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Posts Tagged ‘COVID-19’

Is It the Flu or COVID-19? Here Is Everything You Need to Know This Season. By Our Student Pharmacist, Cassadie Baker.

As the flu season ramps up this year, you might still have questions about how to protect yourself and your loved ones during the COVID-19 pandemic. Here are answers to some common questions about both illnesses.

What is the difference between the flu and COVID-19?

Both infections are caused by respiratory viruses, however, these viruses are different from each other. Influenza is caused by different strains of the Type A or Type B influenza virus, which mutate rapidly and vary from year to year. COVID-19 is caused by a new coronavirus called SARS-CoV-2, which began spreading in 2019. The diagram below summarizes a comparison between the viruses.

FluVsCovid

Is there a way to tell if I have either the flu or COVID-19 at home?

Unfortunately, there is no way to differentiate between the flu and COVID-19 based on symptoms alone. Both viruses cause mild to severe respiratory infections, and they cause many of the same symptoms including, but not limited to:

  • Cough
  • Fever (100°F or greater)
  • Difficulty breathing
  • Sore throat
  • Fatigue
  • Headaches or muscle aches
  • Nasal congestion
  • Diarrhea
  • Vomiting

Sometimes a person experiences a loss of taste or smell after contracting COVID-19, however, not everyone who gets COVID-19 experiences this and in many cases will not show symptoms at all. To complicate matters, it is also possible to contract both COVID-19 and the flu at the same time!

So, what should I do if I feel sick?

While some feel pressured to continue going to work or other activities, the best thing that you can do is stay at home! Getting adequate rest helps your immune system combat the infection more effectively. Additionally, some people are at increased risk of severe complications from catching either of these viruses. Even if you’re not sure, isolate yourself to prevent the spread in case you are infected.

What are signs or symptoms that I should report to my doctor right away?

If you show any symptoms listed above, contact your primary care provider. They may refer you to a clinic for either flu or COVID-19 testing. It is especially important to notify your doctor if you are at least 65 years old, pregnant, or have chronic conditions such as asthma, COPD, or heart failure.

If you experience severe symptoms such as wheezing or a fever of at least 103°F, go to the nearest urgent care or ER. These may be signs of complications such as pneumonia, and they require treatment as soon as possible.

What should I do to protect myself and others?

There are quite a few things you can do! First, if you need to cough, do so into a tissue or your elbow. Both influenza and coronaviruses are airborne, which means that they primarily spread via droplets that are coughed, sneezed, or even talked into the air. Avoid close contact with anyone that you know is sick, if possible. Wear a mask that covers your nose and mouth, and keep a distance of about six feet between individuals to minimize the spread of COVID-19.

Viruses can survive on your hands or surfaces for extended periods of time. Wipe down dirty surfaces, and wash your hands regularly. If soap is not available, use hand sanitizer containing at least 60% of ethyl alcohol (ethanol), as demonstrated below.

EthylAlcohol

Finally, get the flu shot if you haven’t already! The vaccine covers four of the most dangerous strains of influenza so that if you come into contact your symptoms are minimized, if not completely prevented. It takes two weeks for your immune system to build up, so get vaccinated sooner rather than later.

Where can I find more information about the flu and COVID-19?

CDC.gov regularly updates their website as soon as new information is available about either virus. You can also visit your county’s public health website for information regarding local outbreaks and COVID-19 testing locations.

References:

Staying Safe While Enjoying Summer. By Our Student Pharmacist, Stephanie Brokaw.

Precautions to Take During the Ongoing Covid-19 Pandemic:

As various businesses and recreational facilities begin and continue to open as we approach summer, it is important to remember that there are still new cases of COVID-19 and hospitalizations occurring related to the disease. Regardless of what activities you engage in this summer, it is important to keep in mind various safety tips needed to keep yourself and your families safe.

Some of these safety recommendations by the Centers for Disease Control and Prevention (CDC) include:

  • Continue to practice social distancing by staying at least 6 feet apart from people you do not live with.
  • Use facial coverings when possible, especially when maintaining 6 feet distances from other individuals may be difficult.
  • When visiting public spaces like restaurants, call ahead to make a reservation (when applicable) to avoid long wait times and increasing your exposure to other people who may be asymptomatic carriers of COVID-19.
  • If you experience symptoms of COVID-19, which include fever, cough, shortness of breath, or sore throat, avoid public places and public transportation.
  • Utilize services such as online ordering, delivery, and curbside pick-up for essential items or ask someone outside of your household who is not experiencing symptoms to obtain essential items for you and drop them off on your doorstep.
  • Wash your hands often especially after coughing and sneezing.
  • Clean high-touch surfaces daily.
  • It is safe to return to public spaces if you have been three days without a fever and symptoms have improved and ten days have passed since symptoms first appeared.

