CP56: “Extra Extra” What’s New! A Conversation with Dr Christina Madison, PharmD, FCCP, AAHIVP The Public Health Pharmacist

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Pharmacists Guide to Corona Virus
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Vaccine and syringe injection It use for prevention, immunization and treatment from COVID-19

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Transcript

Michelle:
This is Michelle Sherman, president of Michelle RX pharmacist consulting services and your host for the conscious pharmacist. Podcost welcome to today’s episode. We have a returning guest who I’m so excited to have on the show today. We have dr. Christina Madison, who you all know is the public health pharmacist, and she’s back on the show today to do an update and see what’s the latest news out there. So welcome to the show, Christina, thank you so much for, for coming back.

Christina:
Thank you so much again for having me, Michelle. It’s always a pleasure to be with such a amazing force for good. And I just, I truly appreciate your time and everything that you do for your community and how you’re making such a positive impact in the lives of persons with HIV and just your community advocacy. So thank you so much for having me.

Christina:
Oh, well, thank you. That’s that? That is very nice. Thank you so much. And it’s my pleasure. So we’ve got a few topics that we’re going to discuss today, but since you’re the public health pharmacist let’s discuss where are we today with COVID? I’ve just been seeing the numbers skyrocket every day and we all we, and how are we going to get out of this?

Christina:
Yeah, so that’s an excellent question. Unfortunately as a country, we have hit a quite disturbing milestone. So as of November 5th and actually as of November 4th as well we keep breaking records for the daily number of new diagnoses of COVID-19. So as of yesterday, we recorded over 120 new cases of COVID-19, which is pretty astronomical. When you think about where we were at the spring at this, you know, kind of venture within the pandemic and, you know, it’s, it’s disturbing for many reasons, it’s disturbing mostly because, you know, we know how we can stop the spread of the virus, right?

Christina:
So we can wear masks. We can social distance, we can limit our time around others that are part of our family unit. We can engage in enhanced hand hygiene, washing down surfaces, disinfecting things, you know, really just keeping our respiratory droplets to ourself. And unfortunately we have seen the politicization of things like mask wearing and sort of the misinformation campaign of, you know, whether or not the COVID-19 disease and SARS Coby two, which is the virus that causes the disease is actually a thing. And whether or not it is something that we should be concerned about. And I am here to tell you, it is definitely real, and it is definitely something that we need to be concerned about because every state in this country is seeing a rise in cases. And a lot of States are seeing their hospital systems to the point where they’re at 90, 95, 98, 99% capacity.

Christina:
And you know, one of the things that’s been also very challenging to see as a healthcare professional and as well as a public health professional is sort of the lack of, you know, personal responsibility that people are taking for the health and wellness of themselves and their family. And so it’s not just the fact that these ICU beds and hospital beds are now being taken over. But thinking about the staff that is now been working tirelessly since the spring and are exhausted, you know, we don’t just have these ICU beds. These ICU beds are not just, you know, Oh, it’s not just a bed. It’s the staff that goes along with that as well. So these are highly specialized positions where people have to be trained on, you know, sedation protocols and intubation and you know, all of the different things that go along with critical care medicine that I just don’t think the average person understands.

Christina:
They just think, Oh, I’m going to get COVID, it’s fine. I’ll recover. It’ll be no big deal. And yes, I do want to mention that survival rates from COVID are improving and there are more people surviving this infection. However, we are seeing people having significant complications after quote unquote, recovering from COVID. So people who are needing significant rehab you know, having, you know, continued symptoms, persistent symptoms of shortness of breath, fatigue there’s these group of people that we call the long haulers that have had horrible, you know, debilitation and, and potentially not even being able to go back to work because they can’t, you know, they can’t function, you know, they’re having mental confusion. They’ve had strokes, they’ve had heart attacks, you know, this, this disease affects every portion of the body and you know, more and more evidence is coming out to, so that this isn’t just a respiratory illness, that this is potentially a inflammatory as well as a vascular disease, which is why we’re seeing young people having strokes and clots and heart attacks and all of these things that we don’t even know what the full effects will be down the line.

