Clinical Pharmacists Play Active Roles in Coronavirus Preparation Efforts

The 2019 Novel Coronavirus (2019-nCoV) has been monitored closely as the number of positive cases in the United States has risen to 11. In response to the recent alert surrounding the virus, hospital systems, such as the University of Chicago Medicine, are working to determine the best course of action for patients and health care providers alike.

Natasha Pettit, PharmD, BCPS (AQ-ID), clinical pharmacy coordinator of Antimicrobial Stewardship at the University of Chicago, has been involved in the 2019 coronavirus preparation efforts within the university’s hospital system. According to Pettit, leaders from varying areas of the hospital are working together to develop treatment strategies.¹

“We’re not unlike any other academic medical center or hospital that needs to prepare for, at least having policies and protocols in place, for if/when a patient [was] to present at our hospital or clinic with the concern for [coronavirus],” Pettit said in an interview with Pharmacy Times®.

Pettit represents the stewardship program at The University of Chicago Medicine. Within the 2019-nCoV preparation efforts, Pettit supports potential treatment strategies by using data from well-known strains of coronavirus. Although 2019-nCov is a novel strain, Pettit explains that there are well-known data in managing patients with strains of coronavirus, such as Middle East respiratory syndrome (MERS-Cov) and severe acute respiratory syndrome (SARS-Cov).¹

“[The 2019-nCoV preparation efforts] really started with a larger meeting, pulling together not only infection control, but leaders from various departments in the hospital, ranging from our pulmonary care group to [environmental services] workers to admissions staff,” Pettit told Pharmacy Times®. “Now, there have been breakout meetings with the physician staff to come up with what the best treatment strategy is going to look like. Suffice to say we’ll be ready for it if/when the time comes.”

The lack of current information surrounding 2019-nCoV makes it difficult to prepare for every scenario, Pettit explains, but health professionals are doing what they can with the information that they currently have in terms of disease management, diagnostic implementation, and exposure prevention.¹

The 2019-nCoV was first detected in Wuhan City, Hubei Province, China. There are now 146 confirmed cases across 27 countries outside of China, with the first death reported outside of China in the Philippines. There are currently 14557 confirmed cases of infection within China.³ The World Health Organization (WHO) has declared the 2019-nCoV to be a public health emergency of international concern.⁴

The CDC reports that imported cases of 2019-nCoV infection in people have been detected in the United States and there are currently 11 confirmed cases. The virus is not currently spreading in the community in the United States and the risk for the general public is low.²

Because of the threat of person-to-person transmission, health care providers must be aware of their role in managing potential patients with the virus as well as protecting themselves and their patients from transmission. These precautionary steps include providing patients who are presenting with symptoms face masks, following standard contact and airborne precautions, and adhering to strict hand washing and cough hygiene.⁴

“As we’re now getting some of the projections, the numbers of cases are probably much higher than we’re aware of just because of the limitations of testing and the access to care,” Pettit said. “I think just watching it over this time course, but also and especially the first report of it being suspected in a patient that was now in the United States, was definitely the deciding factor of saying, ‘Hey, this is happening, we should have a larger meeting to discuss this.’ But I have to say, Infection Control and some of our leadership, they’ve been watching it since it was first reported.’”

Pettit also explained that the considerations in data availability affect the overall course of the 2019-nCoV, noting that there has been a recent concerns over the fact that a proportion of drugs manufactured in the United States rely on ingredients from China. Because these companies do not have additional or external sources, that dependence could lead to drug shortages down the line.¹

“It’s something that we’re kind of gearing up for as well. Just to make sure that if these are going to be the agents that we need to have available to treat patients with [coronavirus], we have a supply on hand so that we’re not caught without the drugs that we hope to recommend in our protocol,” Pettit said to Pharmacy Times®.

Pettit recommends that frontline pharmacists pay attention to the CDC’s information on presenting symptoms, as well as conducting initial screening and confirming that patients have the proper epidemiological risk factors that would constitute the 2019-nCoV.

This means taking to mind the patient’s travel history, as well as contact with other individuals from Wuhan, China. She also noted that information is evolving surrounding the virus, therefore, pharmacists should remain up-to-date on the latest information from federal agencies, such as the CDC.

“Also, being a frontline pharmacist, obviously the exposure is there, because you’re interacting with the patient. Health care workers should take care of themselves as well. If there’s that suspicion, then following what the CDC has outlined as the proper infection control practices to prevent that exposure,” Pettit said.

REFERENCES

• Interview with Natasha Pettit, PharmD. January 29, 2020.
• 2019 Novel Coronavirus (2019-nCoV) in the United States. CDC Website. Updated January 30, 2020. https://www.cdc.gov/coronavirus/2019-ncov/index.html. Accessed January 30, 2020.
• Novel Coronavirus (2019-nCoV) Situation Report — 1 World Health Organization website. Published February 2, 2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200202-sitrep-13-ncov-vpdf?sfvrsn=195f4010_6. Accessed February 3, 2020.
• Nessel, J. Antrim, A. WHO Declares Coronavirus an International Public Health Emergency as US Reports First Human-to-Human Transmission. Pharmacy Times. Published January 30, 2020. https://www.pharmacytimes.com/news/who-declares-coronavirus-an-international-public-health-emergency-as-us-reports-first-human-to-human-transmission. Accessed January 30, 2020.