Pool Safety:

Some tips by the CDC specific to staying safe from COVID-19 in public swimming pools include:

  • Wash your hands before entering the facility and often during your visit.
  • Use facial coverings when possible (but do NOT use them while in the water, as it is difficult to breath through them when they are wet).
  • Although it has been shown COVID-19 cannot be spread through water, maintain a 6-foot distance from those in pools with whom you do not live.

Do not forget about other pool safety tips such as maintaining adequate hydration and protecting yourself from harmful UV radiation.

Ways to protect yourself from UV radiation include:

  • Cover your skin with clothing when possible. Darker colors may offer more UV protection than lighter colors.
  • When you cannot cover areas of the skin, use broad spectrum sunscreen of SPF 15 or higher. Reapply sunscreen every two hours or sooner if swimming or sweating. Some makeup and lip balms may also contain sun protective properties.
  • Wear a wide-brimmed hat that shades your face, ears, and back of neck. Darker colored hats may offer more protection. Avoid straw hats as they have holes that can permit sunlight to penetrate.
  • Wear sunglasses that block both UVA and UVB rays.

BP2P3

Outdoor Safety:

Physical activity is still very important to engage in despite the pandemic because of the positive effects associated with physical and mental health.

Some tips by the CDC specific for staying safe in parks and other outdoor recreational facilities include:

  • Visit parks close to your home to cut down on any unnecessary travel breaks which could put you at risk of encountering facilities or people who may be infected with COVID-19.
  • Before you leave, check if the park you are planning to visit has restroom facilities open. Regardless, use the restroom at your home before traveling to decrease contact with surfaces in public places. Carry hand sanitizer and disinfecting wipes into these public facilities whenever possible.

BP2B4

In addition to the sun protection methods above, when visiting outdoor recreational facilities, such as parks, it is important to protect yourself against bugs that can transmit disease such as mosquitos and ticks.

Ways to protect yourself include:

  • Cover your skin as much as possible.
  • Use an EPA-approved insect repellant.
  • Pre-treat clothing with permethrin.

Your community pharmacist is a great resource for more information regarding safety against COVID-19, UV radiation, and protection from mosquitos and ticks. Stop by one of our locations for more information and assistance in over-the-counter (OTC) product selection for your upcoming activities.

References:

https://www.cdc.gov/coronavirus/2019-nCoV/index.html

https://www.cdc.gov/cancer/skin/basic_info/sun-safety.htm#:~:text=Put%20on%20broad%20spectrum%20sunscreen,options%20to%20prevent%20UV%20damage.

https://www.cdc.gov/zika/prevention/prevent-mosquito-bites.html#:~:text=To%20protect%20yourself%20against%20diseases,evaluated%20the%20product%20for%20effectiveness.

Photo references:

https://www.colorado.gov/pacific/cssrc/news/zika-virus-resources-and-info-cdc

BP2P1

BP2P2

What Are We Doing to Fight COVID-19? By Our Student Pharmacist, Ryan Peterson.

We are currently living in times of great uncertainty and the ideal approach to treating COVID-19 has been hotly debated. Although several therapies have been touted in the media, none have been proven effective.  The decision to use a drug is based principally on observational and anecdotal reports or extrapolated from indirect evidence. Most patients who test positive can be treated at home with rest and management of symptoms. Several experimental therapies have been tried on patients with moderate or severe disease.

Below, I will outline several of the drugs that appear to be the most promising.

pic 1

Remdesivir.  Remdesivir is a recently developed antiviral medication. Administered by injection, remdesivir prevents the virus from replicating.It has shown to be effective in treating viruses similar to COVID-19 including SARS and Middle East Respiratory Syndrome (MERS-COV). Remdesivir appears to prevent  COVID-19 from replicating in a laboratory setting. However, the activity of remdesivir against COVID-19 in sick patients has yet to be determined.2 Several small case studies show promise of remdesivir as an agent against COVID-19.3,4  The cases studies are limited in that they cannot compare remdesivir to no treatment or other possible treatments. Multiple larger randomized trials are currently underway to determine if remdesivir can be used as an agent against COVID-19.

