FRONTLINE NORTHERN IRELAND: ‘Is this the real life? Is this just fantasy?’

When everyone sensed the imminent arrival of a lockdown, the subsequent panic buying and hoarding of medicines during the first two weeks in March was unprecedented in Northern Ireland. The concurrent shortages eventually increased the cost price of our paracetamol seven-fold.

Our conventional treatment of viral infections with analgesia due to its antipyretic effect has been called into question, however, with a recent report from the Oxford Covid-19 Evidence Service giving the verdict: “the current evidence does not support routine antipyretic administration to treat fever in acute respiratory infections and COVID-19.”

Their rationale being:

• Fever is common and is a good prognostic sign in acutely unwell patients with infection, associated with higher rates of survival.
• In a prospective observational study (n= 502) fever inhibited microbial reproduction and viral replication, as well as accelerated the rate of phagocytosis.

With no drug ‘cure’ or vaccination available as yet for Covid-19, supporting the immune system is the best intervention we currently have. Fundamental to this are the three key areas of:

• Good Nutrition – more veg and fruit. Less sugar, refined carbs and processed foods
• Moderate physical activity
• Better stress management

As our pharmacy specialises in supplements, we have been inundated with requests for those that may help support normal immune function, such as:

• Vitamin C – Some studies have shown it may positively affect the development and maturation of T-lymphocytes, in particular natural killer cells involved in the immune response to viral agents. Anecdotal reports suggest high dose (200mg/kg/day) ascorbic acid may be of benefit treating Covid-19 and trials are underway in the US & China
• Vitamin D – may reduce risk of influenza and Covid-19 infections and deaths
• Zinc – has antiviral activity against a variety of viruses, and via numerous mechanisms.
• Beta Glucan – steadily gaining strong attention as an immunostimulant and potential drug.

If a sale is appropriate, it is accompanied by guidance on the above three fundamentals.

We were very fortunate in the two crazy weeks at the beginning of March that we were able to bring in at least two extra part-time competent members of staff – university students who had concurrently found themselves with some time on their hands. I can’t imagine how the majority of pharmacies coped without any extra team members – never mind those who were a wo/man or two down.

When one meter became two as the recommended social distancing advice, and the viral spread began to accelerate, we changed tack from letting three then two then no people into the pharmacy.

The slight concern about the drop in counter sales paled well into insignificance when weighed against what my excellent team were comfortable with. They are the priority and I want them happy and healthy for the long-haul that this is going to be.

During this period of uncertainty, I have taken my lead from them on occasions, rather than imposing something that they would be uncomfortable with. We have just removed one of our front windows (that needed replacing anyway) and inserted a perspex screen with a small hatch, like what some pharmacies now have at their counter.

There is a fragrance counter just inside this window where we have relocated our second till to, and the fragrances have been replaced with OTC meds and supplements.

This gives us a separate pick up point with drop off at the front door, rather than everything happening at the door. Social distancing between the staff has been one of our biggest challenges and the front door was a bottleneck.

We have reorganised workflow as best as we can in the dispensary. The dispensary team are wearing lab coats and the shop girls, disposable aprons.

We are all wearing fluid resistant IIR face masks or visors and disposable gloves with regular thorough hand washing and alcohol hand gel use.

If there is a silver lining to this cloud, it is the heart-felt expressions of deep appreciation community pharmacy has had from a wide variety of sources. However, it is quite fascinating how a microscopic organism has managed to turn our whole world upside down in a few short months.

Is this the real life? Is this just fantasy? Queen’s Bohemian Rhapsody’s opening line resonates with the surreal situation we find ourselves in.