a row, and Italy’s fell to its lowest level in more than a week. President Trump advised parts of the country to brace for a peak of cases in the coming week.
04.06.20 CDC releases pharmacy-specific guidance
Lisa M. Koonin, DrPH, MN, MPH, who serves as a senior advisor in support of the CDC 2019 Novel Coronavirus (nCoV) Response, announced new guidance from the agency intended to help pharmacies during the COVID-19 pandemic. The guidance, Considerations for Pharmacies in the COVID-19 Pandemic, can be found at apha.us/CDC_pharmacies.
The guidance covers four main topics. The first is a recommendation “making sure that pharmacy staff who have fever or any respiratory symptoms stay home and away from the workplace until they have recovered,” Koonin said.
The second part is about filling prescriptions. In its guidance, CDC outlines steps to facilitate as much physical distancing as possible. Recommended steps include encouraging all prescribers to submit prescriptions electronically or by phone; having patients take a photo or read out loud the information on their benefit or insurance cards, so pharmacy staff doesn’t have to handle them; and washing hands or using hand sanitizer after coming in contact with items a patient has touched.
The guidance recommends using signage, barriers, or floor markers to instruct waiting customers to remain 6 feet back from the counter and from each other, Koonin said. “Some pharmacies are installing sections of clear plastic material so that there can be a barrier of protection at the counter.”
The guidance also recommends frequent cleaning and disinfection of all customer service counters and customer contact areas. Pharmacies can also promote the use of self-checkout stations, which should be regularly cleaned and disinfected.
Administrative controls include using signs to divert as many patients as possible to drive-throughs, curbside pickup, or home delivery; and requesting via text messages that patients who are sick send someone else to get their medication or use alternative pickup methods. Pharmacies could also limit the number of people allowed in the store at one time to avoid crowding and long lines.
Pharmacists who provide chronic disease or medication management services or other counseling could explore providing the services over the phone or through telehealth and telepharmacy, Koonin said.
The guidance’s final recommendations deal with COVID-19 testing. “Pharmacies that are participating in legitimate public health testing for COVID-19 should communicate with their local or state public health staff to determine which persons meet the needs criteria for testing, and also about how to collect, store, and ship specimens.”
Koonin advised that the guidance includes links to information about testing and infection control guidance for pharmacy staff conducting COVID-19 testing.
04.06.20
APhA coronavirus watch: CDC released a recommendation that adult immunizations requiring face-to-face encounters and in areas with community transmission of COVID-19 should be postponed except when an in-person visit must be scheduled for another purpose and the clinical preventive service can be delivered with no additional risk; or a patient and their clinician believe that the potential benefit outweighs risk of exposure to COVID-19.
Pharmacy technicians were added to the HEROES Act. U.K. Prime Minister Boris Johnson was moved to the ICU. U.S. deaths topped 10,000. China reported its first day without deaths since the outbreak began.
04.07.20
DEA allowed increased production and importation of medications in high demand, including methadone, to ensure access to patients in opioid treatment programs.
04.08.20
APhA coronavirus watch: The U.S. Department of Health and Human Services (HHS) authorized licensed pharmacists to order and administer FDA-approved COVID-19 tests, including serology tests.
China lifted its lockdown on Wuhan.
04.09.20
APhA coronavirus watch: HHS’ Office for Civil Rights announced it will exercise its HIPAA-enforcement discretion and will not impose violation penalties for entities or business associates that participate in COVID-19 testing in good faith. This takes effect immediately and is retroactive to March 13, 2020.
One hundred days have passed since China initially notified WHO of COVID-19.
04.10.20
APhA coronavirus watch: FDA issued an emergency use authorization for a blood purification system on adult patients with COVID-19 who are admitted to ICUs.
Global deaths topped 100,000. A New England Journal of Medicine report found Gilead’s remdesivir showed improvements in two-thirds of severe COVID-19 cases.
04.14.20
President Trump announced he will halt U.S. funding of WHO while a review is conducted to assess the organization’s role in “severely mismanaging and covering up the spread of the coronavirus.”
04.22.20
Tissue samples from autopsies of two people in Santa Clara County, who died on February 6 and 17, tested positive for COVID-19, showing that the virus could have been causing deaths weeks earlier than initially thought. Prior to this discovery, the first U.S. death was believed to have been on February 29.