TORONTO — Allan’s Community Pharmacy in Thornhill, Ont., doesn’t typically get a lot of walk-in customers — but recently, as COVID-19 spreads, masks and hand sanitizer have been flying off the shelves.
Kit Leong, a pharmacist at Allan’s, said as of a few days ago, the practice, which is beside a medical clinic, has had someone outside taking precautionary measures such as ensuring patrons use hand sanitizer before entering the pharmacy.
Leong isn’t worried about a strain on staff right now; she said most people look for supplies and don’t ask questions. But as the number of people infected with the virus expands, she’s unsure what her pharmacy’s contingency plan is.
“If it starts spreading … we might have to think about who is going to work if so-and-so is in quarantine,” she said.
“I don’t know if [the pharmacy has] contingency plans if three of our technicians are quarantined.”
Ontario now has at least 22 confirmed cases of COVID-19, the disease caused by the new coronavirus, and Canada has at least 36. Experts have raised questions about the ability of Canada’s health-care system to deal with an outbreak.
In a Twitter thread, Dr. Theresa Tam, Canada’s chief public health officer, recommended Canadians refill their prescriptions in case of an outbreak. However, in certain circumstances pharmacists are not allowed to bill early for prescriptions, depending on a patient’s insurance or medication.
The Canadian Pharmacists Association said in a statement it encourages Canadians who require medication on a regular basis to ensure their prescriptions are up-to-date, but warned against stockpiling medication.
Pharmacists are already seeing heightened demand for over-the-counter items like masks and hand sanitizers. In the event of a more severe outbreak, pharmacists will risk dealing with an increased volume of patients — especially if other health-care facilities reach their capacity — and potential staffing issues if anyone becomes infected.
The Ontario government released COVID-19 guidelines for community pharmacies in February. The guidelines recommend pharmacists screen patients over the phone by asking about symptoms and travel or possible exposures, as well as monitor for physical symptoms.
The government also recommends pharmacy staff post signs asking people to self-identify if they have symptoms of COVID-19 and have masks, tissue and hand sanitizer available for patients and staff to use.
“Community pharmacies have a shared responsibility for informing and educating the public on COVID-19, including promoting infection control and preventative measures,” the guidelines read.
Ontario pharmacies are not currently licensed to conduct testing for the new coronavirus.
The Canadian government’s COVID-19 guidelines recommend health professionals become familiar with the interim case definition for the virus to recognize it in patients with symptoms and relevant exposure history. The guidelines also recommend professionals become familiar with the case reporting form.
Another issue that could come into play is that Canada is dependent on China for raw ingredients for pharmaceuticals.
Barbara Gobis, the director of the Pharmacists Clinic at the University of British Columbia, said although she’s not aware of any shortages caused by COVID-19, if it becomes a longer-term problem, Canada could see drug shortages.
“We have become somewhat dependent on China as a society as a provider of local cost goods, so we do run the risk, potentially, of having drug supply issues in the future,” Gobis said.
At the end of February, health officials in the U.S. reported the country’s first drug shortage as a result of the new coronavirus, though they didn’t identify the manufacturer or the product.
Marie-Pier Burelle, media relations officer for Health Canada, said the department is not aware of any impact of the COVID-19 outbreak in China on Canada’s pharmaceutical supply.
“Health Canada has engaged pharmaceutical industry stakeholders to seek any early signals that may indicate impacts on the drug supply chain, and none have been reported to date,” Burelle said in an email.
She added Health Canada will be monitoring the situation closely, and will take action if necessary to reduce the effect on patients. The department is also working with other international regulators to monitor any impact on the global supply.
Watch: Here’s what Canadians need for a coronavirus emergency kit. Story continues below.
Zubin Austin, a professor in the Leslie Dan Faculty of Pharmacy at the University of Toronto, said the role of pharmacies in an outbreak like this is heightened since part of people’s preparation involves visiting pharmacies to buy over-the-counter items like masks, gloves or hand sanitizer.
But he notes that during unprecedented circumstances, pharmacies also become places for primary care.
“That puts a lot of pressure on pharmacies and pharmacists to not change, but very rapidly evolve their health-care role in the community to meet a lot of fast-changing, emergent needs,” he said.
In 2007, Austin, along with colleagues at the University of Toronto, completed a study about the role of pharmacists during the 2003 SARS outbreak and the massive electricity blackout that hit Ontario and the northeastern U.S. around the same period.
In that study, the authors concluded that while the need for pharmacists and their services increases in times of civic disaster, the infrastructure to support the services “may be severely compromised or nonexistent.”
Austin said there have been significant improvements since SARS, namely in widening pharmacists’ scope of practice. In many parts of the country, but not Ontario, pharmacists can now independently prescribe for minor ailments.
Many pharmacists can also renew and modify prescriptions, saving patients a trip to their primary care office. Some can also order microbiology reports. All of this means patients’ requests can be handled without a doctor, lessening potential burdens on the health-care system.
Austin also notes that now pharmacists graduate with a Doctor of Pharmacy, compared to a Bachelor of Pharmacy, which would have been the norm before SARS. This means they have a more advanced clinical degree, making them better equipped to deal with primary care.
He said the community pharmacy sector is now “more capable and more resilient” to minimize interruptions to health-care services, and take on a larger role in delivering primary care.
One lesson from SARS, Austin said, was that it’s critical to avoid “silos” between health-care professionals.
In 2006, Dr. David McKeown, Toronto’s medical officer of health at the time, recommended that the reporting capacity of the integrated Public Health Information System be improved. He also recommended that the then-Ministry of Health and Long-Term Care move more quickly to allow electronic reporting of cases from laboratories, hospitals and physicians to local public health authorities.
Currently, Ontario uses eHealth for electronic health records. Austin said Ontario’s system is further behind that of some other provinces, but any degree of electronic reporting tools, along with increased communication from professionals, will allow health-care professionals to better manage the spread of the outbreak.
A 2018 study from Canada Health Infoway found that having connected health information makes emergency departments more effective and saves time for both patients and health-care providers.
Despite the lessons from SARS, Austin said we should all be questioning the ability of not just pharmacies, but Canada’s entire health-care system, to respond to COVID-19.
“We just don’t know where it’s going, we don’t know the scale of it,” he said. “There’s a fine line between putting your head in the sand and catastrophizing where this is going, but certainly there is a lot of negative potential to all of this.”
Austin said SARS feels like a long time ago, but it isn’t really — especially with the similarities between the two outbreaks.
“I hope with some of the lessons around [sharing] interpersonal information ... if we can apply some of those lessons now we can try to be as well-prepared as we possibly can.”