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 Table of Contents  
COMMENTARY
Year : 2020  |  Volume : 4  |  Issue : 4  |  Page : 159-163

Provision of pharmaceutical services in time of COVID-19 crisis: A libyan vision


Department of Pharmaceutics and Pharmacy Practice, Faculty of Pharmacy, University of Tripoli, Tripoli, Libya

Date of Submission11-Jun-2020
Date of Acceptance01-Nov-2020
Date of Web Publication28-Dec-2020

Correspondence Address:
Prof. Amal Yousef Benkorah
Department of Pharmaceutics and Pharmacy Practice, Faculty of Pharmacy, University of Tripoli, Tripoli
Libya
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/LJMS.LJMS_48_20

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  Abstract 


Pharmaceutical services play a crucial role in any health system. Pharmacists are the main health professionals to ensure that people have access to good and safe medicines and to make certain that these medicines are used rationally. While the role of pharmacists in providing health-care services in Libya remains restricted, the scope of pharmacy practice is vast and encompasses a variety of roles and functions. Most of today's pharmacists' services are oriented toward clinical outcomes using medicines. Therefore, pharmacists are focusing on optimizing the use of medications, promoting health, wellness, and preventing diseases. Pharmaceutical services are currently being tailored to be event driven to fit the current COVID-19 pandemic crisis and to help combat this disease and its consequences. This article discusses different pharmaceutical services that can be provided by pharmacists in all practice settings, for the Libyan healthcare system and to the society in general during COVID-19 crisis.

Keywords: COVID-19, health care, pharmaceutical services, pharmacist


How to cite this article:
Benkorah AY. Provision of pharmaceutical services in time of COVID-19 crisis: A libyan vision. Libyan J Med Sci 2020;4:159-63

How to cite this URL:
Benkorah AY. Provision of pharmaceutical services in time of COVID-19 crisis: A libyan vision. Libyan J Med Sci [serial online] 2020 [cited 2021 Apr 11];4:159-63. Available from: https://www.ljmsonline.com/text.asp?2020/4/4/159/305241




  Introduction Top


Pharmacists are key health professionals in ensuring that the population has access to quality and safe medicines and that those medicines are used rationally.[1] While the level of pharmacists' involvement in the provision of health care is limited within the Libyan health system, the scope of pharmacy practice, however, remains vast and encompasses many roles which cannot be possibly listed in this text but need to be explored and further practiced.[2],[3] The emergence of the novel coronavirus (CoV) that caused COVID-19 has become evident at the end of the year 2019. The outbreak of the disease was first appeared in Wuhan, China, and ever since, it spreads all over the world and was declared by the World Health Organization (WHO) as public health emergency of international concern by the end of January 2020. Then, COVID-19 was declared by the WHO as a pandemic in March of 2020 when all international health communities started to realize this virus potential to overwhelm the whole world. Significant global efforts are now underway to diagnose, treat, and prevent infections caused by the novel CoV, as health services started its strenuous work to limit its spread, detect casualties, and provide strategies to confront this irrepressible pandemic.


  Pharmaceutical Services and the Current Libyan Situation Top


Libya is no exception to the international community, although the novel CoV did not appear as early as it did in developed countries. This was considered a blessing because of the civil war that the country has gone through, which caused overburdening of the health facilities and shortages in medical supplies and services. However, the first case of COVID-19 was announced on March 24, 2020, but the outbreak of the pandemic started to clearly show although shy in May of 2020 with 5 out of 128 patients (4%) died as a result of the complications of this disease by May 29. The cumulative number of casualties has increased exponentially since then, reaching a total of 76,808 cases until November 19. Of which, 28,153 are active cases, 47,587 cases recovered, and 1068 cases died. The death rate ranged between 1.3% and 2% in the period between June and November of the year 2020.[4]

It is worth mentioning that the health-care system in the country is almost fully dependent on physicians to combat diseases in general, and the COVID-19 pandemic is no exception. The pharmacy profession can, however, contribute effectively, being an integral part of the main health professions, by providing so many services to fight all kinds of diseases during this critical time and to contribute to curbing the current COVID-19 pandemic that terrified the entire international community.

