COVID‐19: How Can Rural Community Pharmacies Respond to the Outbreak?

The global impact of Coronavirus disease (COVID-19) has been overwhelming, and the public health threat it represents is the most serious seen in a respiratory virus in modern times. In every affected country, the disease has impacted the global economy and threatened the health care system with new challenges. In the United States, the outbreak has quickly led to considerable morbidity and mortality, particularly in already fragile rural health care systems with inadequate staffing of health personnel, surveillance systems, diagnostic facilities, isolation rooms, and personal protective equipment. Rural communities are often isolated from large health centers with the capabilities of handling an outbreak such as COVID-19. Rural patients also face unique challenges such as extended travel time to an acute care facility, hazardous terrain, and the lack of reliable or public transportation. These geographic challenges may cause patients to postpone or go without accessing needed health services. Amidst the avalanche of reports concerning the spread of the virus, there is also recognition that pharmacists are in a unique position to make essential public health contributions, especially in rural areas, to address the shortage of primary care providers. Nurse practitioners and physician assistants are often listed as helping to reduce the shortages of rural providers but only account for 19% and 7% of the primary care workforce, respectively. Pharmacists are often overlooked in their ability to provide care in areas with primary care shortages. In fact, pharmacists are the most accessible health care providers, with about 90% of Americans living within 5 miles of a community pharmacy. When patients are experiencing mild illnesses such as the common cold or seasonal allergies, they often seek symptom relief from over-the-counter medications from their community pharmacies. Given the similarities in symptoms between COVID-19, cold, seasonal allergies, and flu, pharmacists can identify differences between flu and coronavirus symptoms and help patients navigate the health care system. Pharmacists can refer patients to the appropriate medical institution for testing, encourage them to seek treatment more rapidly, and provide information to limit the spread of this disease in the patients’ community. If an effective vaccine is developed to prevent COVID19 infection, community pharmacists would be accessible health care providers to offer this immunization as evidenced by the growing number of patients receiving their influenza vaccine at local pharmacies. In recent years, pharmacies have become the most commonly used nonmedical setting for flu vaccination in adults due to convenience and lower costs. In 2017, the CDC estimated 28% of adults received an influenza vaccine at a pharmacy, up from 23% in 2016. It has also been shown that immunization rates are higher among the high-risk group of patients aged 65 and older where pharmacists provide immunizations. Increased vaccination rates also lead to decreased deaths and hospitalizations among elderly patients, and should yield cost savings related to reductions in direct medical care. As treatment options for COVID-19 materialize, drug– drug interactions will increase and need to be managed. These interactions will be more prevalent in the elderly population because they are more likely to be taking