Christina:
So that’s kind of where we’re at right now is that we are seeing a surge in cases. And unfortunately, I think people are thinking, Oh, this is the second way. Well, we really didn’t get out of the first wave because we never were able to get our case numbers to a point that was manageable. So, you know, I don’t know about you, but I don’t know of any state that was able to get to that benchmark that was set by the, who was, which was the 5% or below percent positive rate. And so, you know, we just, we never were able to hit those benchmarks.

Michelle:
And to me, it’s, it’s like, it’s like a national tragedy. I mean, I’m looking here. We, we, we got together and we did episode 33 on February 6th of this year. And you did it. We did an update on Corona virus. It was just hitting me. Like we were one of the first podcasts that put this information out. And at that time we knew that only 11 people were infected in the us. And when we look at this today, like nearly 124,000 new infections, it makes me want to cry. Like it’s J like, I mean, it is so outrageous and the absolute wanton disregard, like for, for human life like that, that’s out there for each other, like the lockdowns, yes, they were uncomfortable, but it’s our communities and to protect each other and to wear a mask. I mean, I ride in a mosque every time I leave the house, I’m in a mosque and I can breathe just fine. There’s nothing wrong with it. And when people don’t listen to like the doctors and the scientists, this is how we got where we are. And everybody’s expecting that quick fix that magic pill. Why isn’t it on the market? Like, this is like a Twitter feed or a Facebook post, like social media, instant gratification. And we know like, you know, being HIV, pharmacists, like we were 40 years into this pandemic and we still don’t have an HIV vaccine. So we’re 11 months in how, how, how much force for, can we go?

Christina:
Yeah. It is really interesting to see the parallels between, you know, the HIV epidemic and COVID-19, and it’s really funny that you bring that up. You know, I’ve mentioned this before. I feel like my you know, my, my background in public health, you know, when I was working as the clinical pharmacist for our local public health department, I did tuberculosis management. And then I also worked in STDs and HIV. And I feel like it’s, it’s almost as if tuberculosis and HIV had a baby and it’s COVID-19, so it’s like, it’s a respiratory communicable path, the gym, that’s a virus that impacts every organ system in the body and it overwhelms your immune system. Right. So it’s so odd that this is like the conversions of these two, like huge public health juggernauts. Right? So these are things that as public health professionals we’ve been dealing with for decades, and we still haven’t been able to get a good handle on, right.

Christina:
So we used to have TB sanatoriums right. So, you know, we’re complaining about a shutdown. What if you had to go away from your family for a year, a year and a half, because you had tuberculosis, right? Like we’re not, we’re, we’re forgetting about the old ways we’re forgetting about the things that people used to do in order to protect society for the greater good, right. Cause when you think about public health, it’s really about the health of the many versus the health of the one. And we used to do that. I mean, we did that with typhoid Mary, right? So the first documented evidence of an asymptomatic shedder of a communicable illness, we jailed her twice and she, you know, got out and she continued to be a chef and cook and not wash her hands. And then she gave a bunch of people typhoid, right.

Christina:
So we know that these are things that work and we’ve forgotten the old ways, I think. And it’s, it’s this whole thought process that somehow personal rights or your liberties are being taken away. And it really is. And that this is for the greater good, you know, like vaccinations, right? So if we had a vaccine for this, I don’t even know if people would take it because there is so much consternation and so much doubt and misinformation that has been spewed throughout our diaspora. You know, who in the beginning of last year said that we’re in the middle of an an info DEMEC because we have all of this overwhelming misinformation that keeps going out and it’s like the anti-vaccine movement and the anti masker movement have kind of like merged. And now we have people who are like, you know, you’re taking away my rights and I don’t want to wear a mask and you’re going to make me get this vaccine.

