PharmacyNow Podcast: COVID-19 Awareness with TRHC’s Richard O. Schamp, MD

Richard Schamp
Thank you Farah, I’m glad to be with you today.

Farah Madhat
Excellent. And could you please share a little bit about your background and what your current role is at Tabula Rasa?

Meet Dr. Richard Schamp

Richard Schamp
Sure. I’m a physician by training. I started out training in pathology and then transitioned into family medicine. After that, I spent 15 years in rural Appalachia doing, well, whatever you think of a country doctor doing, that pretty much what they did is everything. During that time I learned a lot, grew a lot in my professional life and then went from there to training, taking a faculty position in ST Louis where I did geriatrics training for a number of years. I joined the Tabula Rasa about 10 years ago, currently in the role of Chief Medical Officer. And in this role I get the privilege of helping our healthcare team with a number of different projects. But as of late, we’ve been spending quite a bit of time and energy understanding the impact of the Coronavirus on our activity as a company and our clients that we serve and how best to cope with this in a very rapidly changing environment.

What is COVID-19?

Farah Madhat
And thank you so much for sharing your background and how you support us is very much appreciated from all of us. Can you start with the basics of what is COVID-19?

Richard Schamp
Well, a couple of technical things to understand first about this. COVID-19 represents the disease that is caused by the novel Coronavirus. Novel Coronavirus is the term were use to describe a very specific virus called SARS- COV-2. Because the novel Coronavirus is new, obviously a novel, and then it’s in the same family of viruses that the number of other Coronaviruses. One of the typical ones that we are familiar with that’s been around for a couple of decades is the SARS virus that was problematic on 2003 and 2004 which did for severe acute respiratory syndrome. So these viruses are related. In the current novel Coronavirus has taken on the same technical name, but the disease that it causes it not just called SARS is called COVID, COVID-19 specifically. And so when we refer to the virus, we call it SARS COV-2, and when we refer to the disease we call it COVID-19. 

How Coronavirus is Spreading

Farah Madhat
Thank you. And then, is it the same origin of SARS or where did it come from?

Richard Schamp Good question. The current belief is that the virus is in this family are what we call zoonotic.  Zoonotic means that they originated in animals and then were able to, at some point, be transferred to humans and then proceed among humans in a person to person transmission. This particular virus probably originated in bats like the SARS virus did, and many others. Then traveled from that to other animals and then it was first detected in China where it was felt to be a part of what is known as a wet market, where live animals are being sold for food.  And by the the close interaction of those animals that became transmitted among them, and then among workers and others who were involved with that market. So, that’s the understanding of of where it came from, being a zoonotic virus it’s like a lot of other diseases in the viruses that that we’re familiar with that originated in the animal world. And then eventually it became a human host.

Farah Madhat
Interesting. And and so for this disease, we’re hearing a lot of, um people safeguarding it and wiping down things a lot more vigilantly than than any other flu epidemic that we have seen. And we’ve heard issues where people are saying that it is the virus stays alive on metal surfaces and other things much longer than what we’ve seen before. Is this true? And how is it really spread? What’s the dormancy rate of this virus.

Richard Schamp
Good question. I think there is a lot of concern have been incorrect about that than a lot of precaution that are being taken. Although, currently we don’t have any evidence of any spread where transmission that directly from surfaces. The spread is almost 100% through, we’ll call droplets, respiratory droplets that come from one person and then transmitted directly to another, either through touch to the hands, for example, or directly through the air and to their nose, mouth, or eye. The virus is transmitted in droplets that carry the virus to a new host in their eye, nose, your mouth and the mucosal membranes. That’s where it begins the infectious process and the new host. It could theoretically exist on a surface, say, a door handle, where it may stay for a matter of hours in a state that could be transmitted to somebody’s hands, and then the hands touch their faces or their mouth and transmit the virus that way. It’s just that we don’t have any direct evidence that that’s actually happening, but who want to take that chance right? So, the precaution of surface cleaning are generally quite appropriate, and they would be appropriate for Influenza too. If people were concerned about that, that they are about the novel Coronavirus.

Quarantining and Social Distancing

Farah Madhat
And we’ve heard a lot about people saying, There’s clearly news about test kits being available. But yet people are told to quarantine. When is it best to delineate between the two and and why quarantine?

