SALT LAKE CITY — Sunday was the first day Tiffani Airmet saw evidence of hope.
Until then, what the lead pharmacy technician at a Salt Lake County pharmacy saw every shift was what happens when fear permeates every decision and customer interaction.
“Today was the first day I saw a bright light and hope of it getting better,” said the 30-year veteran who works at a pharmacy inside a retail store. “The last two weeks, it’s been like nothing I’ve ever seen in all the years I’ve been doing this.”
Long lines, impatient and frustrated customers, as well as near daily runs on different items. From thermometers to vitamins, people rush in and buy up anything mentioned as helpful or useful in surviving COVID-19, the illness caused by the new coronavirus.
“Like distilled water is flying off the shelves,” she said. “And we have all these people who need it for breathing treatments, but because people want to store it, those who need it can’t find it. The panic is harming people who really need it.”
Airmet’s experience isn’t unique as pharmacies become a sort of ground zero for COVID-19 panic and hope. Every mention of minerals that might help (zinc) or old medicines offering promising new treatment possibilities (chloroquine or hydroxychloroquine) bring a new wave of people desperate for the secret to staying safe or getting well.
“There is a lot of misinformation or people misunderstanding,” Airmet said. “And that is causing kind of a panic. People are hearing on the news that they should stock up on their medicines, and the insurance company won’t pay for it.”
Other times, the pharmacists make a decision not to fill requests because they don’t want to run out of medication. When President Donald Trump mentioned chloroquine and hydroxychloroquine as medications that were “promising” in the treatment of COVID-19, pharmacists immediately fielded questions and calls for the drugs.
“As soon as the news started coming in that maybe it was effective, we started getting doctors prescribing it for themselves, like in huge quantities,” said Benjamin Jolley, who is a third-generation pharmacist at Jolley’s Compounding Pharmacy in Salt Lake City, “for their offices and family and friends. So we said no to all of those requests.”
The drugs, he said pointing at the four bottles the pharmacy possesses, are used to treat chronic conditions like rheumatoid arthritis and Crohn’s disease. Those at the pharmacy want to have the medications available for customers who need it and are already relying on it.
On Monday, Utah Department of Health Director Dr. Marc E. Babitz said patients could access those drugs mentioned by Trump through an online screening. But Tuesday, Gov. Gary Herbert stopped that order, and said hydroxychloroquine and chloroquine should be reserved for those who have prescriptions from doctors.
Babitz, a family physician, said Monday he has “seen enough evidence of benefits to make it worth trying.”
On Wednesday he said he understands the governor’s perspective but still believes the standing order would “provide some real benefits” to Utahns. Babitz said part of the problem is doctors who are writing prescriptions for patients who may not need them.
”There still is the concern about panic buying. I would like to believe that all of my physician colleagues, all my health care providing colleagues, will only issue prescriptions for patients who really meet the CDC criteria,” he said. “But I know that’s not the case.”
Babitz said he’s expressed those concerns to the governor’s office and has “great trust and faith in the governor and his staff and know they were getting things from all over the place. When they said they were pulled in all directions, I can only imagine.”
Herbert’s office said his office is monitoring how the drugs are being used to battle COVID-19.
“Our office is closely tracking reports and studies of this drug’s effectiveness in mitigating and treating symptoms of COVID-19. The drug will be available to Utahns seeking it through an in-person visit or via a telehealth consultation with a health care provider,” the governor’s spokeswoman, Anna Lehnardt, said in a statement.
Greg Jones, director of pharmacy at Harmons, acknowledged that news of new drugs or possible treatments “created a bit more panic” but asked customers to trust them to find ways to fulfill their needs.
“We’re just encouraging people to do normal supplies,” Jones said. “Hydroxychloroquine is what people take for chronic conditions and we’re filling their prescriptions. If we get it for an active case of COVID-19, which would be 12 tablets, we’ll fill it. ... I don’t think we’ve seen any of those prescriptions.”
All of them understand that walking into a pharmacy and seeing empty shelves causes anxiety in patients, most of whom rely on the medications these pharmacists and technicians find for them.
“When you walk into the store, you’ll see a lot of empty shelves,” Jones said. “But we’ve been able to get most of the drugs we need.”