Christina:
No one’s making you get anything. No, one’s making you wear a mask. We’re just asking that if you choose not to do these public health measures that you stay home and that you don’t endanger others. Right. And that’s really how I explain it. You know, I do a lot of media for my local TV stations. And I think that’s the number one thing that I’ve tried to portray is that no one is trying to take away your rights. No one is wanting, you know, for you to be uncomfortable or to fill that you were, you know, not able to gather with people. We just want you to take personal responsibility and that if you do want to be around test, find out if you have it, you know, over 50% of people who have COVID-19 are asymptomatic spreaders. And that incubation period is so long, like that’s what makes this so different from things like influenza or even the first version of SARS Kobe, right?

Christina:
So the first version of SARS did not have this prolonged incubation period, which is anywhere from two to 14 days. And that whole time, you know, even the two days prior to when you are symptomatic, you are shedding virus and you are infectious. And so it’s really difficult to get a handle on an infection that you can’t see. And I think that’s, what’s so disheartening for people is that that’s, you know, they don’t see people as being sick or ill and they don’t realize that, you know, their actions can potentially be harmful to others, especially if they are older immunocompromised have chronic medical conditions are smokers, you know, have things like HIV, which by the way, we actually haven’t seen a significant increase in any kind of risk associated with just having a positive status and COVID-19 complications. However, there are things that we know that HIV positive patients have as far as chronic medical conditions, which are known to cause complications associated with COVID-19 like diabetes, cardiovascular disease, you know, those kinds of things.

Christina:
So, you know, we’re learning more as we go. And again, bright spot is that we are learning how to manage the cases that we have. So the mortality rate of those who are infected is lower than what it was in the spring, but we are seeing so many more cases and we’re seeing people who are young people that are coming in and are being intubated and are very sick, you know, being on the vent for things like seven weeks, you know, being extubated and then having to go to pulmonary rehab or having to, you know, learn how to function all over again, like that’s detrimental to our society, not to mention the fact that if you’ve had COVID-19 now you have a preexisting condition. And if we lose our healthcare benefits through the ACA, technically, you know, if we were to have that happen, now half of this country practically would not be able to get health insurance because they have a preexisting condition.

Michelle:
Oh, I’m so glad you brought that up because, you know, we, we, as a society, like a democratic free society have a responsibility to our communities. We have a responsibility to our communities and how we way this complete paralysis of our healthcare system comes in when the healthcare system is a foe for prop profit behemoth, how can you ever have a healthy society? So, you know, w w when you talk the ACA and then what, you know, I think next week is November 10th is the Supreme court hearing on ripping this away from everybody. You’re right. Half the people are going to have a preexisting condition. And how do we do that? I mean, if we have a healthy society, my thing is always a wealthy society is a healthy society, and it’s got nothing to do with the economy or how much money you have in the bank, because if people aren’t healthy, they can’t work, they can’t function.

Michelle:
And, you know, I, you know, my, my program’s called the Boone to pharmacist K K program. I really like to live that spirit of, we bring to every day, what happens to me happens to you, happens to all of us. And I think the lesson we can learn out of this whole pandemic is that it’s not the me, it’s not the I, it’s the we, and what I choose to do, whether I wear a mask when I go out or go to, into a crowd or whatever benefits everybody. And I think the single most catastrophic event that took place in this pandemic was having this country pull out of the world health organization in the middle of a pandemic. You know, it doesn’t matter. I mean, we cannot be xenophobic this world, as we saw with the virus spreading across the world is it’s like a little ball in the sky borders mean nothing.

Christina:
Yeah, no, I mean, I heard a statistic the other day that, you know, before we develop any kind of lasting immunity within the population, this virus will have circled the, grow the globe at least three times. So, you know, that’s what we have to look where we do. And, and it’s funny. I mentioned this to a friend of mine that everyone keeps saying, Oh, I’m so over 2020, like I just can’t wait for this year to be over. And my mind is going, wait a minute who told you that 20, 21 was going to be any better? Right? Like this is not going to just up and decide to leave because 2020 is over. Right. You know, we’re, we’re, this is in for the long haul, you know, we’re, it’s going to take us at least nine to 12 months to completely immunize the population once the vaccine is available.