Although the practice of pharmacy in Libya is still confined to the basic roles that include retail, storage, dispensing, supply of medicinal products, supply chain management, interpretation, evaluation, and dispensing of prescriptions for medical purposes, which are considered in their entirety necessary for the practice of the profession, there are other important roles that are practiced by pharmacists, but to a lesser extent. These roles include patient counseling and other patient care services such as pharmaceutical care, provision of effective medication therapy management (MTM), promoting rational use of medicinal products, in addition to other clinical pharmacy services. All these roles make pharmacists the key personnel within the health-care system, who ensure that the population has access to quality and safe medicines and that those medicines are used rationally.

This article addresses all possible pharmaceutical services, in all aspects of practice [Figure 1], which may be provided by the pharmacy profession for the Libyan healthcare system and to the society in general, to help combat this pandemic. Pharmacists may play important roles through responding to the nation's needs during this difficult time, in various settings, including community, hospital, and governmental ones.
Figure 1: Brief illustration of pharmacist's role during COVID-19 pandemic

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Community pharmacists are essential health-care providers during the outbreak, as they remain on the frontline of public health by serving as direct points of access for their patients. Hospital pharmacists also have important roles during the outbreak in infection control as well as patient care and support. Furthermore, government pharmacists are essential in the decision-making process regarding the management of medicines supply which includes: the selection, procurement, distribution, and tracking the use of these medicines all over the country in addition to being the key personnel responsible for developing drug policies and legislations.[3],[5]


  The Academic Perspective Top


Pharmacy colleges across the country can play a pivotal role by contributing positively to the national health-care system, and to serve the society in general. One of the pharmacy education institutions' inherent roles is to conduct pharmaceutical and clinical research that may closely follow all scientific developments to confront the consequences of this pandemic on our society in particular, and on humanity in general. The faculty of pharmacy at the University of Tripoli, as an example, can actively participate by providing many services, the most important of which is converting its laboratories into small factories for the formulation and production of basic pharmaceutical preparations such as antiseptics and disinfectants that support the process of preventing the spread of the disease within the society in this time of crisis. Moreover, faculty members and students can contribute effectively as supporting public health providers by delivering knowledge-related services through spreading awareness and health education, preparing reports, supporting and providing special services, for example, on-line screening and triaging, and medication-related services. Besides, the most important role that Libyan pharmacy educational institutions can play is research activities related to this pandemic whether through biochemical/biomedical studies on the emerging CoV, studies concerned with the immunity of the Libyan community in relation to this pandemic, field studies to survey those who have been exposed to the virus and who have contracted the disease, developing social treatment studies related to treatment methods, studying the efficacy of drugs used globally in treating people with this disease and their conformity with international protocols in dealing with COVID-19, in addition, studying the effectiveness of drugs used on Libyan patients to add new treatment cohort data and to establish a true comparison with other international cohorts, as well as conducting MTM for patients with other comorbidities. Interprofessional research activities in collaboration with other health colleges are also encouraged, according to specialties and abilities of the scientific departments in these colleges. These and other studies need to intensify the efforts of specialists in various fields and sciences related to pharmaceutical and medical education such as immunology, molecular biology, pharmacology, toxicology, and modern pharmaceutical sciences that include pharmacovigilance, pharmacoeconomics, and pharmacogenomics studies among others. All of this requires allocating sufficient financial resources to support these types of research and entails the concerted efforts of scientists in all disciplines to work out sound and effective scientific studies that see its impact on the health of the society in general, and to obtain healing answers that may contribute to understanding the behavior of this stubborn virus and thus protect members of the society of its danger.


