New York is bracing for an explosion in COVID-19 cases as the state starts the week with most businesses shuttered and nonessential gatherings banned, following a March 20 executive order from Gov. Andrew M. Cuomo.
The confirmed COVID-19 case count in the state is over 15,000 and growing, with most infections concentrated in New York City.
“In the Bronx ... we’re probably getting hit the hardest of anybody across the country,” said Andrew Smith, emergency medicine clinical pharmacist at SBH Health System Bronx St. Barnabas Hospital, as the weekend approached.
“It’s just really been out of control,” he added.
Smith said the 422-bed community hospital and Level 2 Trauma Center was caring for about a dozen COVID-19 inpatients at the end of last week, with additional people being evaluated in the ED.
“The [ED] numbers really vary,” he said. “Patients can get discharged from the emergency department as long as they’re stable, they’re young, and they’re in that low-risk population for self-quarantine.”
Smith said the medical staff has been studying the limited available data to determine what medications to use for the treatment of people who are acutely ill with COVID-19. At the moment, he said, the best option seems to be hydroxychloroquine, an FDA-approved antirheumatic and antimalarial drug.
He said the interleukin-6 receptor blocker tocilizumab is a “last-line” drug for seriously ill patients. The monoclonal antibody therapy is being used in China to reduce dangerous lung inflammation in patients infected with SARS-CoV-2, the virus that causes COVID-19.
St. Barnabas Hospital has also obtained Gilead Sciences, Inc.’s investigational antiviral drug remdesivir under a compassionate use protocol as a second-line option, Smith said.
But Gilead, citing overwhelming demand for the drug and the need to maintain sufficient stocks for ongoing clinical trials, announced that remdesivir is no longer unavailable for new compassionate use requests. Instead, the company is developing expanded access programs to ensure the collection of critical data from all patients who are treated with the investigational drug.
Smith said the off-label use of drugs that haven’t undergone controlled testing for efficacy against the virus is a concern among his colleagues, despite approval from the hospital’s medical board and Pharmacy and Therapeutics Committee to try the medications.
“There’s no guidelines on this type of stuff,” he said. “We’re taking it minute by minute and day by day and really trying to do what’s best for these patients.”
A major treatment goal, he said, is to get patients off ventilators, which are in critically short supply.
A February report from the Johns Hopkins Center for Health Security estimated that there are just under 170,000 ventilators available in the United States. Cuomo said March 22 that the state needs 30,000 ventilators to meet the COVID-19 crisis.
Cuomo also issued a plea to businesses to sell the state personal protective equipment (PPE), such as masks, gloves, and gowns, for use in hospitals.
Smith said standard gear for ED staff includes a surgical mask and, when there is a high suspicion that a patient has COVID-19, an N95 respirator mask, a face shield, and a disposable surgical gown.
“People in the emergency department are certainly on the front lines and have the highest risk of contracting this disease,” he said. “We still show up to work every day, and we try to do our best for our patients. But we also want to make sure that we’re protected with the appropriate PPE. And I think the hospitals are doing everything they can.”
Smith said this is a frightening time for everyone.
“People — especially in the high-density-infection-rate areas — are starting to realize that we are going to stress the healthcare system, and we are going to start running out of resources, isolation rooms, ventilators, and space for these patients as we start to hit the peak” in the weeks ahead, he said.
He urged pharmacists who haven’t yet encountered COVID-19 to reach out to colleagues in hard-hit places like New York and Washington State.
“We’re meeting every day, we’re creating treatment guidelines,” he said. “And we should just share that information with everybody.”
For more information and free tools regarding the pandemic, including a recently released Assessment of Evidence for COVID-19-Related Treatments, visit ASHP’s COVID-19 Resource Center and the new COVID-19 Community at ASHP Connect.