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.