Coronavirus: What Clinical Pharmacists Do

Preparing for Covid-19: What the coronavirus epidemic means for hospital pharmacists like Frank Dörje from Erlangen and why he is now producing disinfectants himself

In hospitals, drugs such as antibiotics are often given as an infusion

© W & B / Fotolia

The new type of coronavirus - called Covid-19 or SARS-CoV-2 - is now also spreading in Germany. Almost all federal states are affected. Federal Health Minister Spahn spoke of the beginning of an epidemic in Germany. The Robert Koch Institute currently assesses the risk to the health of the population as moderate. The respiratory tract infection is mild in most people, but severe in some. Such cases are treated in the hospital.

Professor Dörje, how is Erlangen University Hospital preparing for the coronavirus epidemic?

We have set up an interdisciplinary task force in which, among other things, we define measures such as how we deal with returnees from high-risk areas, how staff protect themselves, which hygiene measures hospital visitors must observe, and, and, and. Our experience with the bird flu virus in 2009 helps us with this.

Prof. Frank Dörje, head of the hospital pharmacy at Erlangen University Hospital

© ADKA

What do the measures mean for you as head of the hospital pharmacy at Erlangen University Hospital?

The hospital pharmacy must ensure that the clinic is adequately supplied with medicines at all times. Of course, we have prepared ourselves in the event that many people with the coronavirus may have to be treated with us within a short period of time. For example, we have stocked up on certain antibiotics in order to be able to care for sick people who, in addition to the virus infection, have bacterial pneumonia. We also keep an eye on the fact that there are first experimental studies with antiviral agents in China that are supposed to help against the virus. The Federal Ministry of Health may facilitate imports of these drugs if necessary. All of this is a great challenge for us, but it is our job and it is now important to keep a calm head.

Mouth guards and disinfectants are so popular among the population that you sometimes find yourself in front of empty shelves. Does that lead to delivery bottlenecks in hospitals where both are urgently needed?

The demand from the population is really high. This puts pressure on manufacturers and repeatedly leads to short supply bottlenecks in public pharmacies, drug stores and supermarkets. In such situations, hospitals are supplied with a higher priority so that, among other things, medical staff and nursing staff can comply with the hygiene protection measures. That's immensely important in a hospital. In addition, in the pharmacy we manufacture drugs for cancer patients, for example, according to strict hygiene standards, for which we need, among other things, a face mask and disinfectant. At the moment, however, the need for hand disinfectants and face masks is largely secured at the UK Erlangen.

Can you make hand disinfectants yourself in an emergency to ensure supplies to the clinic?

We can do this on site, as we are one of the few clinic pharmacies in Germany that still has a production facility for disinfectants. That means we can also produce disinfectants in a certain amount in advance. Normally this is not provided for by the legislature. Today, however, the Federal Institute for Occupational Safety and Health has issued a temporary exception regulation that allows hospital pharmacies, public pharmacies and the pharmaceutical industry to manufacture certain hand disinfectants. We are in the process of producing the first batch.

At the moment, the infection can only be treated symptomatically, for example medication against fever and cough. Seriously ill people may also need antibiotics or need ventilation. You have surely increased your supply of such funds. In which dimensions do you have to think at a university clinic?

Of course we have increased our stocks. We care for 1500 inpatient beds, 250 of them in intensive care units. You have to think in terms of pallets rather than packs.

Are there any problems with delivery bottlenecks here too?

We currently have no delivery problems for the medicines you have mentioned. Overall, however, that is a huge issue. For example, there are always bottlenecks in antibiotics and cancer-inhibiting drugs, as many active ingredients are largely manufactured in a few plants in China or India. If a problem then arises with a drug manufacturer, it affects all pharmaceutical companies worldwide that purchase their drugs there. The extent to which a spreading corona pandemic could affect this supply chain cannot currently be assessed. But you have to ask yourself whether you want to get into such dependencies. Authorities and pharmaceutical companies have therefore recently started advising regularly how to solve this problem in a meaningful way. I am cautiously optimistic that the pharmaceutical industry will re-establish factories in Europe in which they produce active ingredients.