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New York pharmacist on how COVID-19 is killing his patients


Dear Pharmacy in Practice Editor,


SARS-CoV-2 has officially infiltrated my life.


Outbreaks, epidemics, and pandemics…those are events that only occur in third world countries or movies, right?


Well, that is what I thought when I used to hear those words thrown around in the past. In the last two weeks, it feels as though my world and everyone else’s has been flipped upside down due to COVID-19, and this pandemic has hit too close to home.


The types of patients in the intensive care unit (ICU) in which I practise has significantly changed.


The ICU has literally converted from a Cardiac ICU into a COVID-19 ICU.


In just a week, my service has gone from having just two COVID-19 positive patients to 16. Almost all of the patients with the virus who become critically ill have ended up with severe respiratory failure, shock, multiorgan failure, and in some, death.


Management of these patients has been challenging from every aspect of their care because there are many unknowns when it comes to optimal medication therapy, environmental precautions, and shortages of both medications and personal protective equipment.


The health care system is already getting strained, supplies are running low, personnel are being forced to work remotely to prevent the spread of the virus, and people are dying.


My daily routine has changed significantly and I’ve experienced some of the most emotionally difficult days I’ve ever had in my life in such a short period of time. One thing that has not changed is my passion for providing patient care to critically ill patients and educating the future of pharmacy.


Although most of the news regarding the struggles of healthcare workers such as physicians and nurses have been highlighted in the media, pharmacists in the community, hospital and academic settings have also been gravely impacted. As quickly as the virus has spread over the globe, the number of changes that have occurred in my life as well as many other pharmacists’ lives, have spread just as fast.


Academic and medical institutions in New York have been scrambling to come up with policies and procedures in order to be prepared to keep healthcare workers and students safe from the virus, as well as to provide care to the increasing number of patients that have been flooding the hospital systems. Cases of COVID-19 positive patients have been at least doubling every day, and many patients are requiring ICU level of care to support them.


Over the last two weeks, recommendations, policies, procedures, and etc. have been changing constantly, which has made coming up with contingency plans for myself, my students, and my patients very challenging. A plan that had been finalized one minute was necessitating either modification or complete overhaul the next.


Many hospitals have suspended experiential education of all disciplines.


Universities have converted to online teaching for the rest of the academic year. As you can imagine, this has resulted in immense stress and frustration for clinical faculty such as myself who both practice and teach. COVID-19 has forced me to become a remote clinician and educator, which was an unthinkable thought before the pandemic. Developing contingency plans for my students and maintaining my clinical services at my site has been both challenging, stressful, and emotional.


As a critical care clinician, physically being at the bedside of my patients and rounding in the ICU with my team is what I love to do and how I believe optimal patient care should be provided.


As an educator, I believe that modelling and teaching pharmacy students and other healthcare professionals or students in person is the most ideal way to improve knowledge and clinical skills. All of my ideals and morals have been tested in the last couple of weeks.


Allowing the challenges that I faced prevent me from continuing to teach my students and continue to provide care to the patients that need it most, would just allow COVID-19 to win. I could not imagine being completely removed from my practice site for a prolonged period of time so I felt fortunate enough to obtain remote access to the hospital’s electronic medical record for myself and my students, in order to continue to provide patient care and experiential learning.


I believe that going remote was the best plan that I could come up within this very difficult and constantly changing situation in order to make sure that my students, other healthcare providers, and ultimately patients remain safe.


If I can teach you anything from my recent experiences, COVID-19 should not be taken lightly or considered a joke.


Please stay safe, stay home, and stay positive.




Peter Nikolos, PharmD Assistant Professor of Pharmacy Practice Arnold & Marie Schwartz College of Pharmacy & Health Sciences, Long Island University Clinical Pharmacy Manager – Cardiac Critical Care NewYork-Presbyterian/Weill Cornell Medical Center.




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