Richard Schamp
A couple more technical definitions here. Well, let’s look at in the spectrum. On one hand, we have what we call isolation. Isolation is what applies to somebody who already has the disease and considered to be infectious and so isolation is a technical term that defined the infectious disease control around that person. I’m not gonna go into the detail on that, but that’s what happens, for example, in the hospital room where they would be isolated. Quarantine is designed for people who do not have disease but are suspected of having it. And, so that the public health action, where isolation is more of a medical procedure. Quarantine is more of a public health procedure where people who may be infected but not confirmed, are kept apart from others so that if they turn out to be infected, they will not be transmitting that directly. A little further on the scale would be what we call self-quarantine. Quarantine by itself is enforced by public health authorities. So it is a public health policy that, in most jurisdictions actually, have police power behind it so they can enforce that. Moving up the spectrum little bit, self-quarantine is voluntary where individuals will separate themselves from others to prevent a transmission of the virus. But it’s not being forced upon them. And that maybe a little bit looser during that time they’re watching themselves looking for signs of symptoms of any disease that could be developing. And then further on the spectrum of that is what we have come to know as social distancing where we aren’t completely apart from other people but we’re not engaging in the usual practices that a physical contact and we are avoiding, for example, crowds and trying to stay distant to prevent transmission of the virus. If you look at it upon the spectrum from social distancing all the way up to isolation, you can see how they fit.

COVID-19 vs. Influenza

Farah Madhat
So, Dr Schamp, How would you rate this against influenza as it relates to symptoms or even rates of death?

Richard Schamp
Well, that’s a good way to think about it because we’re pretty familiar with the Influenza virus and the damage it causes in our country and in the world. And on one hand you could look at it and say, well, you know, 450,000 people are gonna die of Influenza this year which is very many more than we’ve seen, for example, in China with the novel Coronavirus. So what’s the problem? And the answers are pretty significant and deal around the case fatality rate. The case fatality rate is a measure of how deadly a disease is. In this case for Coronavirus, there’s a lot of speculation about what the case fatality rate is. For example, with Influenza the case fatality rate is generally regarded as about 0.1% or about one person in 1000 that gets Influenza will die from it. In the novel Coronavirus, the case fatality rate been reported in China, for example, about 3 – 3.5 percent, which is, you know, 35 times as deadly as influenza. In the U. S. and other places, it’s been reported closer to 2%. And most experts now think that it’s probably gonna land somewhere around 1% and the reason for that is that when we figure that percentage, the denominator, is based on the number of cases that we know about. But the problem with the novel Coronavirus is there are many more cases out there that have not been detected. And so the death rate is being mathematically inflated because you don’t have the right denominator. And once all the cases are actually understood and  collected, I think we’ll see the death rate drop to somewhere around 1% which is much better than 3%. But if you think about it, 1% is still 10 times more deadly than the flu. And the possibility if if this thing goes unchecked of fatality could be actually greater or great as or greater than the influenza virus that we we currently experience. So it is a deadly condition a deadly disease. But it’s important to note that it’s most deadly in a certain population. So on an average, about 80% of people who contacted virus will have mild disease and will not need to be hospitalized. They’ll have a cough, they’ll have symptoms that are flu-like in nature. They will have maybe a runny nose, fatigue, fever. But they’ll recover in anywhere from 2 to 4 weeks. 15% of them will be seriously ill, sick enough to be in the hospital. But the vast majority of them, about him 95% of those will also recover. But then another 5% will become critically ill, and there’ll be sick enough to be in the intensive care unit, many of them on respirators or ventilators. And those folks have a very high mortality rate, and those folks tend to be people who are older, older than 60 or 65 or they have underlying medical conditions chronic lung disease, chronic kidney disease, heart disease, things that weaken them before they even have the virus so that’s the population that we’re most concerned about in terms of trying to protect as well as try to find treatment for.

Coronavirus Symptoms

Farah Madhat
Wonderful. Is there a certain symptom where, if someone’s self-isolating or self monitoring, that would lead someone to say, this is the time I need to go to the hospital or as healthcare providers, letting their patients know it’s time to certainly go to the hospital, regardless of testing results? Or what have you?