Christina:
And, you know, according to, you know, our CDC director Redfield, we’re most likely not going to have vaccine available to the general population until third quarter, late spring, early summer of 2021. So that’s now getting us into 2022 before we even are looking at the possibility of having any kind of sustained immunity within the population to this infection. So it is, we are in for a challenge if we don’t continue, continue to do these preventative measures. And until we figure out a way to live with the virus, instead of thinking about how we can defeat the virus, because we only technically now have one therapeutic that’s been FDA approved, which is run Dem is bare. And, you know, there are other things in the pipeline, but we, we really only have one drug that has technically been, been proven to reduce mortality and hospitalization patients.

Christina:
And that’s dexamethazone, and that’s it, you know, I mean, if you told me that either tuberculosis or HIV or influenza for that matter only had one therapeutic and we had to deal with the entire epidemic of all of those things with one therapeutic and no vaccine, would you think I was crazy? You would think I was crazy, right? Like, so why are we thinking that we’re going to get by with just that for COVID. So again, I go back to like, thinking about, you know, we, we ha we know the history of these infectious communicable diseases. We can take lessons from how we dealt with things like tuberculosis, how we dealt with the HIV epidemic and the pitfalls and the things that we learned, and, you know, as well as influenza. And again, right now, we’re trying to avoid this concept of a twin pandemic without having both simultaneous influenza. And COVID-19 overwhelming our healthcare system at the same time. So getting people backdated with something, we actually do have a vaccine for, versus people being resistant to things that we actually know work.

Michelle:
I mean, it’s just, it just completely like it blows your mind. And, you know, it’s like, well, where are the drugs where the drugs? I mean, I started doing this work when we actually had no drugs and people would die, you know, within 82, within 18 months of HIV. And it was after the first cases were identified, it was seven years before they came out with act one drug. I mean, it’s been like all this time, really 40 years to get to where we are with a slate of it. So it’s, it’s, it’s all our responsibility to make this happen.

Christina:
Absolutely. And I, I’m hopeful that, you know, that we, as a society will come to some sort of collective agreement that this is what we need to do for the greater good. And ultimately those who still challenge the science will realize that, you know, that this was not something that was a personal attack upon their, their Liberty or their, you know, their sensibilities. And that really, this was, you know, something that we wanted to do for the greater good. And fortunately, you know, we got off on the wrong footing, right. So I just was listening to a story, how they were talking about, you know, the centers for disease control and prevention. When that first test came out and was released to the state health departments, because they made it to where you could only test for COVID through the centers for disease control.

Christina:
So all samples had to be sent to the CDC prior to that, but when they first sent out those test kits, apparently they knew before they sent the kits out that 30% of them could potentially give false results. And that the, the the actual controls were were defective. And I’m like, it’s like we were crippled from the beginning, you know, and that month and a half, it was about seven weeks that they did not have a functional test. So from the end of January to the beginning of March, that really hindered us at the beginning of the pandemic, because we weren’t able to do testing. And all of these state health departments were waiting, you know, to be able to analyze these tests. And they could, you can’t do a contact investigation if you don’t know whether or not the person is positive or not.

Christina:
So that alone set us back so far. And we just never have been able to recover from that one incident where an unfortunately, that person who was running the lab is no longer there. You know, there’s all these things that are coming up no after the fact, but during it, when we were in the thick of it, nobody knew like nobody could understand why we were sent this full C test and that nobody could use it. And that we were now having to ship samples to the CDC. And it delayed, you know, the contact investigations of these people where you truly probably had community spread probably all the way back in December, but we just didn’t see it in the large enough numbers. And tell, we start seeing all these travelers coming in from Europe and that it just, it spread like wildfire in New York, right? Like, that’s really, obviously we saw the initial you know, sets of deaths in the long-term care facilities in Washington state. But really when we saw that, that epicenter was when we started seeing all those people coming in to New York city, because that was a travel hub and it just blowing through that population like wildfire,

