Chief Pharmacy Officer Todd Karpinski, PharmD, and his team at the WVU Medicine Pharmacy in J.W. Ruby Memorial Hospital have possibly the most challenging role in the COVID-19 pandemic: how to attack an illness that has so far baffled scientists and the public.
COVID-19 stands apart from other recent viruses like HIV, Ebola, and Zika with the rapidity of its spread, its ability to disrupt every major biological process in human cells, and the wide range of symptoms among the population it affects. The disease has affected all age groups and has been fatal to some individuals but almost inconsequential to others.
Meanwhile, every aspect of the virus dominates the news, social media and conversation, causing providers on the frontlines to sift through an ever-changing landscape of updates and breakthroughs mixed with a healthy dose of opinions, speculation, and inconclusive possibilities.
“The greatest challenge during the pandemic has been how fast the new information for treatments or vaccine prevention hits the news,” Karpinski said. “Our staff is being asked daily about potential new treatment regimens that are being studied or are U.S. Food and Drug Administration (FDA) approved. We are putting together a list of pipeline treatments, where they are at in development, so that we can track.”
Karpinski reports his findings to incident command twice a day, while also giving them an update on key medication supply used in treating COVID-19 patients. The pharmacy has also been part of a multi-disciplinary team that has developed a COVID-19 treatment algorithm, a plan for non-severe and severe disease cases. The algorithm is updated and tweaked whenever necessary and includes a list of recommended medications, along with rationale for use, notable adverse reactions, and other considerations.
From the outset of the pandemic, the pharmacy’s initial focus was to identify the stock of key medications being evaluated to treat COVID-19 and/or provide supportive care.
“Our staff here in Morgantown coordinated ‘buy-aheads’ of more than 50 medications we felt could be used in treatment and therefore be subject to a national drug shortage,” Karpinski said. The pharmacists have advised others in the WVU Health System and consulted with systems across the country on medication protocols on how best to conserve drugs. However, the first course of action for patients who have tested positive is not medication but a quarantine until the virus runs its course. If a patient has trouble breathing, high fevers, or other significant symptoms they may be hospitalized for supportive care, which includes medications.
No medications are currently proven to be effective against the virus, Karpinski said. However, “some drugs, like hydroxychloroquine, lopinavir/ritonavir, azithromycin, and others have gained a lot of attention, albeit, unproven. We do have one agent, remdesivir, which has been shown to reduce the duration of the impact of the virus, however, its impact on mortality is unknown.”
The State of West Virginia has been allocated a small amount of remdesivir from the federal government. A team from WVU Health System is working with other clinicians across the state to develop a standard protocol on how the medication is used and distributed across the state.
Convalescent plasma is another possible therapy that involves treating patients by transfusing neutralizing antibodies from individuals who have recovered from COVID-19. The concept has worked in previous viral outbreaks. Brian Peppers, DO, and his colleagues have developed a convalescent plasma protocol for WVU Medicine which has given providers an opportunity to explore this option for COVID-19, Karpinski said.
As time goes on and more data is available, a more precise plan, and possibly a vaccine, will develop.
Outside of the rapid developments he has seen in COVID-19 patient care, Karpinski said his most memorable experience during the pandemic is “seeing the tremendous teamwork with our pharmacy staff, physicians, nurses, administration, and all others who have worked tirelessly to take care of our patients.
“The ability to take on the pandemic and the rapid rate of change to accomplish the action plan and educate our staff was very impressive. Finally, the ability of our leadership team to be very nimble and the presence they have shown has been truly remarkable.”