Richard Schamp
The most common symptom in the novel Coronavirus is fever. And at the time of diagnosis, only 40 or 50% may show that, but by the time they’re hospitalized, about 90% will. The second most common symptom is cough and shortness of breath. And thats because this virus causes pneumonia. It’s a type of pneumonia that can be very rapid and infect the lungs in such a way that the air exchange is limited and so shortness of breath is a very prominent feature in the symptoms. And so, if fever and shortness of breath develop, and these usually will develop within 5 to 6 days or a week of becoming infected, that would be the time. I would definitely contact a healthcare provider and ask about evaluation or testing.

Farah Madhat
And how would you best protect yourself, our patients, the communities from COVID-19.

Richard Schamp
The message that has been transmitted, I think around our country is most commonly it’s been very, very valid in terms of both public health and infectious disease control. And that method has two pillars to it. First, is trying to keep the virus away from ourselves by the term social distancing. And basically, if we don’t touch anybody or don’t hang around anybody who has the virus than our chance of getting it is very low. And the opposite side of that, if we were to happen to have the virus, our chance of passing it on to somebody else also becomes lower. So that’s an extremely important pillar in the management of this pandemic. It’s not easy for some people in our society to understand the value and the importance of them. And some have outright ignored it. But I think it is a social responsibility we have for each other now, particularly since the transmission rate and the transmission patterns are still being studied. We don’t know all that we need to know yet about the virus and so we have to take an extra careful approach in this matter of social distancing. The second pillar is really about hygiene. Which is hygiene of our own selves which is cleaning our hands and not touching our faces. Cleaning our hands involves mostly just soap and water. Soap and water is very, very effective in this as long as we spend 20 seconds. So the viral particles and bacteria, for that matter are covered with a coating that combined of lipid proteins and 20 seconds is what it takes to dissolve for soap to dissolve that. And when that happens, the wall of the viral particle breaks down and they die. So, you would think it’s a magical 20 seconds versus 10 seconds. Well, not magical, but 10 seconds has some effect, 20 seconds has almost 100% effect. If the virus is exposed to regular soap, detergent, doesn’t have to be anti-bacterial, doesn’t have to be any special thing other than soap. So, cleaning your hands, the way I like to describe it that every summer we make salsa at our house, and then we are done cutting the hot peppers, you can bet that we wash our hands very carefully before we touch our contacts. And so that’s the kind of washing we’re talking about, Yeah, a minimum of 20 seconds in a lot of different way picture a song and sing it for 20 seconds. And that’s very effective along along the same line of personal hygiene is the not touching your face and eyes. Many studies have been done showing how unconsciously we do that up to 20 times a minute and that could be very common. And so developing a sensitivity to that and trying to avoid it is also very important. And then the last aspect of hygiene really has to do with avoiding contaminated surfaces. And we talked about that little bit earlier. The virus can live on different surfaces.It is still being studied about what, how long it can live on different surfaces. But generally speaking, the harder the surface, like a steel or metal surface, the virus tends to live a little longer on those surfaces verses something that softer like cardboard or paper.

Community Pharmacists as Essential Healthcare Workers

Farah Madhat
Interesting. You would think things with pores would have more of an absorption of it, but fascinating. On the the effect of hygiene and social distancing and protecting your community, what I’ve seen is a lot of our pharmacies have done very interesting and unique things out of our allowing and preserving their patient population, their community. As you know that a lot of them have been deemed as essential health care workers or essential employees and therefore keeping their doors open and serving their communities. So they deployed things such as even having special times where the most susceptible patients can come within the pharmacies or insuring or providing curbside pickup for their prescriptions so that not everyone’s being exposed to it. So, outside of just, you know, self quarantining or navigating these tricky waters, our pharmacists are serving the frontline, trying unique things to best serve and preserve their communities. It’s been truly an amazing thing to watch them mobilize and adapt so nimbly and quickly to this. With that being said, a lot of things, as you are aware, start getting perpetuated in the media as far as, and especially now with media it’s a great thing and a not so great thing that we spread information or misinformation rather at a fast pace. We’ve heard things such as children can’t get the Coronavirus or drinking silver will prevent the Coronavirus. Can you address some of the misinformation that you may have heard out there and help our communities start getting the right bit of information to their patients and their loved ones?