Michelle:
And it hasn’t stopped. It’s, it’s, it’s incredible

Christina:
Are some, you know, bright spots. There are some communities that continue to have, you know mid mitigation measures and they have been able to have their rates of infection be lower. But again, all States in all 50 States have seen a rise in cases in the last,

Michelle:
And that’s why if we had like a national strategy, like we have an HIV national strategy. I mean, yeah, no, that would

Christina:
Be great. National testing strategy, national you know, contact, racing strategy, all of those things would be fantastic. I would welcome that.

Michelle:
Oh my goodness. Because really what happens in orange County managed to here in Las Vegas. Yeah.

Christina:
Oh my gosh. He does it. You guys party in Vegas and you bring me all of your goodies or less

Michelle:
Stuff, right. Oh my gosh.

Christina:
I would say like, Vegas is like little LA, right. Cause it’s like, you guys come here, we go there. Like Becca, you share all kinds of good stuff.

Michelle:
Yes we do. And the numbers prove it. Right? Oh yeah. So, you know, another thing I wanted to touch on in, in things you’re working on is you know, the health and human services declaration that pharmacists can provide COVID vaccines. So we’ve talked about the absolute exhaustion of like the frontline healthcare workers. Well, we too, or frontline healthcare workers and, you know, pharmacists have stepped up to the plate and done extraordinary work. I think pharmacy has been catapulted like light years into the future during this pandemic. And now pharmacists will be able to give COVID vaccines. Can you tell us a little bit more about that too?

Christina:
Yeah. So there’s actually multiple things that have happened through HHS secretary ASRS declarations under the prep act which is the emergency preparedness act. So the first one that came out was actually COVID 19 testing that you could actually have pharmacists order the tests as well as perform the test. And then that was then added to have pharmacy technicians be allowed to perform that testing as well. So that was actually the first thing that came out. And then after that, there was a declaration in response to record low numbers of pediatric vaccination rates. Also allowing licensed pharmacists state authorized intern pharmacists and qualified technicians is very specific wording that they can also allow PDA pediatric vaccination administration all the way down to the age of three. And then they also added on to that further clarification that now pharmacy staff, including pharmacists, pharmacy, interns, and technicians can provide COVID-19 vaccine.

Christina:
So there are multiple layers within that emergency act that are really expanding the roles of pharmacists as well as pharmacy support staff. So it’s really lovely to see us being utilized ultimately at the level of our licensure. But I, I do want to make sure that, you know, people understand that this is one more added job onto the already full plate of community pharmacists, right? So we’re, we are dealing with a confluence of, you know, people are seeking pharmacies and pharmacists more because we are one of the most accessible points of healthcare access, but it’s also been extremely stressful to our community pharmacy staff, because they’re being asked to do, you know, multiple prescriptions they’re being asked to, you know, give vaccinations, they’re being asked to do COVID testing. And there, along with all of this dealing with short supply of PPE, right. And making sure that they’re keeping themselves and their staff protected. So I am all for us being able to work at the top level of our licensure. I just want to be mindful of the fact that these provisions need to be planned for, and when the implementation of these new services occur, that you need to plan for adequate staff and adequate time to allow for them to be able to do this successfully. So that’s really where my, my thought processes and advocating for pharmacists to be able to provide these types of services.

Michelle:
Oh, absolutely. And I mean, to that end you, you’ve created a pediatric vaccine training that that’s available and pharmacists can get CE CE for that as well. Can you tell us about that too?

Christina:
Yeah. So I partnered with CE impact to provide a pediatric administration best practices training. It’s a one hour continuing education program, and it’s actually accredited for both pharmacists and pharmacy technicians. So you can meet you know, the requirement that HHS has set aside, which States that you have to have at least two hours of continuing education in pediatric vaccinations prior to administering vaccines. And that also has a provision in there for state authorized pharmacy interns as well.