What is the risk of using remdesivir before its effects are proven? Remdesivir can cause nausea, vomiting, liver and kidney damage, and potentially organ failure. In patients with kidney disease, remdesivir can build up in the body causing the side effects to last longer than normal.1

Hydroxychloroquine/chloroquine. Much speculation exists about whether hydroxychloroquine and chloroquine, either alone or in combination with azithromycin, may help treat patients with COVID-19. Please refer to my previous post (see “What is up with hydroxychloroquine?“)  where I discussed hydroxychloroquine in detail. Currently, there is not enough data to say if hydroxychloroquine or chloroquine has a role in treatment of COVID-19.2 The most recent research(published mid April 2020) indicates that hydroxychloroquine, either alone or with azithromycin, does not reduce the severity of the disease. In fact, patients who were given hydroxychloroquine were more than twice as likely to die and more likely to require a mechanical ventilator to breathe compared to those who did not receive  hydroxychloroquine.

Convalescent plasma. Researchers are investigating convalescent plasma as a potential therapy in patients with severe or life-threatening COVID-19. After a person recovers from COVID-19 they have antibodies to the disease in their blood. Within their blood, the plasma, a golden fluid that contains nutrients, can be separated from the red blood cells. There is hope that convalescent plasma can be given to people with severe COVID-19 to provide them with the antibodies needed to fight the virus and increase their chances of recovery.6

pic 2

The Food and Drug Administration (FDA) has recently expanded access and approved convalescent plasma for emergency individual use.7 Several patients in case studies showed substantial improvement after they were administered convalescent plasma. This, however, does not establish a causal effect, and whether plasma is useful in therapy remains largely unknown. Additionally, hospitals face logistical challenges finding appropriate donors and establishing testing to confirm the antibodies in the plasma have activity against COVID-19. 2,6

Tocilizumab. Tocilizumab inhibits the activity of Interleukin 6, a protein that affects the body’s response to infection and inflammation. Tocilizumab is approved by the FDA to treat rheumatoid arthritis and cytokine release syndrome.8  The basis for the use of tocilizumab to combat COVID-19 stems from reports of elevated Interleukin levels in patients with severe COVID-19. As with the other potential therapies, several cases indicate the positive impact of tocilizumab, but its place in therapy is still uncertain. Other Interleukin 6 inhibitors such as sarilumab and siltuximab, are also being evaluated in clinical trials.2

pic 3

References

  • LexiDrugs. Hydroxychloroquine. Updated March 2020. Accessed on 21 April 2020
  • Coronavirus disease 2019 (COVID-19). Updated April 2020. Available at Uptodate.com. Accessedon 21 April 2020
  • Lescure, F.X. et al. Clinical and virological data of the first cases of COVID-19 in Europe: a case series. Lancet Infect Dis. doi: https://doi.org/10.1016/S1473-3099(20)30200-0•
  • Grein, J. et al. Compassionate Use of Remdesivir for Patients with Severe Covid-19.N Engl J Med.doi: 10.1056/NEJMoa2007016
  • Magagnoli, J. et al. Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19. (In Press) medRxiv preprint. April 2020.doi: https://doi.org/10.1101/2020.04.16.20065920
  • Mayo Clinic. Convalescent plasma: Possible treatment for COVID-19? 2020. Available at: https://www.mayoclinic.org/diseases-conditions/coronavirus/expert-answers/convalescent-plasma/faq-20484383. Accessed on 21 April 2020.
  • US Food and Drug Administration. Recommendations for Investigational COVID-19 Convalescent Plasma. Available at: https://www.fda.gov/vaccines-blood-biologics/investigational-new-drug-ind-or-device-exemption-ide-process-cber/recommendations-investigational-covid-19-convalescent-plasma. Accessed on 21 April 2020.
  • LexiDrugs. Tocilizumab. Updated March 2020. Accessed on 21 April 2020.
  • Michot, J.M. et al. Tocilizumab, an anti-IL6 receptor antibody, to treat Covid-19-related respiratory failure: a case report. Ann Onco 2020. doi: 10.1016/j.annonc.2020.03.300.