Richard Schamp
Sure. I want to reemphasize what you said Farah about the role that pharmacists can play in this because the opportunity to give out truthful, factual information to people who are really hungry for it, I think pharmacists have a fantastic opportunity for that and a very important role to play in the community. I think that President Trump said as much himself this past week where he identified pharmacists being on the front line for this and becoming more and more important in the health care system, and that’s giving a wonderful time opportunity for that to happen. So arming pharmacist with good information is part of what we’re about. But let’s address some of the question that you raised, I think that there are a good deal of misinformation, internet memes that are going around and some just flat out mercenary activities that I think need to be called up. So, for example, and let me preface this by saying that I certainly understand that in a situation like a pandemic that we’re in where people are feeling helpless, afraid, anxious maybe, anything that they can do that will take action t help feel like they’re doing their part to defend themselves against this unseen enemy. I think it’s a strong human reaction, so I didn’t have any criticism for people who are looking for home remedies. That are looking for anything they can do to lessen their chances. I think that that’s legitimate and it is part of our shared humanness. And so my criticism is not towards that. My criticism would lie on where that becomes something that is taken advantage of or giving false hope when there’s really not appropriate to do that. So, for example, flushing the water out by drinking virus. Excuse me, flushing the virus out by drinking water more frequently has been promoted. The idea that if a virus lands in your mouth and you’re drinking water every 10 minutes or every five minutes, you’re basically flushing it down to the stomach where the stomach acid will kill it and you’re safer. The problem is that we have really no evidence to support that. The concept is nice and drinking water is good for all of us. And so it’s not a harmful thing, but it’s probably not helpful. Another remedy that was promoted on the internet this week that I saw had to do with the virus’s sensitivity to heat. It’s been identified that viruses will not survive a temperature of 133 degrees. And so, one enterprising gentlemen decided to promote a concept of heating the air that goes into our sinuses. Because if we can, that’s where the virus lives according to him. And so if we can heat the air that goes into our sinuses it will kill the virus and we’ll be home free. The problem is that holding on a hairdryer against your face and spraying your face with a water mist was the answer that was proposed. And again, that may feel good for a short period of time but we know that even at 130 degrees, a 10 second exposure will cause a third degree burn. So I don’t think anybody want to do a third degree burn on their sinuses. That sounds bad to me. So we’re not recommending that either on a number of different fronts but that one could be harmful. And another popular remedy that’s been promoted is the drinking or otherwise taking in a colloidal silver. Silver has been around for centuries reall in terms of the understanding of it’s  anti-bacterial, anti-viral, even anti-mold effects. That because the silver ion is toxic to microorganisms. And so silver is used in a lot of preparation, particularly skin preparations and ointments that burn victims, et cetera. Silver is very useful. Unfortunately, we have no real evidence that taking silver on an oral basis will be of any benefit. Again, the potential harm in this, because silver does accumulate in the body, and it causes a condition known that as Argyrosis where is deposits in the skin and other tissues. So, in fact, the FDA this past week, actually, last week, sent a cease and desist letter to seven companies around the country that have been promoting silver as a treatment for novel coronavirus. So we would advise against that as well.

Farah Madhat
Interesting. Thank you so much. Like you said, a lot of them are not that harmful, but some of them, they are. So I appreciate you being the steward and helping us promote some of the information to go out to our pharmacists and pharmacies. And as you said–

Richard Schamp
–Let me say one more thing that is often promoted and that’s the use of vitamin supplements and other supplements. I think that this is one of those situations where we’re pretty sure it will not harm. We’re not sure if it’ll help. But obviously, you know, everybody needs vitamin C. Everybody needs other nutrients and vitamins that they may or may not be getting through their diet. We’re not promoting that, but it’s one of those things that probably isn’t gonna help. I mean or hurt at least. And that goes to the point of what I really want to say is that the best thing we could do in our individual life is just trying to keep ourselves strong and healthy. And in doing that, we can promote our own safety and immune system and have the best opportunity to fight against the virus if we should get it.

