Coronavirus: Resources for pharmacists and an interview with a virus expert

The new coronavirus, known as COVID-19, is causing fear around the world, and new cases in 12 U.S. states—89 cases as of 1:30 pm on March 2—mean that questions from patients will ramp up. A number of resources are available to help pharmacists separate fact from fiction, care for patients and communities, and stay prepared for whatever lies ahead.

Available resources

APhA has 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.

CDC Clinician Outreach and Communication Activity (COCA) prepares clinicians to respond to emerging health threats and public health emergencies by communicating relevant, timely information related to disease outbreaks, disasters, terrorism events, and other health alerts. COCA will host a call on what clinicians need to know to prepare for COVID-19 in the United States on Thursday, March 5, 2020, at 2:00 to 3:00 pm Eastern Time. The call will focus on identifying persons under investigation, applying infection prevention and control measures, assessing risks for exposures, optimizing the use of personal protective equipment supplies, and managing and caring for patients—inpatient and at home. To learn more and access call-in information, visit https://apha.us/COCAcall.

A virus expert’s perspective

For more than 15 years, Timothy Sheahan, PhD, has studied the molecular mechanisms of viral pathogenesis in hopes 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: To start, tell me about yourself and your work.

Timothy Sheahan: I’m an assistant professor at the Gillings School of Global Public Health at University of North Carolina Chapel Hill. I have my PhD in virology, so I’m not licensed to give medical advice. My research focuses on discovering new methods of viral control.

Pharmacy Today: Given that many pharmacists have a hard time convincing people to get their flu shots, with these two conditions coexisting, 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? I had the flu in 2009, and I was having hallucinogenic fever dreams. I don’t know why people are kind of laissez-faire about it, especially when thousands of people die in the United States each year.

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]. Other kinds of masks are designed to filter out microbes and are commonly called N95 masks. 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.

And be aware of where you’ve been and who you’ve been around, especially if they are sick. That’s pretty practical advice.

Pharmacists may get questions about medication. There are no approved drugs specifically for any human coronavirus, which is something that I’m working to change. So, unfortunately, there’s nothing that 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? Do you have any sense of what we might see as things develop?

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 underway 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. (Editor’s note: This interview was conducted on February 28.)

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. So, I think it is really important that people in the United States stay vigilant and aware of their health and the health of those around them. Handwashing is really important after being out in public.

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: What do Americans not understand about coronavirus?

Sheahan: One thing that most people probably don’t get is that there are coronaviruses everywhere. They’re in wild and domestic animals, and there are four that circulate among humans that give us the common cold. By the time we’re adults, we probably have immunity to those coronaviruses. But because common cold coronaviruses don’t normally kill people and you just get cold-like symptoms, they tend to be forgotten.

People think about SARS coronavirus, or maybe they remember people talking about MERS coronavirus just because of the severe symptoms they caused. [Severe acute respiratory syndrome first appeared in China in 2002 and spread worldwide, with no known cases since 2004. Middle East respiratory syndrome first appeared in Saudi Arabia in 2012, with two unlinked cases found in the United States in 2014.] But we live among coronaviruses all the time. That’s one thing that the average person might not know.

Because there are coronaviruses everywhere, the likelihood that we will have continued emergence—like this new coronavirus, and like we had with both SARS and MERS—is definitely possible, if not inevitable.

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 common cold–causing coronaviruses. But right now, it’s hard to know how that’s going to go.

Pharmacy Today: There’s a lot of fear around COVID-19, even as the risks of flu are consistently underestimated. What do influenza and this specific coronavirus have in common, and how do they differ from each other?

Sheahan: They’re both respiratory viruses, so they’re transmitted primarily by the respiratory route—coughing and sneezing and contact with respiratory secretions.

There is some thought about potentially the new coronavirus being spread by the fecal–oral route, and that people might shed it from their GI tract. That’s still not proven, and it’s also not known how much spread might be due to that route, but that would make it different from the flu.

Flu and coronavirus both have RNA for their genetic material. The virus particle itself can be made up of different things or in a different style, and both influenza and coronavirus are enveloped viruses. That means that as they’re leaving the cell in which they’re made, they take a part of the membrane of the cell that they’re growing in with them—that’s different from poliovirus or rhinovirus, which basically have a naked protein shell on the outside rather than having this membranous envelope around it. That has a direct impact on stability in the environment.

The viruses that you typically think of as causing GI issues, like polio or norovirus, are not enveloped and so are really stable in the environment. Stability is largely driven by how the particle is made and what it’s made of. Usually, enveloped viruses are less stable in the environment, and they’re susceptible to alcohol disinfectants and stuff like that, whereas with some of the tougher viruses, you really need bleach to kill them. So, handwashing with soap and water and alcohol-based hand sanitizers should be effective against the new coronavirus. Normal household cleaners like soap and water, alcohol-based cleaners or bleach-containing disinfectants should be sufficient to clean surfaces and objects in the home.

Pharmacy Today: Are there cultural or environmental factors that could make coronavirus worse for other areas than it would be here in the United States?

Sheahan: SARS is thought to have emerged from a bat ancestor. Viruses similar to SARS are found in bats in China, and that type of bat doesn’t live in North America. So, ecology has a role.

We don’t know for sure if the emergence of coronavirus might be in part driven by cultural differences. If it is, differences in how food systems work could be making it more likely for coronavirus to emerge in China rather than in North America. Differences in the prevalence of smoking or underlying comorbidities might predispose one population to this more than others, but we just aren’t sure. Ecological, behavioral, and cultural differences do drive that.