Discussion
Nowadays, the world is facing a predatory pandemic infection caused by
COVID-19 requiring a concerted effort by health care professionals and
public health experts to contain the rate of infection and the havoc it
wreaks. Pharmacists, as essential health service providers, are
important in the management and control of COVID-19. Hearteningly, the
results of this survey indicated that pharmacists in the MENA countries
have good awareness about the COVID-19 and acknowledge the different
roles they can play during these times. Further, this study revealed
that pharmacists are aware of the important responsibilities of the
different educational faculties/educational institutes and
pharmaceutical associations in preparing them to take on their roles
during pandemics. Barriers impeding pharmacists from acting to their
full potential were also explored, with fear from contracting the virus
while performing their duty emerging as an important barrier that
requires resolution.
The source of information gathered by healthcare professionals is
important as it can affect clinical practice. The results of this study
illustrated that more than 90% of the pharmacists monitor closely
COVID-19 news, with the major sources of information being social media,
WHO reports, and published literature. The collective responses are
indicative of a well-informed group of pharmacists, possibly the high
proportion of students and early pharmacy graduates contributed to this
result. Although the pre-mentioned sources of information are important,
García and Júlvez reported that referring to websites prepared by
official public health organizations is important to ensure a trusted
and updated source of information about COVID-1926. Interestingly, the
majority of respondents reported that they have good awareness of
COVID-19, and they have sufficient information about the infection.
Social media may not always be the best source of accurate information
although previous studies in the region indicate that this has been an
important source of information for pharmacists in the MENA region
through several epidemics
earlier27.
Many medications for the management and treatment of the coronavirus
have been discussed within the media/social media. Chloroquine and
hydroxychloroquine for example have been frequently mentioned as
potential treatments for the virus. In this study, 35% of the
pharmacists reported that these medications can be used not only for
treatment but for the prevention of the virus. Given that there is no
evidence supporting their use, this belief is disturbing. Currently more
than 140 clinical trials to test the COVID-19 efficacy of these
medications alone or in combination with other medications, such as the
antibiotic azithromycin, have been registered worldwide to explore their
use as treatment/prevention options for
COVID-1928. However, on
the 24th of April 2020, the United States Food and
Drug Administration (FDA) issued a warning on the use of chloroquine and
hydroxychloroquine for treating COVID-1929. The warning was due
to reports of serious cardiac rhythm problems associated with the use of
these medications particularly in combination with azithromycin, causing
QT interval prolongation, a measure of delayed ventricular
repolarization 30. As
another example, the majority of the study participants concurred that
the use of non-steroidal anti-inflammatory medications (NSAIDs) such as
ibuprofen would increase the risk of COVID-19 complications. This
probably was based on the fact that NSAIDs use as antipyretics for acute
viral infections may induce serious complications such as empyema
(presence of pleural effusion on chest radiograph and acidic pleural
fluid) 31. However,
Capuano and co-workers published a review on the effect of NSAIDs on
COVID-19 infection based on the available preclinical and clinical
published studies32. They reported that
there is conflicting data in the current literature, and there is no
scientific evidence correlating NSAIDs use to the deterioration of
COVID-19 patients’ symptoms32. On March
18th 2020, the European Medicines Agency (EMA)
declared the need for further epidemiological studies for this issue,
and urged health professionals to wait for formal results of an ongoing
revision by the Pharmacovigilance Risk Assessment Committee (PRAC) on
the association of Ibuprofen/Ketoprofen and worsening of infections33. Accordingly, NSAIDs
usage by COVID-19 patients should be conducted with ultimate caution and
under medical supervision. This conflicting news lead to conflicting
believes and incorrect counseling provided by healthcare professionals
all over the world, not just the MENA countries. Unifying the source of
information for pharmacists worldwide and keeping it updated is vital to
prevent such undesirable consequences.
Fear is a normal consequence to pandemics and public quarantine34. Our study findings
demonstrated that the majority of pharmacists have fears about being
infected with the coronavirus during their work at the pharmacy. Such
findings have been acknowledged previously by pharmacists from other
countries around the world35. Mental health is a
priority for healthcare workers during pandemics, and pharmacists are
not an exception 35.
Training sessions and online workshops were requested by the pharmacists
in this study, as has been the case in previously published findings. In
this term, the FIP had published a guideline for the pharmacists and
pharmacy workforce, clarifying all the required responsibilities and
role of both the community and hospital pharmacists36. This guideline also
demonstrates all the preventive measures, tips on infection control and
some recommendations for outpatient care36. Interestingly, this
study resonates with research investigating the experiences of other
healthcare professionals, which highlights the need for more tailored
and appropriate training to improve preparedness for deployment18.
Delivering medication to patients’ homes can decrease infection spread
especially for elderly patients were the risk of infection is increased.
As an example, in Jordan, the Jordan Food and Drug Administration (JFDA)
allowed community pharmacists and hospitals to provide free delivery of
medications to patients’ homes. Before the COVID-19, this practice was
not allowed by the local laws37, which is the case
in most countries in the MENA region. The majority of participants in
this study were willing to deliver medicines to patients’ homes. This
provides an example of an effective service that can be successfully
delivered everywhere if the safety of pharmacists from COVID-19 was
guaranteed.
Social media was employed in the conduct of this study, which
facilitated a large and rapid collection of sample size from numerous
countries in the MENA region. It is of note that a significant
correlation between pharmacists’ awareness across the countries included
in this study and the COVID-19 statistics of cases and deaths was found.
This may indicate that countries with people (hence pharmacists) of
higher awareness are likely to end with lower numbers of COVID-19 cases.