CommentsPUBLIC HEALTH POLITICS-The image above, is to me, an example of “Best Practices” for a pharmacy -- a glassed-in barrier with minimal openings for prescriptions, and pharmacy personnel wearing face masks and disposable gloves.
Thank you, CVS, for displaying this best practice during the Coronavirus!
As a former pharmacy technician, there are three things that I don’t believe belong in the same environment – prescription medications, vaccines for injection onsite, and laboratory specimens. Let me clarify:
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Pharmacies should have as close to a sterile / almost “clean room” environment to protect the integrity of the prescription medications that pharmacies are dispensing.
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There should not be vaccines available for a pharmacist to give to a customer.
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Pharmacies, in my opinion, should not be receiving laboratory specimens such as Coronavirus aka: COVID-19 specimens inside an area that is dedicated for prescription medications.
Recent news broadcasts have referenced pharmacies that are going to have the capability to test for the Coronavirus. While I understand the tremendous need for COVID-19 testing, and while I understand the need for testing to be located in convenient areas, I do not believe that the laboratory specimens should be housed in the pharmacy environment.
“At the testing locations, Walgreens pharmacists will oversee the self-administration of Abbott’s new ID NOW COVID-19 test.”
“Minute Clinic, the walk-in medical clinic inside select CVS/pharmacy stores, is the largest provider of retail health care in the United States.”
This image shows in which states CVS is currently offering drive through testing at their CVS minute clinic locations. Currently, they are testing in Connecticut, Georgia, Massachusetts, Michigan, and Rhode Island according to this webpage. CVS pharmacy website.
Why is this strategy (above bullets) so important to me now?
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Our Governors and our other Elected Officials are being called upon to reopen our States.
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In Counties that are reopening, there is the risk of people in a “Closed County” with strict “Stay at Home” orders going to other counties that are open. An example of these people are those who have flocked to beaches like in Orange County in California where people flocked to the beaches recently without using social distancing and without some people wearing face masks, and our Governor having to order the closure of the Orange County beaches.
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We risk a “new wave” of the Coronavirus in weeks to come as people venture outdoors thinking that they are safe or that they are not vulnerable.
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In the Fall, we risk a combination of the Coronavirus and the “seasonal flu.”
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Parents want their kids to go back to school in the Fall, and kids want to go to school in the Fall.
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Some pharmacies already have problems with quality control issues in medications, whether from those that are imported or from pharmacies that have their own contamination issues.
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I am concerned that with the Coronavirus, healthy adults, especially those who are over 65, or those who have preexisting health conditions, may be unable right now to get their necessary vaccines in the offices of their Primary Care Physician.
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I am concerned if Pharmacists give vaccinations to patients, that they could contract the viruses that are in the open environment that the patient is in. They can carry it back into the pharmacy on their gloves, on their masks, and on their white coats.
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If Pharmacists are giving out laboratory tests for COVID-19, they are placing themselves at risk, their families at risk, and potentially risk carrying it unknowingly back to the pharmacy in the future.
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I have to acknowledge that what I am recommending will require a major change in our infrastructure. But I also recognize the COVID-19 virus has already required numerous changes to our infrastructure, and what I am recommending is a, in my opinion, “Best Practice” for the future. I am recommending “Stand Alone Vaccination Centers” run by owned and operated by physicians, Physician Assistants, Nurse Practitioners, companies like CVS that have Minute Clinics, or whoever is legally licensed to do so.
CDC Guidance for Vaccinations:
The CDC has created new guidance for recommended vaccines for children and adults since the Coronavirus aka: COVID-19 pandemic:
CDC Schedule Changes & Guidance.
Screen shot from the CDC website link above.
In the image above, the CDC discusses the need to ensure that because of the COVID-19 pandemic, to ensure that Childhood immunizations are given, that the healthcare providers impacted by this virus may need to use new strategies. They give examples of scheduling “well patient visits” in the morning, and “sick” visits in the afternoon. They discuss spatially separating patients by placing patients with “sick” visits in different areas from those with “well” visits. And there is a discussion of “Collaborating with providers in the community to identify separate locations for holding well visits for children.
And this is what I am recommending – that children who may not need a health care visit, have a “stand alone” vaccination clinic for well children only to get their vaccinations.
Above: Screen shot from CDC.
This image explains that:
Measles & Rubella Initiative Statement:
“More than 114 million children at risk of missing out on measles vaccines as COVID-19 surges” It talks about how, as COVID-19 has spread globally, over 114 million children in 38 countries may miss out on receiving the life -saving measles vaccine. “Measles immunization campaigns in 23 countries have already been delayed; more will be postponed.”
Please see this page linked above if you want more information related to the Measles and Rubella vaccines.
Screen shot from drop down menu on CDC page.
General Information on Adult Immunizations
This box basically explains that clinicians (physicians and other healthcare workers) must continue to provide their patients with access to clinical services in environments that are “safe for all.” They reference strategies such as postponing of canceling non-urgent elective procedures and using telemedicine instead of face-to-face encounters for routine medical encounters. “Delivery of some clinical preventative services, such as immunizations, requires face-to-face encounters.”
Please see this page linked above for further guidance.
CDC: Table 1. Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2020.
CDC: Table 1. Recommended Adult Immunization Schedule for ages 19 years or older, United States, 2020.
In conclusion:
· I highly recommend that our Los Angeles County Department of Health work with the California Department of Health and the CDC regarding recommendations for “Stand Alone Vaccination Clinics.”
· For Children – as with the Polio virus, I remember going to my elementary school with all members of my family to receive the vaccine. Could the Los Angeles Unified School District – just as they are distributing meals for school children, set up school nurse’s offices in August or throughout the summer for well children to receive their vaccines if they do not have a pediatrician or if they are missing their mandated immunizations prior to the Fall 2020 school year? These visits should require an appointment, social distancing, and “Best Practices” (Mask and gloves) as I reference for “Stand Alone Clinics” below.
· For Seniors in Senior Facilities and Nursing homes: Can the nursing staff at these homes get orders for their patients to have the Flu shots in the Fall as soon as they become available without the patient needing to see a physician? Can the Seniors in these facilities see their physicians remotely? How many of the Senior living facilities have on site physicians?
· Until there is a reliable vaccine for COVID – 19 which may take a year or more to try and to do studies as to their safety and efficacy, Seniors and those at risk may need to distance themselves from their Primary Care Providers. This is why I recommend “Stand Alone Vaccination Centers” which require an appointment, social distancing, where both the healthcare worker and the patients wear masks; the health care worker wears disposable gloves; the health care worker washes their hands when finished with the patient, and uses new gloves when interacting with the next patient. These facilities should not be large enough to allow for waiting patients to sit in a closed environment.
I hope that my Elected Officials will read and consider carrying these recommendations to the appropriate Department of Public Health employees.
(Chris Rowe, a former health care employee who has worked at Northridge Hospital, Tarzana Medical Center, and West Hills Hospital has a B.S. in Health Education. She is a 42-year resident of West Hills. She has written for the Los Angeles Daily News, RonKayeLA.org; OurLA.org; and CityWatch. She has a blog on the USC/ Annenberg Center for Health Journalism website and can be reached at [email protected]) Top photo: CVS Health. Edited for CityWatch by Linda Abrams.