Taking Care of Your Emotional Health During COVID-19. By Our Student Pharmacist, Alison Samsel.

It is very normal to feel overwhelmed, anxious, stressed, and grief during a global outbreak. Everyone has different reactions to stress and even your own feelings can change throughout this time.

peaches

Ways to cope with stress:

  • Take care of your body.
  • Connect with others.
    • Maintain relationships with friends and family. Virtually have get togethers or game nights with Skype or Google hangouts.
    • Let your loved ones know how you are feeling.
    • Email or send cards if phone or video chats are not available.
  • Take breaks.
    • Make time to unwind.
    • Try meditation. Use apps like Calm and Headspace which offer free meditations.
    • Try to do activities you usually enjoy and explore new hobbies.
  • Stay informed.
    • Watch, listen to, or read the news for updates from officials.
    • Be aware that there may be rumors during a crisis, especially on social media.
    • Get information from a trusted source: coronavirus.ohio.gov
  • Avoid too much exposure to news.
  • Continue seeking treatment for ongoing health needs and continue treatment regimens.
  • Seek help when needed.
    • If distress impacts activities of your daily life for several days or weeks, talk to a clergy member, counselor, or doctor.
    • Madison County – Mental Health & Alcohol/Drug Services:
      740-852-6256
    • Franklin County Youth (17 years old and under) Psychiatric Crisis Line: 614-722-1800
    • Franklin County Mental Health and Substance Abuse Crisis Hotline: 614-276-2273
    • Ohio Mental Health and Addiction Services Hotline: 1-877-275-6364
    • Ohio Crisis Text Line – Text keyword “4HOPE” to 741 741
    • Contact the National Disaster Distress helpline at 1-800-985-5990

Common signs of distress to look out for:

  • Feelings of numbness, disbelief, anxiety, or fear.
  • Changes in appetite, energy, and activity levels.
  • Difficulty concentrating.
  • Difficulty sleeping or nightmares and upsetting thoughts and images.
  • Physical reactions, such as headaches, body pains, stomach problems, and skin rashes.
  • Worsening of chronic health problems.
  • Anger or short-temper.
  • Increased use of alcohol, tobacco, or other drugs.

For Parents:

Children and teens react, in part, to what they see from the adults around them. When parents and caregivers deal with the COVID-19 virus calmly and confidently, they can provide the best support for their children. Parents can be more reassuring to others around them, especially children, if they are better prepared.

What Health Providers Can Do:

  • Help connect people with family and loved ones to help lower distress and feelings of social isolation.
  • Let older adults and people with disabilities know it is common for people to feel distressed during a crisis. Remind them that asking for and accepting help is a sign of strength.
  • Have a procedure and referrals ready.

Remember: “Every day begins with an act of courage and hope: getting out of bed.” Mason Cooley

References:

https://emergency.cdc.gov/coping/selfcare.asp

https://mha.ohio.gov/Health-Professionals/About-Mental-Health-and-Addiction-Treatment/Emergency-Preparedness/Coronavirus

https://www.nimh.nih.gov/about/director/messages/2020/coping-with-coronavirus-managing-stress-fear-and-anxiety.shtml

ParentTips

 

What is Up with Hydroxychloroquine? By Our Student Pharmacist, Ryan Peterson.

2019-coronavirus

With the ongoing COVID-19 pandemic, there has been much speculation about the use of hydroxychloroquine from public officials and in the media. Therefore, with all the information floating around, it is important to separate fact from speculation.

What is hydroxychloroquine?

First approved for medical use in the United States in 1955, hydroxychloroquine is used for the short-term treatment of malaria and the long-term treatment of various autoimmune diseases such as lupus, rheumatoid arthritis, and dermatomyositis. Hydroxychloroquine is marketed under the trade name Plaquenil.

Does hydroxychloroquine work against COVID-19?

The short answer is possibly.  Hydroxycholoroquine has been shown to have direct antiviral activity against SARS-CoV-2 (COVID-19) in a petri dish in a laboratory under controlled conditions. Several small clinical trials looking at whether hydroxycholorquine works have led to conflicting results.  Two small studies1,2 in China found that hydroxychloroquine either aloneor in combination with azithromycinappeared to be associated with a more rapid decline in viral RNA.  However, another small observational studyin patients with more severe illness did not suggest rapid viral RNA clearance after treatment with hydroxychloroquine and azithromycin. Multiple trials evaluating hydroxychloroquine for COVID-19 treatment are underway.

