Wednesday 6 May
- If recruitment for the Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial is kept above 1,000 patients per week, results on some of the treatments being tested could be available within 5-7 weeks, the UK’s chief medical officers (CMO) have revealed in a letter to NHS staff. The letter, which was signed by the CMOs for Wales, Scotland, Northern Ireland and England, and the national medical director for NHS England and NHS Improvement, Stephen Powis, highlighted that over 9,000 participants had enrolled in the RECOVERY trial so far. However, the signatories said that in order to obtain strong evidence large numbers were required; around 2,000 participants per arm of the trial. Current enrolment to the trial is at 13% of all hospital admissions but the CMOs and Powis said that this proportion needed to be increased. “We appreciate that the operational pressure from Covid-19 makes research hard, and local situations will lead to variability in ability to recruit, but increasing this proportion is important,” the letter said.
- The Medicines and Healthcare products Regulatory Agency has authorised seven batches of Chiesi’s Clenil 100 microgram inhaler (beclomethasone) to be dispensed within the UK to cope with increased demand. The inhalers were reported to be in short supply in early April 2020 following a surge in demand caused by the COVID-19 pandemic. The batches required authorisation due to a variation in their appearance from those usually dispensed in the UK. However, Chiesi said in a statement, published on 5 May 2020, that the inhalers “will contain the same medication and therefore requires no differences to the way prescriptions are written or how patients manage their asthma”. The additional inhalers are expected to come into circulation from 11 May 2020, Chiesi said, with further batches “being released into the supply chain over the coming months”.
Tuesday 5 May
- Details of a phase II/III study to determine the efficacy, safety and immunogenicity of the COVID-19 vaccine candidate ChAdOx1 nCoV-19 have been revealed. The new study, carried out by researchers at the University of Oxford, will assess how well people of all ages can be protected from COVID-19 with the new vaccine as well as provide information on safety and its ability to generate good immune responses against the virus. The researchers have said that they will enrol 5,260 volunteers in total starting with a small number of older adults (56-70 years, then 70+ years) before expanding to large numbers of adults across all ages (18+ years). Following this they will assess the vaccine in a small cohort of children (5-12 years).
- The vaccine is currently being tested in a phase I/II trial, which began on 23 April 2020, whereby researchers are randomly allocating 510 healthy participants, aged 18-55 years old, to receive either the vaccine or a placebo injection in addition to doing blood tests and collecting information about any symptoms that occur after vaccination. The next phase of the trial is still awaiting approval from the Health Research Authority.
- A Yellow Card website dedicated to reporting side-effects or incidents from medicines being used to treat COVID-19 has been set up by the Medicines and Healthcare products Regulatory Agency (MHRA). The MHRA said the aim of the site was to ensure that there was “rapid identification of new or emerging risks” which might not have been previously known about that would allow it to take appropriate regulatory action, where needed. “While our aim is to ensure that potentially lifesaving COVID-19 treatments and medical equipment reach patients as quickly as possible, patient safety is our highest priority,” said June Raine, chief executive of the MHRA. The site also contains information about fake medicines and devices, ventilatory and respiratory support, and the latest news on COVID-19.
- Community pharmacies in Wales are working with the Royal Mail to ensure patients who are shielding or self-isolating receive their medicines during the COVID-19 pandemic. Using the Royal Mail’s ‘Tracked 24’ delivery service, postal workers will collect prescriptions from pharmacies and deliver them the next day. Pharmacists will be given access to the Royal Mail’s ‘Click and Drop’ system so that they can track the deliveries. The Royal Mail link-up supports Wales’ volunteer prescription delivery scheme, in which over 400 volunteers will be linked up with more than 650 community pharmacies to deliver medicines to patients who have no-one else to collect their prescriptions.
- With support from the National Pharmacy Association (NPA), a web-based tracking system called Pro Delivery Manager will also be made available to pharmacies and volunteer drivers. Raj Aggarwal, NPA board member for Wales, said the system was “a tried-and-tested product”. Vaughan Gething, Welsh Minister for Health and Social Services, said he was “pleased to see how the skills and expertise of organisations from the private, public and third sector have been brought together to make this a success.”
Monday 4 May
- Scottish prisoners who are currently prescribed opiate substitution therapy (OST) will be switched to buvidal, a longer-lasting form of medicine, as part of Scottish government support for drug users during the COVID-19 pandemic. This programme will cost £1.9 million as part of a budget of more than £2 million set aside by the Scottish government. Buvidal is a prolonged-release injection form of buprenorphine, which is administered weekly or monthly, rather than daily. Joe FitzPatrick, Scottish minister for public health, sport and wellbeing, said that “by making this available to people in prisons, we will support continuity of care, while reducing the need for daily contact and reducing pressure on our frontline prison officers and NHS staff”.
- The funding will also support additional residential rehabilitation places for those leaving prison who need help to recover from drug or alcohol misuse. And naloxone will also be made more widely available.
- Pharmacists feature in a new COVID-19 version of the classic children’s game Top Trumps. The new “Britain at its Best: Key Workers” version of the ever-popular card game includes a card that covers both pharmacists and pharmaceutical scientists. They are given an “unsung hero” rating of 7 out of 10, but score only 2 out of 10 in the “gadgets and gizmos” category. According to the pharmacist card in the game, pharmacy originated in 1752, and pharmacists have been credited with a “street style” score of 6 out of 10. Other groups of workers in the pack include refuse collectors, teachers, NHS volunteers, and even journalists.