  Pharmacists' Roles in Various Settings During the Pandemic Top


Pharmacists can play important roles in other settings, whether societal, institutional, or governmental by responding to the community needs to confront this pandemic. This can be achieved through addressing the following:

  1. Correcting wrong information and rumors related to this disease that may create negative effects on society
  2. Publishing famous scientific articles related to preventing the spread of the disease during the pandemic period, such as those published by the Health Advisory Committee of the WHO for Pharmacy (FIP) that are constantly updated
  3. Assessing needs through:


    1. The need for rapid development of drug treatment protocols and guidelines for the use of such drugs
    2. The need to monitor the safety of these drugs and everything related to the adverse effects/adverse drug reaction
    3. The need to release a drug information page from a trusted authoritative source. In light of this, the emergency response may be set up by establishing the following:


      • Mechanism to respond to early assessments of special drug shortages[6]
      • Mechanism for supplying and distributing medicines in emergency situations
      • Mechanism for monitoring and safe use of medicines
      • Event-driven pharmaceutical care when possible
      • Completing the verification of obtaining all the needs until reaching the point of recovery by stopping the emergency response and dealing with the consequences, then evaluating and improving, and finally stopping responding.


Libyan pharmacists can get help through the use of the American Society of Health system Pharmacist Tools and Guidelines.


  Role of Community Pharmacy Top


There are two special needs that can be provided by pharmaceutical services in community pharmacies during the period of active infection with COVID-19;

The first one is to help prevent and control the pandemic as it occurs by practicing the following:

  1. Ensuring safe and effective environmental control operation through cleaning and disinfecting the pharmacy premises and wearing personal protection equipment (PPE), in addition to establishing new workflows and creating emergency plans
  2. Providing health information related to adhering to good practices, such as social distancing and PPE use. Posters and flyers related to these practices may be displayed in the pharmacy premises
  3. Sorting patients in a correct manner, as the community pharmacy may be the starting point for identifying the disease when citizens seek treatment for cold and flu symptoms similar to the symptoms of COVID-19 and send the suspects immediately to the declared screening places in the country to seek medical help
  4. Extended prescribing roles and activities, especially in our country where no regulations are enforced concerning this matter. Therefore, qualified pharmacists should obtain authorizations to deal with dispensing of repeat prescriptions of medicines for chronic diseases, managing doses if necessary until patients reach their primary care physicians, instating additional required medications, or removing unnecessary/over prescribed medicines, emergency supply of medications at appropriate intervals, in addition to managing minor ailments such as allergies, skin rashes, coughs and colds, GI complaints, etc.
  5. Pharmacists may also play an important role in promoting continued medication adherence. Studies have demonstrated the negative impact of natural disasters on medication adherence[7]
  6. Patients cut back or terminate their medication intake following the disaster for a variety of reasons, including limited access to physicians and financial problems, particularly in case of asymptomatic conditions such as diabetes and hypertension.
  7. Pharmacists may contribute to clinical teams working to combat COVID-19 by providing advanced, event-driven pharmaceutical care through managing medication therapy used within the context of clinical trials on Libyan patients and providing drug information on drugs tried on the following conditions;


    1. Confirmed COVID-19 pneumonia cases using hydroxychloroquine/chloroquine with or without azithromycin[8]
    2. Lopinavir/ritonavir to treat acute respiratory distress syndrome and the use of corticosteroids with widespread inflammation of the lung[9],[10]
    3. The use of tocilizumab in severe COVID-19 cases in the context of clinical trials[11]
    4. The use of remdesivir to treat COVID-19.[12] The antiviral drug under the brand name (Veklury-Gilead) was approved by the FDA within the context of clinical trials on May 1, then received full approval from the agency on October 22, 2020.[13],[14] Clinical trials of remdesivir in COVID-19 patients are still underway around the world. However, controversy around its benefit is still ongoing. On November 19, the WHO recommended against its use after reviewing evidence of four trials. An expert panel convened by the WHO determined that “remdesivir has no meaningful effect on mortality or on other important outcomes for patient, such as the need for mechanical ventilation or time to clinical improvement”[15]
    5. Anticoagulant treatment for COVID-19 patients who may suffer thrombotic risk[16]
    6. The role of zinc in antiviral immunity and the possibility of reducing the severity of COVID-19 through the selection of most effective zinc salt and dosage form(s)[17]
    7. The Infectious Diseases Society of America in its treatment guidelines also recommends the use of COVID-19 convalescent plasma in the context of clinical trials.[18] This opens the door for Libyan immunologists with a pharmacy education background to serve in clinical research teams who may use convalescent plasma in patients who were subjected to different previously mentioned medicines in their treatment.