Farah Madhat
Absolutely, and that’s certainly where pharmacists can play that role insuring that they are staying healthy, taking care of themselves and taking the medications that they were prescribed and making sure that they were adherent to their medications and that because of some of the chaos and the unrest that remains, that we’re not neglecting what we know will help our patients stay healthy which is compliance to the right medications. So absolutely. As we think about pharmacists and playing a role within the community, we know that one out of every four vaccinations in the US are performed by a pharmacist and on that note, any updates on the vaccine and the science behind that as well.

Richard Schamp
There are probably a dozen different companies at this point working on a vaccine very diligently. I think the general understanding is that one that seemed to be on track to try to be done within a year. Most of the time, vaccines are going to be 18 to 24 months out. There definitely will be a vaccine. We don’t know how effective it will be, but there’s certainly a rush in trying to find the vaccine that will work. So this is a rapidly developing area and probably on a weekly basis will hear more news about it. But I would not expect to see a useful vaccine yet in 2020. While we’re talking about vaccines, let me also take a mention about other medical treatments that are being proposed for the novel Coronavirus. As you know, there are no medication currently indicated for treatment, but there are several under investigation. And the World Health Organization has just this past week initiated a trial called the Solidarity Trial. This is a WHO sponsored protocol involving multiple countries with a very simple design to allow for many health systems to be able to participate. And they’re gonna be looking at four different medications. One is an antiviral drug called Remdesivir, which has shown activity against the SARS COV-2 virus in vitro and other Coronaviruses. The second one is using a combination treatment that’s been used for HIV, with or without interfere on beta. And the third one, that would be number two and three, and the fourth one is the use of Chloroquine or Hydroxychloroquine. Hydroxychloroquine is being tested in China and showing some activity against the novel Coronavirus. The interesting thing about this is that the way this worked, what we call in my uniform, which opened the passages within the cell to allow zinc to enter in. And so the zinc itself is toxic to the viruses. But the Chloroquine make the zink be available to the cells. So this is a very interesting concept that it being studied. So I think that probably within a few months we’ll actually sees them results from these studies and cross our fingers and have a little hope that there will be an opportunity to try a medical treatment against the the the folk that are sickest with the novel Coronavirus.

COVID-19 Testing

Farah Madhat
There’s been a lot of talk about being able to have these test kits for Corona readily available for the most susceptible patients. We’ve heard that there there are the nasopharyngeal testings as well as the rapid diagnostic testings. Can you tell us a little bit about what the test entails and what the differences are?

Richard Schamp
Sure. Let me first say that there’s a natural sort of progression that occurs in a situation like this when testing becomes available. So, for example, where I live in Michigan, we almost double the number of cases in the past two days that have been reported here about 250 to 500 something. And the reason for that is not because of that pandemic is so much worse. It it’s simply that the testing became available and we’re able to identify and confirm the number of people who are already infected. So I think we’ll be seeing that over the next couple of weeks that there will be a rapid increase in the reported cases not because there are more people sick, but because we’re actually putting a name on it with the testing. So that’s a little side note about the testing. But now that it is becoming much more available, it will be used much more. But let me say something about who it should be used for. A testing is a diagnostic test, and it’s important to understand that it’s not a screening test. It’s not designed to detect early disease in somebody who maybe just getting started with the virus, for example. And it is designed to confirm that the presence of the virus in a person who is already having symptoms and so that the CDC and others have recommended that testing be limited to people who we think have the virus based on clinical evaluation with fever, cough, maybe X-rays showing changes in their lung. And that the testing really confirmatory. So there are some rapid diagnostic tests that are becoming available at the point of care and those will still need to have confirmatory testing done on them. But they can be helpful again in the early detection of people who are already symptomatic so that they could be properly isolated. You might ask, why shouldn’t we be testing people who aren’t sick yet? And maybe we can help keep them from getting sick or say you’re in a high risk environment like a nursing home? Should we be testing everybody? Because we know that if they get sick, it will very quickly go downhill. Well, again, the test itself is not designed as a screening test. Now they may come out with a screening test that will be useful for that. But the concept behind screening is that you want a test that is very, very sensitive so that you don’t miss anybody who had the disease. The concept behind diagnosis is that you want a test that is very specific so that you aren’t concerned that you have made the right diagnosis.

Farah Madhat
So Dr. Schamp, you mentioned and referenced specificity as well sensitivity. Can you speak to what percentages should be we be looking for as we’re getting more and more test kits on the market and making sure that we’re not producing a lot of these results that are false negatives or even false positives.