Michelle:
And that’s available on demand, right?

Christina:
It’s available on demand. It was offered live at the end of October to end American pharmacist month with a bang,

Michelle:
Right. This yes, we did. So for, for the listeners out there, there’s, there’s in the resource section, in the show notes, there’s a link to do that training if you want to take it or have your technicians and pharmacists do that as well. And yes October pharmacist month did end with a bang because I want to congratulate you on the show because you were the next generation pharmacist civic leader of the year. So yay. Congratulations.

Christina:
Three of us that were finalists. So yes, I was one of the honorees. And so I was very happy to that. Actually my colleague Victoria Reinhart was the, the official winner. The plaque that you saw me post was my, my commemorative prac from from pharmacy times and Parata systems, which were the sponsors of the award for this year, which was pretty phenomenal. So it’s, you know, national award you know, there were 30 pharmacists and pharmacy technicians and I think two, Oh, no, sorry, three student pharmacists that were part of that contingent of honorees. And it was a, it was a really great experience to see sort of the amazing level of commitment to the profession of pharmacy, as well as just getting, you know, quality care out to those in need. So definitely highlight for me for this year to be recognized at the national level, by my, my, my professional and by my peers

Michelle:
Definitely well deserved. This has been quite, quite, quite the year. So talking about quite the year, I think you know, we, we can end off with looking, we’ve just, we’ve just been through a general election and you know, so we could talk about some, you know, gender and ethnic, like successes that came out of this election that you know, would be empowering for our communities going forward. What are some of the highlights? And we had so many women and minorities being elected to like offices nationally and state in, in, in the state seats as well.

Christina:
Yeah. And so many things to celebrate in our gender minority and ethnic minority groups. You know, the first thing I will say as a native Nevadan Nevada became the first state in the nation to protect same-sex marriage in its constitution. So that was one of our, our ballot measures that passed. So that was pretty exciting as a, as an ally for sexual and gender minorities. We also saw the election of the first non-binary Muslim person elected to the Oklahoma legislature, which was fantastic. As a pharmacist and a female, it was extraordinarily exciting to see the first female pharmacist elected to Congress from Tennessee. And then we had three Iranian women elected to Congress as well. So I mean, just a phenomenal, you know, time to be a woman, to be a woman of color, to be, you know a sexual or gender minority, seeing somebody who looks and sounds like you just the big thing I will say, I’m sure you feel this way as well, is that representation matters.

Christina:
And when we have our public officials look and sound like us, we can start to dismantle things like, you know, systemic racism and health inequities in our populations. And that starts by electing people into office that understand the needs of those communities. Yeah, absolutely. And, you know, for the people elected officials have to represent us. So, absolutely. So it’s been an absolute pleasure having you on the show again. I know we can, we can sit and talk for hours and hours and hours, but thank you so much for being on the show. Is there anything else you, you, you want to add to today’s today’s episode wear a mask and wash your hands. We’re going to all get through this together. That’s the big thing that I want people to take away is that, you know, things seem unsurmountable right now, but I know that we will be better off on the other side and really think about this time to determine your priorities and to really think about how you as an individual can make an impact in your community because, you know, it takes all of us to make a change.

Christina:
And even if you just help one person it’s everything to that one person. So if anybody’s heard the, you know, the starfish story I’m sure, you know about the, the child who’s, you know, throwing all the starfish back in the, in the ocean and the, the parent that asks, you know, you know, when you see all of these starfish, like how do you, you know, why do you think that throwing this one back is, is going to make a difference? And the child says, you know, it made everything to that one starfish. And so I think leaving it with that and, and understanding that we can all make an impact and that we’re all in this together. And it’s all about community engagement and community partnership, because that’s what we’re going to have to do. You know, our economy is, is still healing. And it’s going to take time, but we will get through this together.

Michelle:
No, absolutely. And thank you so much. And remember to all your listeners out there, you are the change.