- The Scottish NHS death in service provision for the families of frontline NHS staff who die as a result of COVID-19 will include community pharmacy, Harry McQuillan, chief executive of Community Pharmacy Scotland (CPS) has said. In a video update published on 1 May 2020, McQuillan said CPS had received confirmation that “community pharmacy colleagues will be included in proposals to provide a COVID-19-related death-in-service benefit scheme”. CPS was, he continued, working with the Scottish government on the terms of the benefit. McQuillan added that “I very much hope we never have to implement it”, but that it was nonetheless “reassuring to know that you are valued along with all other members of the health and social care team in Scotland”.
- The Scottish scheme will provide a lump sum of twice the staff member’s annual earnings and continued survivor entitlements. In England and Wales, the families of frontline health and social care workers — including community pharmacists — will receive £60,000 under the scheme. When asked by The Pharmaceutical Journal if the scheme covered other members of the community pharmacy team, a spokesperson for the Welsh government said that “details of the operation of the scheme in Wales are still being considered” but that final confirmation would be available soon. The Pharmaceutical Journal has asked the Department of Health and Social Care for similar clarification in England.
- Police forces in Wales will be providing extra reassurance and advice to community pharmacists on the protection of staff and pharmacy premises during the COVID-19 pandemic. The move follows concerns raised by the Royal Pharmaceutical Society (RPS) about aggression and even violence towards community pharmacy teams, based on reports from members. Assistant chief constable Nigel Harrison, chair of the All Wales Police Gold Command Group for COVID-19, said that the police “recognise the key role of pharmacies in our communities and as such we are more than happy to offer assistance”. The police will, Harrison added, “robustly deal with those who feel it is acceptable to act in an aggressive way to our pharmacy teams doing such great work at this time”.
- Elen Jones, RPS director for Wales, said that the majority of people had been “hugely supportive and understanding of the current pressures on pharmacy teams”, but added that “given the nature of the reports from our members, we felt that it was appropriate for us to highlight these concerns to police forces in Wales”.
Friday 1 May
- Nearly 40% of anaesthetists surveyed by the Royal College of Anaesthetists have said they are not confident that they will have sufficient supplies of anaesthetic drugs for COVID-19 patients over the next month. The survey of 2,174 anaesthetists added that 14% currently “do not have access to all the usual drugs”. This comes after the government warned on 16 April 2020 that supplies of atracurium and cisatracurium were expected to run out “over the coming days” due to increased demand from COVID-19 patients. The survey, published on 23 April 2020, said: “Departments of anaesthesia and intensive care are currently collaborating with each other and with pharmacists to ensure drugs are prioritised appropriately across the two areas.”
- Researchers have linked severe COVID-19 infections with a unique blood clotting disorder in the lungs that could be contributing to mortality levels. The research published in the British Journal of Haematology on 30 April 2020 looked at 83 COVID-19 patients, 81% of whom were Caucasian, 12% were Asian, 6% were African and 1% was of Latino/Hispanic ethnicity. They found that those with a higher level of coagulopathy – blood clotting activity – primarily focused within the lungs, had a significantly worse prognosis and were more likely to require admission to intensive care.
- “In addition to pneumonia affecting the small air sacs within the lungs, we are also finding hundreds of small blood clots throughout the lungs,” explained James O’Donnell, consultant haematologist in the National Coagulation Centre in St James’s Hospital. “This scenario is not seen with other types of lung infection, and explains why blood oxygen levels fall dramatically in severe COVID-19 infection … understanding how these micro-clots are being formed within the lung is critical so that we can develop more effective treatments for our patients, particularly those in high risk groups.”
- Preliminary results from trials assessing the use of chloroquine and hydroxychloroquine (CQ/HCQ) for treating COVID-19 should be “treated with care” to avoid misinterpretation by the non-scientific community, pharmacy experts from the University of Huddersfield have warned. “Care should be taken to avoid exaggerating the preliminary safety/efficacy evidence of CQ/HCQ treatment in prevention and treatment of COVID-19 as it can lead to potential self-harm,” Syed Shahzad Hasan and Hamid Merchant wrote in the British Journal of Pharmacy on 30 April 2020, in collaboration with Chia Siang Kow, a pharmacist at the International Medical University in Kuala Lumpur.
- The authors highlighted how publicity around the antimalarial drugs had led to “unnecessary hoarding” and called for pharmacists across the world to dispense them responsibly, discouraging the over-the-counter supply of CQ/HCQ in pharmacies. “It is the duty of pharmacists and other healthcare professionals to monitor the proper usage of these antimalarial drugs…its use should be restricted for the treatment of COVID-19 associated pneumonia in severely ill patients only under clinical supervision of a licensed practitioner and close cardiac monitoring.”
- Consultation rooms in Boots pharmacies are being designated safe spaces for people experiencing domestic violence during the COVID-19 lockdown. Working in partnership with the charity Hestia Crisis Support as part of its “UK says no more” campaign, information about 24-hour UK domestic abuse helplines will be available in the consulting rooms from 1 May 2020. Marc Donovan, chief pharmacist at Boots UK, said he hopes the initiative “can help people find the support they need at this difficult time, when many other options are temporarily unavailable”.
- The move is backed by the Royal Pharmaceutical Society (RPS) and the General Pharmaceutical Council (GPhC) which urged other pharmacies to follow the multiple’s lead. “The trust that the public have in pharmacies make them an ideal place to access help and take a step away from harm towards a better future,” said Sandra Gidley, president of the RPS. “It’s as simple as making your consultation room available for a phone call to the relevant agency who can help.” On 27 April 2020, the Parliamentary home affairs committee said the government should consider making pharmacies and supermarkets safe spaces for victims of domestic abuse.
Citation: The Pharmaceutical Journal