Each day, pharmacist Cristina Privado worries about ensuring prescriptions are ready for all customers that visit the four pharmacies she manages north of Toronto.
Now, due to the coronavirus pandemic, she’s also concerned about the safety of her staff, her family and herself as she interacts with patients sometimes not wearing personal protective equipment (PPE).
“It’s very challenging for most of the pharmacies now to access protective equipment,” she said.
As concerns about COVID-19 in Canada began to increase, Privado put in an order for more PPE in February. She says she only got it recently.
In Ontario, pharmacists are not considered front-line health workers and are not eligible for a priority allocation of PPE from the government. Pharmacists like Privado have to order PPE out of pocket, and availability is scarce.
Privado says she understands hospital workers remain the priority for accessing PPE. But pharmacists have increasingly become the first point of contact for many patients who are coming in for treatments or questions they have, including symptomatic people, she explained.
“We are also a health-care provider and we actually are a gatekeeper as well before the patient even goes to the hospital, or even going to a walk-in clinic or to their physician,” she said.
“We are always the first point of contact among patients, but even more so now with everything that’s going on… with patients coming from their health-care provider because a lot of them aren’t even open.”
Health-care workers who may be exposed to someone infected with the coronavirus are recommended to wear PPE — consisting of gloves, a long-sleeved gown, facial protection and a medical-grade face mask — if they are likely to be exposed, according to Health Canada.
Pharmacies aren’t eligible for government-issued supplies of PPE and the Public Health Agency of Canada doesn’t provide guidance on PPE, according to the Canadian Pharmacists Association.
The Ontario Pharmacists Association (OPA) is participating in advocacy for its members by asking the provincial government to consider pharmacists essential front-line workers, so PPE will be set aside for them, said Justin Bates, chief executive officer at the OPA.
In a statement to Global News, the Ontario Ministry of Health says it values the role of pharmacists and the work they do to keep Canadians healthy.
“As you would imagine, the global supply chain for personal protective equipment is extremely strained right now as all jurisdictions face challenges in procuring supplies,” the ministry said.
“With that said, personal protective equipment is being prioritized for frontline workers who may experience exposure (close contact within two meters) to members of the public who are symptomatic.”
In the meantime, the OPA is going to its own private suppliers to help pharmacies order PPE but the supply is incredibly limited, Bates told Global News.
“We felt that was a critical thing for the association to do because the concerns are real. Pharmacists are exposed to a lot of patients coming into the store that are symptomatic and sick,” he said. “It’s difficult to manage patients safely without the proper protective equipment.”
Health-care workers across the country have noted a critical shortage of PPE available and Prime Minister Justin Trudeau announced on March 31 that his government is putting $2 billion towards companies to ramp up production of PPE and other medical supplies, like ventilators.
Pharmacies do not have priority access to government-stockpiled PPE. The Ontario government has been very receptive to the OPA’s requests, but with such a limited supply, they aren’t the priority, said Bates.
“Pharmacists see about 12 times the amount of patients per year than other health-care providers,” said Bates. “So they are always at risk and it’s really increased some of the concerns about bringing it home to their families.”
If a pharmacist and their staff get sick due to their exposure at work, it would interfere with a pharmacy’s ability to remain a designated essential service and provide Canadians with their medication, explained Bates. Pharmacists are worried about having to close as a result, he explained.
Trying to stay safe while missing PPE
At Privado’s pharmacies in Innisfil, Schomberg, Angus and Orillia, Ont., she and her staff have increased protocols in lieu of PPE. She’s paid out of pocket for Plexiglas barriers, has increased signage encouraging patients to phone first if they have symptoms, and has set up prior screening of patients over the phone.
While the OPA has established a recent partnership with Ronco, a PPE manufacturer, to access supplies faster, it’s something individual pharmacies currently have to pay for out of pocket, said Privado. They needed the protection as soon as possible and couldn’t wait for a discussion with the government about reimbursement, she added.
She and her staff are highly anxious, and Privado says she’s had a lot of sleepless nights worrying about ensuring patients have their medication and whether her staff are safe.
Despite their extra screening efforts and signs outside, some symptomatic people continue to come into the pharmacy, she said.
Removing work clothes before going home and taking extra precautions when washing them is something Privado has been doing and has encouraged staff to do to protect their families.
“In my case, I have my mother and my mother-in-law living with us, who are elderly. I also have a seven-year-old child at home because the schools are closed. And I always have to worry about them when I go home,” she said.
With protection difficult to acquire, she encourages the public to be extra mindful of the safety of pharmacists and staff when they go to get their prescriptions, she said.
“Let’s not be selfish and just think about ourselves,” she said. “Just try to be mindful of the other people surrounding us.”
Questions about COVID-19? Here are some things you need to know:
Health officials caution against all international travel. Returning travellers are legally obligated to self-isolate for 14 days, beginning March 26, in case they develop symptoms and to prevent spreading the virus to others. Some provinces and territories have also implemented additional recommendations or enforcement measures to ensure those returning to the area self-isolate.
Symptoms can include fever, cough and difficulty breathing — very similar to a cold or flu. Some people can develop a more severe illness. People most at risk of this include older adults and people with severe chronic medical conditions like heart, lung or kidney disease. If you develop symptoms, contact public health authorities.
To prevent the virus from spreading, experts recommend frequent handwashing and coughing into your sleeve. They also recommend minimizing contact with others, staying home as much as possible and maintaining a distance of two metres from other people if you go out.
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