Open access article
The Royal Pharmaceutical Society has made this article free to access in order to help healthcare professionals stay informed about an issue of national importance.
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On 23 March 2020, when the UK went into full lockdown to control the coronavirus — SARS-CoV-2 and the disease it causes, COVID-19 — it had a knock-on effect on many areas of our healthcare system. I’m a clinical pharmacist working across three general practices, which my patients have not been able to access in their normal way, to order medication, book appointments or see clinicians, and this has caused a multitude of problems.
One of these problems was caused by the information circulated by the media about patients with asthma and their increased susceptibility to COVID-19. After the reports, we noted a 30% increase in the issuing of inhalers in a two-week period in one of my practices.
Patients with seasonal asthma, who were not necessarily symptomatic, ordered inhalers to have a reliable supply should they develop chesty symptoms. And patients who had not ordered their inhalers in over three years were putting requests in for them. When the requests were queried with the patients, it was apparent they had been asymptomatic and had been for an extended period of time. One patient requested their partner’s inhalers for themselves, despite never having asthmatic symptoms nor any diagnosis or medication for a breathing-related illness — they felt they needed the same medication too.
This problem lead to more triaged calls coming my way and to the GP, and nationally it lead to a shortage of steroid inhalers in most wholesalers in the Clenil (Chiesi) and Soprobec (GSK) brands. Although stock of the Qvar (Teva) inhalers remained fairly stable, the extrafine particle size of the active ingredient beclometasone within the inhaled solution means it does not make for a straight swap with Clenil and Soprobec; a clinician would have to look carefully into switching a patient from one brand to another.
Stock issues also arose in early April 2020 when local pharmacies were unable to supply patients with hydroxychloroquine. US president Donald Trump had just claimed, without full scientific backing, that the drug was useful for combatting the virus, leading to an increase in requests for the medication. Locally, this had an effect on a small, but important, number of patients on the immunosuppressing therapy for rheumatoid arthritis; shortages meant one patient missed two weeks’ worth of medication, which caused a flare-up of their condition.
Perhaps the most remarkable increase in queries from patients was from those established on angiotensin-converting enzyme inhibitors; in March 2020, a study published in The Lancet
suggested that patients on these drugs with hypertension could be at an increased risk of infection with COVID-19, owing to an increase in expression of the angiotensin-converting enzyme 2, which is linked to susceptibility to the virus. The chain reaction of patients contacting my surgeries to query this was a surprise to the entire team. We were concerned about patients stopping these medications and the effect it would have on their conditions. A disparity between the extent of the data and the severity with which it was reported caused a lot of confusion locally. Guy’s and St Thomas’ NHS Foundation Trust lead a rebuff: 30 years of preclinical and clinical trial data of these drugs are robust, and their withdrawal could lead to increases in both mortality and hospital admission rates.
These reports have undoubtedly led to an increase in both queries and medication requests at the practice, and we have felt the strain on our time and resources, while also dealing with other patient queries. During the COVID-19 pandemic, and as we move through the lifting of lockdown, more routine matters are taking a backseat in general practices. We’re seeing a reduction in the day-to-day monitoring of patients with chronic conditions because accessing us is more difficult and some are choosing to stay away. I feel this will be a growing problem for the population.
Acute stock shortages and misinformation have been big hurdles, but we must make sure we continue to review and alter our patients’ medications in the coming weeks to avoid a ‘catch-up’ scenario for the rest of the year. Hopefully, very soon, clinicians will be able to return to a more proactive and preventative approach to care.
Danny Bartlett, clinical pharmacist, Coastal West Sussex Clinical Commissioning Group