Richard Schamp
That’s a hard question, Farah. I think there were some missteps early on with the CDC when they promoted the tests the amount of the states for point of care testing and they had not gone through all the rigorous evaluation that they need to. They got very inconsistent results then. So you have to be careful about that. And because of the emergency that we’re facing, the typical processes for approving what tests can be used in a public setting have been relaxed. And so there are a number of tests kits out there that may or may not have met the same rigorous evaluations that we’re accustomed to. Having said that, the technology behind the standard testing at a molecular level, is really pretty straightforward. And if they’re using that technology with a reputable company, there’s good reason to suspect that the test should be accurate. And and what I tried to say earlier about specificity and sensitivity is that for a test to be useful at ruling out a disease, or what we would call a screening situation, it would have a very high sensitivity so that it can be able to detect even a small amount of the virus. But for a test to be specific, which is what we do when we want to confirm a diagnosis, then you want a high degree of specificity. So you tend to have a trade off. The more specific tend to be less sensitive, you know, with any type of diagnostic testing. But the current test that we have available now for the COVID-19 virus have aimed at the high specificity rate and none of them have been approved for screening. I’m sure that some of them are in the works. I’m sure we will see screening to tests probably at some point. But that that currently isn’t the case. For example, there are no screening tests for Influenza, right? It’s a very specific test. So I think we’ll be seeing a screening tests or something like it. Much more rapid point of care, testing for the COVID virus  at some point within the next few weeks.

Farah Madhat
Excellent. And we know that there is a lot of, not only the kits that the pharmacist or other health care providers need to to wear to protect themselves. But at this rate, a lot of them aren’t really stocked with the right amount of equipment needing the N5 masks as well as goggles. And clearly this is a virus that we know is highly contagious and so needs an additional set of PPE’s that are pharmacies need to get in-hand before doing these testing procedures.

Richard Schamp
Well you bring up a good point. I think that it could be very valuable for pharmacists to have on-site testing or drive-through testing. There’s just a ton of precaution that have to be taken in that case in terms of their staff training and then proper protection equipment, hazardous waste disposal, all kinds of processes where they make sure that they have the proper identification of people that they have been screened adequately to make sure that they’re eligible for the test. It’s a very involved process but it would be a wonderful public service.

Farah Madhat
Absolutely. And it has been quite humbling to see the responses that we’ve gotten from our community pharmacies, raising their hands and saying that they would love to continue serving their community and being front lines of doing these screenings and testings for for their patients. You know, I know within the hospital, Dr. Schamp, you had strict protocols of how to approach presumed patients that have highly contagious disease states. And in this situation, the pharmacists are dealing with patients day in, day out and and don’t have necessarily the precautionary measures or the organization to act swiftly. What advice would you give our pharmacist in protecting themselves and their staffs on this COVID-19?

Richard Schamp
You know, that’s a question that probably deserves a lot more thought and a lot more discussion. You get the pharmacy which has variably over the years taken on more of a retail environment, but it now also becoming a place where people come for health care. There you have this mix and of purposes of why people are there and it certainly can be a magnet for people who are sick, right? That’s why they’re there. So how to protect other people in this store or in the pharmacy? How to protect the pharmacy staff becomes paramount without trying to get too invasive or paternalistic about it. But I think that in a pandemic situation like this, they would be very legitimate for pharmacy staff to put some parameters around who actually enters their environment and under what guidelines, what parameters, they would do that. So I don’t know what that would look like. You don’t want to stand at the door and keep people out. But for example, if somebody had a fever, perhaps somebody at the door could help help them get what they needed without them coming in or some other method of where they come in and they’re assisted  to complete their business. Or they could pick up her prescription, the drive thru is obviously a good answer for that. But there’s a very good reason why people are not getting tested in the stores and why they’re doing drive throughs, because they don’t want them in the stores right?.

How Can Pharmacists Can Stay Safe

Farah Madhat
Absolutely. And it’s it’s It’s been fascinating to see how pharmacists have been so adaptable to this new workflow, let’s say. For those who have drive throughs just operating the drive thru only and those who don’t have drive throughs creating a texting platform where they can go back and forth with one another to let them know they’re outside for curbside pickup so that the patients aren’t coming in the pharmacy and exposing them to unnecessary pathogens.

