Episode 1: Long Term Care and the "Unsung Health Care Heroes" of the Pandemic

June 17, 2020

How can we care for our elderly during a pandemic? Pharmacists practicing in long term care settings discuss the changes and response from their facilities, plus insights on a potential treatment specific to older adults for COVID-19.

00:10

Drug Topics®: Welcome to Over the Counter, the podcast from Drug Topics®. I'm Gabrielle Ientile. In this episode we'll be talking about COVID-19 and issues connected to one of the viruses most vulnerable hosts. There are elderly, or the older adult population, particularly those who are residents at assisted living nursing homes or some kind of long-term care.

According to the CDC, nursing home residents have a heightened risk for infection, serious illness and death from COVID-19. The New York Times reported that about one third of all COVID-19 deaths in the United States are nursing home residents or those that work there.

In this unfamiliar global crisis territory, pharmacists and other health care workers and long-term care facilities must now navigate delivering care while also making sure that they and their patients are safe.

01:10

Amie Blaszczyk: I've been teaching geriatric pharmacotherapy with Texas Tech since 2005. When I graduated from my PGY 2 geriatric pharmacotherapy program at the University of Maryland. I started out with a practice site at the VA here in Dallas. And then in 2014, I transitioned to practicing within the long-term care environment. In this environment, I've been working with our corporate team or individual facilities consultant pharmacists on research and education initiatives for the company.

01:37

Drug Topics®: Dr. Blaszczyk explained that changes to long term care in response to the pandemic come in many forms.

01:42

Blaszczyk: One that's been getting a lot of press is the restriction of visitors. And this has really been an important strategy to keep our most vulnerable residents from the threat of COVID but it hasn't been without consequences for sure. Many of our residents have regular visits with family and friends and this has been a really difficult transition for them. We're definitely doing everything we can as health care providers in the facilities to decrease the spread of COVID. So we do have some increased vigilance when it comes to temperature taking and symptom checks, as well as ensuring personal protective equipment or PPE, and masks are being used by everyone in the buildings. And so those are some pretty big changes.

02:19

Trista Bailey: There’s been some significant changes in the long term here.

02:22

Drug Topics®: That's Dr. Trista Bailey, Assistant Professor with the School of Pharmacy at Texas Tech University Health Sciences Center.

02:29

Bailey: Basically, they close the nursing home to always staff and so no visitors no vendors or consultants like me or a dietitian - even most physicians are doing their visits through telehealth as much as possible. And this is just to reduce the spread as much as possible to the nursing house especially for the asymptomatic.

02:48

Drug Topics®: And while these precautions and regulations may be moderately effective in limiting the exposure to and spread of COVID-19 they also come at a cost.

02:58

Bailey: I think a lot of people are scared to do a lot right now, especially with older adults. And so instead of going and visiting their parents or instead of setting up for medications, they may hold back a little bit. And that can be very harmful for older adults that maybe need help setting up their medication. I think the neglect part of elder abuse is going to be an issue, as well as people being stressed out. And sometimes when you're stressed out, or you're nervous, you take it out on others. Ways that we can combat that would be to make sure that self-care is important so that the workers aren't being burned out, that resident needs are going to be met, both in the nursing homes as well as community dwelling. So making sure that neglect is not happening and still checking up on them.

03:44

Drug Topics®: So older adults are not only more likely to contract COVID-19 and show severe symptoms, they also present atypical symptoms, which can be difficult to identify.

03:55

Bailey: We’re seeing a lot of delirium being seen as coronavirus, and so that's something to look out for. Older adults aren't presenting like we expect them to, and also just the fact of older adults in nursing homes have COPD or significant lung damage because of whatever issues they may have or chronic disease, they might not have that cough [typical of COVID-19 patients.] Catching those atypical signs in older adults is very difficult sometimes. Most of these people are going to have dementia, especially my facilities that have a high dementia population, and so they don't really have the executive function to understand exactly what's going on: to understand that they haven't been abandoned by their families, and that there's a pandemic, so they can't be visited.

04:41

Drug Topics®: But while older adults show increased risk of contracting COVID-19 and present atypical symptoms for the virus, some researchers have identified what might be a treatment for older adults due to the potential side effects. Dr. Armand Balboni, CEO of Appili Therapeutics, is conducting research on favipiravir, an antiviral drug,

05:00

Armand Balboni: The safety profile is really well understood with this with this drug. It is approved for pandemic flu in Japan and China. It's been recently approved for COVID-19 in Russia. I expect that India will also end up with the COVID-19 approval, at least for emergency use, or the equivalent in the next couple of days. I think the other thing we know about this drug is the mechanism of action. We know how it works. It targets the RNA dependent RNA polymerase, which is a protein important for maturation packaging, and then subsequent reinfection of other cells. It’s really important to get it on board early. Ramdesivir, by the way, works the same way. I think scientifically, we know how it works. And again, we have a very good understanding of the side effects profile. If I had to say there's one knock on this drug, and there is, it's the fact that in the preclinical studies, it was noted that there may be some teratogenicity, or a fetal embryonic kind of effects in animals. We haven't seen that in people, but we have noted that in animals and I and I suspect that that's a concern for folks going forward. It is another reason that we thought that the long term care setting was probably the most appropriate for the profile of the drug, if there are concerns about potential tertogenicity, the best way to deal with that is to simply not give it to people who may be at risk of getting pregnant or having children. This population is fairly low risk in terms of that.

06:36

Drug Topics®: So preventative measures and effective treatment for COVID-19 are the objectives for now. Dr. Blaszczyk and Dr. Bailey hope that long standing issues related to long term care won't be ignored.

06:46

Blaszczyk: There is there is some significant loneliness in some of our residents. Any chance I get to talk about just the amazing frontline health care providers that we have in nursing homes, I do. I've seen some reports that are kind of vilifying nursing home staff and placing blame on their shoulders for the spread of COVID within facilities, but if I can help somebody understand that it's just not that simple. Long-term care is essentially, for lack of a better term, built for this disease to be devastating and spread the way it does. You're combining a resident patient population who's frail, has comorbid diseases, many have memory impairments, secondary to dementia. And then you put them all in a group living environment. I've worked with some incredible nurses, incredible frontline health care providers who come to work, day in and day out, and bring joy and caring to the residents that they serve. I just always have to give them a big shout out as big as I can possibly make it because I kind of think they're the unsung healthcare heroes of the pandemic for sure.

08:15

Drug Topics®: That's it for this episode of Over the Counter. Tune in next week for more interviews from industry experts on the latest news trends and innovations in pharmacy.

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