Priyank Patel has been a pharmacist for six years and has owned MedX Drugs pharmacy on 118 Avenue for three years. Pharmacists are frontline workers, providing patient care through Covid testing as well as giving vaccines.
Patel studied microbiology after completing his pharmacy degree in Toronto, but even knowing what he does about viruses and pandemics, the intellectual knowledge is different from the experience of living through one. Patel said that, in the beginning, “We never thought it’s going to be this bad, this challenging, this stressful.”
Throwing out the pandemic plan
In 2014, the Alberta government developed a pandemic plan to deal with a possible influenza outbreak. The plan detailed the responsibilities and organization of various levels of government and service providers. It was clear from the start of the Covid pandemic that this plan was not being used.
There was a failure to communicate by the Government of Alberta and AHS (Alberta Health Services) to all other levels of health-care providers. Patel explained how this looked in his industry. “Pharmacists learn about an opening for a new vaccination phase because the phone won’t stop ringing.” Patel laughed ruefully. “So that’s how you know.”
Patel continued, “Somebody from the government makes an announcement; they’re opening Phase 1, Phase 2, Phase 3 [levels of people eligible for the vaccine], but we wouldn’t get an official email until 4:30. At one o’clock, when a new phase opens up, we started getting phone calls.”
“So that’s how it was every single time. A news release is made. It’s the TV that tells us what’s going on rather than if they informed the health sector or the health professional members,” he explained.
“Somebody from the government makes an announcement; they’re opening Phase 1, Phase 2, Phase 3 [levels of people eligible for the vaccine], but we wouldn’t get an official email until 4:30. At one o’clock, when a new phase opens up, we started getting phone calls.”
“So that’s how it was every single time. A news release is made. It’s the TV that tells us what’s going on rather than if they informed the health sector or the health professional members,”
Patel said the Alberta Pharmacist’s Association has raised concerns, but to date that still wasn’t solved. “Yesterday, they announced [ages] 75 and up, [and] after six months, can do their third shot. We were not informed ahead of time. So a patient comes in and asks, ‘Hey, can I bring my mom?’ And I’m like, ‘Not yet. They just announced it 10 minutes ago.’ So that’s how we learn there is a new phase again.”
Patel emphasized. “This is not an effective way. We are frontline workers and should be included and kept in the loop.” He said, “That’s something I’ll keep complaining about.”
“Informing officially to professionals—that’s something they should have done before. It should be switched around. But what do we know? Maybe there is something that prevented them. God knows what,” Patel wondered.
Staffing and scope of practise
The absence of communication from the government presented tremendous staffing pressures. Patel said, “Of course, that day [of the government announcement] I’m working with one or two staff. The phone calls keep one staff member constantly answering the phones.”
Every staffing level in the pharmaceutical industry—community and hospital pharmacists, assistants and managers—has found the pandemic taxing. “Everybody’s stressed. The stress was about not knowing things. That’s how it started. Not knowing how it’s going to be. What direction we are going. There’s a lot of anxiety about that.”
Some of the pressures were unexpected. Patel pointed to the buzzer at the front door of the pharmacy. “We didn’t have the door locks before. Covid was one of the reasons that we installed them in all of our pharmacies.” Capacity requirements meant staff had to monitor the number of people in the pharmacy, as well as having the staff to serve them.
It took a lot of training to establish the new skill sets required for his staff. He said, “I did swabbing in my past career for strep throat, but doing Covid testing was a different thing. Learning new skills, extra training time that we ended up having to do and then it started with the third wave. So that’s stress.”
Long wait times for testing from AHS sites meant pharmacies took on testing for asymptomatic people, or for people who were exposed to Covid and needed to determine whether or not they were positive.
Despite the limitation of testing asymptomatic patients, unvaccinated people with symptoms would come to the pharmacy wanting to be tested. Patel said, “We can’t risk our staff.” He also commented that the unvaccinated people with symptoms “seem to be the same who are not wearing masks.”
From a systems perspective, pharmacists were having to learn new skills and take on new tasks all the time. “There were new guidelines, new emails, not only from AHS but from Blue Cross as well, the eligibility for claims process. We test somebody, we send it to them, it has to be in a certain timeframe. It is stored at different temperatures. Everyday, there’s a new learning process. And that learning process changes every time. We acquire skills and then we’ve got to amend or modify the skill.”
Failure to communicate
In addition to staffing problems, the poor chain of communication meant that pharmacies were not stocked with vaccines when new phases were announced by the government. When the public began calling for appointments, the pharmacy would book appointments for a week or two weeks after the announcement, although they didn’t know if they would have access to the vaccines.
Patel stated, “We make the appointments in advance [for vaccinations]. And for some reason, the stocks or the shipments were cut down.” Then, the pharmacy would have to call all the people with booked appointments to reschedule them, which would require additional staffing.
Vaccine appointments could also be booked online through an AHS portal, but even here there were communication breakdowns. The AHS online booking system was confusing. You could choose a pharmacy, but if you chose the wrong one, or found a pharmacy closer, or with a better time, it was not possible to cancel the appointment through the online system. Even if you did call, cancelling the appointment was an additional phone call the pharmacy would have to manage.
People who found the website too confusing to navigate would call pharmacies instead. “One person would call 10 pharmacies to book their shot until they [got] the time they want, and then forget about the rest of [the appointments they had made].”
During the initial vaccination period, Patel had to hire someone just to manage the phone calls and appointments. “We had some outreach, contract workers or employees. We were able to get summer students. That was a huge help worth mentioning.”
Vaccination pushback
The constant changes and poor communication to health-care professionals created stress for many people. Patel said of patients, “The moment they come in, we know what’s going on. The week they made [vaccines] mandatory for all employers, or the vaccine passport card, we did see some aggression.”
Patel heard of many pharmacists whose patients offered them a bribe to create a false vaccine record. “We have had one to date. We just have to turn them away now.” He paused and laughed. “In a really nice way though, because you don’t know where is this coming from?”
Patel said, “I know one pharmacist, she said somebody asked her to sit down in a private counselling room and offered her a $1,000. The pharmacist just opened up the counselling room door and walked out and politely asked him to leave.”
There was backlash and suspicion about the technology of mRNA vaccines. He said, “They [the government] could have done that as an educational session, but they never did. They could have explained the difference between RNA and DNA [with posters].” Knowing that this is more complex science, Patel acknowledged, “And that’s not for everyone in one session. They should have done it on TV.”
Patel contrasted the lack of education to what he sees with other public health issues like smoking cessation. “We have all the materials provided by AHS. If anybody comes in with questions, I can say, ‘Here, just watch.’” If people have further questions and need more detail, Patel provides further explanations. But with Covid, and vaccines, he has had to explain the basic concepts to every single person.
“When they ask us, we do sit down and make sure they understand that the proteins are made from mRNA. It’s an explanation, but they could know before they went to make their appointment.”
The pandemic has been a trying experience. Patel said, “There was nothing good about Covid. Apart from longer hours, and everybody got well compensated. That’s the only good thing if you see in financial or monetary terms, but there’s nothing else good.”
Still, he takes his job and responsibilities seriously. “You are in the public domain. You’ve got to help. That’s how the ethics are.”