Richard Schamp
Well, in a related issue would be personal protective equipment for the pharmacy and their staff. Currently, we’re having trouble getting the types of masks that are necessary. I think gloves are in good supply. But how to go about protecting staff who know they’re gonna be interacting with people who are sick and could have the Coronavirus. So putting pharmacies on the same priority as other health care facilities for being able to get that type of equipment would be a step in the right direction from a policy perspective,

Farah Madhat
I think that you bring up a lot of great points. Dr Schamp. We need to make sure as we’re taking care of our patients and our community, that we’re pausing and taking care of our staff and ourselves. So please make sure that we are taking those extra precautionary measures of extra sanitation, cleaning down things, hand washing to ensure that we are in fact protecting our front line service as health care providers. Now in the incident of the unfortunate incident that I suspect that one of my staff members or one of my staff members does test positive for COVID-19. What actions or what would you say are the next best steps in discovering this?

Richard Schamp
That could be a very challenging situation for a pharmacist, or pharmacy staff. If somebody showed up to work and they’re getting sick, then obviously in that setting you’re gonna send them home. But what happens if three days later, you find out that they went home and got worse, went to the doctor’s and was tested, and now they have COVID-19. And three days earlier they were working in the pharmacy, what do you do? That would be a nightmare for me of the pharmacist, because at that point, the CDC guidelines say that if you have a person with known or suspected that person under investigation for the COVID-19, then for 14 days prior to that, you need to assess who had close contact with him. And close contact would be either direct physical contact or contact with the secretion that they’re coughing or sneezing. Or even just being in the same closed space with them for in the period of time over two hours, or within six feet of them for over 15 minutes. That type of close contact creates a risk environment that would put them in at least the medium risk category. That medium risk category would generally require that another employee who they spoke to that infected person would then need to go home basically, and self quarantine. Doesn’t mean that they’re going to get sick. But it does mean that they have a significant risk of contracting the virus and passing it on to others even before they know that they’re sick. And so that recommendation is for shelf quarantine at that point, or at least not being in a public environment where you could be practicing social distancing at home.

Farah Madhat
I think that the incubation period of being asymptomatic or just being asymptomatic generally is what causes pause and a lot of people. of a shock and awe essentially of exposure. And I think that’s where we’re going to see some of these incidents of transmission are those who are in that the first couple weeks of asymptomness and then going into work and then possibly passing it along to others.

Farah Madhat
And I think that’s what makes it the management of it so difficult. And why we again social distancing is just a general best practice for everybody.

Richard Schamp
That’s right. It’s hard to overemphasize how valuable social distancing could be in controlling the pandemic. And I don’t want to get into the apocalyptic type of conversation here. But the the the positive impact of social distancing have been modeled out, and it is very significant in terms of dealing with, for example, that way have a hard limits of how many intensive care bed there are in the country. And how many ventilators there are, and we will far surpass that if the if the current models are not mitigated with actions like social distancing. So I think this has been pretty reliably modeled out, and nobody can predict the future. But there’s a strong public argument. Strong scientific argument, strong mathematical argument for the social distancing.

Farah Madhat
Well, we heard Governor Gavin Newsom here in California, where we’re based out of give a very strong order by essentially mandating social distancing and hopes of, we hear this often, flattening the curve. And we’ve taken great measures so that we’re able to prevent the spread of it as early on as we can. Dr. Schamp, you have been incredibly insightful, and I appreciate all the time, the the information the resource you’re able to provide for us are much needed in this ever involving world that we’re in right now. Any final remarks for our pharmacist or other health care providers that are listening in?

Richard Schamp
Well, I just want thank you, Farah, for inviting me on the podcast today and the opportunity to try to help provide your pharmacists and others with reliable information that they can use in their very important mission in helping the healthcare needs of their patients that come to them. You’re doing very important work, and I’m very glad to be part of it. Thank you for inventing me.

Farah Madhat
Thank you, Dr Stamp. And thank you all who are listening in. Thank you to our community pharmacists who are tirelessly working and and taking care of their patients. Remember, you are a critical component of a patient care, and we’re so thankful for everything that you’re doing. I’m humbled and signing off. Thank you all so much for joining in.