  8. Staff training by providing knowledge on COVID-19 prevention and provision of counseling points of related medications.


The second role is to provide and help meet the needs of the same group of community pharmacy patients by focusing on:

  1. Providing and continue managing medications for patients suffering from chronic diseases without leaving their homes, in addition to providing psychological support
  2. Patient education through disseminating information about the disease, its symptoms, and how to prevent it from occurring; how to choose hand/respiratory hygiene and antiseptics; the safe use of disinfection products, their types, and how to use them, in addition to the selection and proper use of masks and how to properly dispose of them after use and self-protection strategies outdoors.



  Conclusion and Recommendations Top


It should be pointed out that the emerging severe acute respiratory syndrome (SARS)-CoV-2 and the disease it causes (COVID-19) have not been fully explored yet, and treatment protocols for the disease are constantly changing in light of the changing results of clinical trials globally until the writing of this article. Furthermor, there is no effective vaccine up to this time. However, two pharmaceutical manufacturers, namely Pfizer/BioNTech[19] and Moderna,[20] announced potential vaccine candidates against COVID-19. Both the companies claimed that their products have achieved nearly 95% success and filed for emergency use authorization (EUA) for their products. FDA is expected to approve the use of both vaccines soon enough to make them available to the public in the coming few months. In a recent news, specifically on November 21,, 2020, the FDA announced granting Regeneron Pharmaceuticals' experimental therapy an EUA for casirivimab and imdevimab to be administered together for the treatment of mild-to-moderate COVID-19 in adult and pediatric patients with positive results of direct SARS-CoV-2 viral testing and who are at high risk for progressing to severe COVID-19.[21] Therefore, care must be taken to ensure sustainable follow-up of all new information in this regard, and this follow-up is founded on extracting evidence-based information from its sources. Pharmacists, therefore, should assume full responsibility by participating effectively in all practice settings, including medical teams, to manage medications effectively and to provide evidence-based information concerning the use of these medicines. Pharmacists should also assume their societal role by being in charge of matters related to their profession and working to consolidate their role professionally through legal and official documentation, in addition to the participation in the integrated research work that requires the pharmacist researcher to implement it.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Annex 8 Joint FIP/WHO Guidelines on Good Pharmacy Practice: Standards for Quality of Pharmacy Services; 2011. p. 310-23. Available from: https://www.fip.org/files/fip/WHO/GPP%20guidelines%20FIP%20publication_final.pdf. [Last accessed on 2020 Jun 09].  Back to cited text no. 3
    
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The Libyan National Center for Disease Control (NCDC). March-November 2020 Reports. Available from: https://www.ncdc.org.ly/ar/libyan-covid-19-dashboard. [Last accessed on 2020 Nov 19].  Back to cited text no. 4
    
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Gautret P, Lagier JC, Parola P, Hoang VT, Meddeb L, Mailhe M, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: Results of an open label non-randomized clinical trial. Int J Antimicrob Agents 2020;56:105949.  Back to cited text no. 8
    
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Lai ST. Treatment of severe acute respiratory syndrome. Eur J Clin Microbiol Infect Dis 2005;24:583-91.  Back to cited text no. 9
    
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Zha L, Li S, Pan L, Tefsen B, Li Y, French N, et al. Corticosteroid treatment of patients with corona virus disease 2019 (COVID-19). Med J Aust 2020;212:416-20.  Back to cited text no. 10
    
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Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC, et al. Remdesivir for the treatment of COVID-19: Final report. N Engl J Med 2020;383:1813-26.  Back to cited text no. 12
    
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