MW-IC064_corona_20200311170341_ZQ

Has hydroxychloroquine been shown to prevent COVID-19?

No medication including hydroxychloroquine is known to be effective for preventing COVID-19.  Clinical trials are ongoing to determine whether hydroxychloroquine should be used in post-exposure prophylaxis for household contact and in healthcare workers. It has been suggested that neither hydroxychloroquine nor any other medication be used for COVID-19 prophylaxis outside of clinical trials. 4

Why is there hesitation among clinicians to use hydroxychloroquine?

There are three main reasons physicians are hesitant about the use of hydroxycholoroquine in COVID -19 patients: 5

  1. Hydroxychloroquine is associated with significant side effects. In many patients, the potential side effects outweigh the benefits of the medication which is a major reason why the drug has not been used.
  2. Hydroxychloroquine is a critical drug used for the treatment of malaria and other diseases throughout in the world. A surge in the use of hydroxychloroquine or use in unapproved indications (including COVID-19) can create major drug shortages.
  3. While clinicians are hopeful that hydroxychloroquine will work to treat COVID-19, they do not have enough evidence at this time to say whether it does or not. Asking a patient to take a medication that can cause significant side effects and has yet to be proven beneficial is very difficult except in extreme cases.

What side effects are associated with hydroxychloroquine?

Patients taking hydroxychloroquine have reported numerous side effects.

These include:

  • dizziness
  • fatigue
  • headache
  • anxiety
  • weight loss
  • diarrhea
  • hair and skin discoloration
  • hair loss
  • nausea and vomiting

Additionally, hydroxychloroquine has been associated with heart problems that make it harder to pump blood to the rest of the body and can lead to heart failure. 6

It is often recommended that before patients take hydroxychloroquine they receive genetic testing.  Patients taking hydroxychloroquine with a mutation leading to a particular enzyme, G6PD, being deficient are at a higher risk to develop a condition called hemolytic anemia where the body destroys red blood cells faster than they are made.

Can I get hydroxychloroquine?

Hydroxychloroquine is a prescription only medication.  The Food and Drug Administration (FDA) issued an emergency use authorization to allow the use of hydroxychloroquine and other agents in adolescents or adults hospitalized for COVID-19.7 Additionally, the Ohio Board of Pharmacy issued an emergency rule8  regarding the dispensing of hydroxychloroquine. According to the rule, new prescriptions of hydroxychloroquine are limited to a 14 day supply and must contain the patient’s diagnosis. Prescriptions written for a COVID-19 diagnosis must have documented a positive test result on the prescription. Additionally, prescriptions for either patients believed to be positive with COVID-19 or prophylactic use is strictly prohibited.

coronavirus symptoms

References:

  • Gautret et al. Hydroxychloroquine and azithromycin as a treatment of COVID‐19: results of an open‐label non‐randomized clinical trial. International Journal of Antimicrobial Agents – In Press 17 March 2020 DOI:10.1016/j.ijantimicag.2020.105949.
  • Molina JM,et al. No Evidence of Rapid Antiviral Clearance or Clinical Benefit with the Combination of Hydroxychloroquine and Azithromycin in Patients with Severe COVID-19 Infection. Medecine et Maladies Infectieuses,
  • Chen J,et al. A pilot study of hydroxychloroquine in treatment of patients with common coronavirus disease-19 (COVID-19). Journal of Zhejiang University, 2020.
  • Coronavirus disease 2019 (COVID-19). Updated April 2020. Available at Uptodate.com. Accessed April 7, 2020.
  • Cortegiani, A. et al. A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19, Journal of Critical Care, In Press 2020. https://doi.org/10.1016/j.jcrc.2020.03.005
  • LexiDrugs. Hydroxychloroquine. Updated March 2020. Accessed on April 7, 2020
  • US Food and Drug Administration. https://www-fda-gov.proxy.lib.ohio-state.edu/media/136534/-download. Accessed on April 7, 2020
  • State of Ohio Board of Pharmacy. ORC 4729-5-30.2 – Prescription requirements for chloroquine or hydroxychloroquine. Updated March 26, 2020.