Airmet’s pharmacy has had to limit some things, like inhalers, so that “one person doesn’t end up with a six-month supply and someone else can’t get one.”
The Jolleys are keeping an eye on their supply — and the supply chain — although they said it’s difficult to drastically increase a pharmacy’s normal requests.
All of the pharmacies have made changes, whether that’s altering their hours so they can spend time cleaning facilities, or offering drive up or curbside offerings. The Jolleys locked their front doors last Tuesday, even though pharmacies aren’t required to do so.
They said they made the decision to lock their front door and only dispense medications and other items through their drive-thru window or carside service for their safety and that of the customers.
“We thought it was a wise idea,” Dean Jolley said. “We’ve heard some colleagues of ours who were doing something similar across the nation. ... I feel like I’m working at Wendy’s, going out asking what people need, writing it down, coming in to get it, and then bringing it to them.”
State Senate Majority Leader Evan Vickers, R-Cedar City, owns three pharmacies in southern and central Utah. Despite not having active cases in the communities where his pharmacies are located, he said they’re already filling more prescriptions, and they’re trying to keep businesses afloat as restrictions imposed to control the virus hurt their ability to stay profitable.
“At our main store (Bullock’s in Cedar City), we employ 45 people, and we have a large front-end operation,” Vickers said. “That business has fallen off significantly. We’re trying to keep people busy with projects we’ve put off, but we’re going to have to start curtailing some of the hours of our retail store and limiting hours for employees. So that’s stressful, too.”
The pharmacists said insurance companies have been more flexible with signatures and prescription limits, but he worries that continuing to fill larger prescriptions earlier would lead to shortages in some medications.
“We’re kind of being forced into this middle ground of allowing people to get enough medication, while continuing to do normal dispensing patterns that would allow us to stay within our guidelines for allocations.”
Jones has been a pharmacist for nearly three decades, and he said he’s felt more pressure in the last few weeks, but he’s also seen more patience among those they serve.
“Our customers have been great,” Jones said. “They know there is a lot going on. I’ve been amazed at how kind and patient people have been. It’s been quite heartwarming that people are being humane and more patient and realizing, ‘Hey, we’re all going through a tough time’.”
Even small, independent pharmacies are experiencing the same run on products that larger chains have seen, which is evident by the empty shelves where thermometers and hand sanitizer used to be displayed.
The issues that cause frustration and fatigue for those working in the pharmacy come from the panic buying and occasional outburst when something can’t be purchased.
Airmet said a week ago people purchased all of the children’s Tylenol and children’s ibuprofen. This week, they’re buying cold medicines.
“All the zinc in the store is completely gone,” she said.
These pharmacists and technicians had some advice for customers: Don’t stockpile your medicine or medical supplies. Buy what you need and leave enough for others. Don’t buy supplies you don’t need. And remember that sometimes insurance companies make the decisions, not the pharmacist.
Call ahead if you can, and remember that everyone is struggling to deal with the new normal.
“Just do what the (Centers for Disease Control and Prevention) says,” Jones said. “Wash your hands and practice appropriate social distancing. We’ll get through this. It’s going to get worse.”
Adds Airmet, “Remember that a lot of health care workers are putting their own needs aside to help others. We’re working longer hours, through lunches and breaks, and that makes it hard, wearing on health care workers. ... Don’t stockpile your medicine. It’s going to be there, and if you’re not hoarding it, there will be enough for everybody.”
While many people are stuck at home and complaining about boredom, most health care workers are struggling with long hours filled with stress and more pressure.
“Everyone is overworked, so please don’t come in and be demanding,” she said. “It’s always a joke among us that people are willing to wait longer for a latte than medicine. ... Some people have become impatient and panicky, and that’s not good for anybody.”
Airmet said she’s seen people rip boxes out of the hands of those stocking shelves. Sometimes, she said, the fear is too much to just ignore.
“In all the time I’ve worked, I haven’t felt like this,” she said. “I’ve come home sobbing a few times because it’s just so overwhelming.”
Whether the pharmacist is a well-known, trusted family friend or a stranger with a nametag and wary smile, just keep in mind, they are human beings who are also scared and worried, but are happy to be helping you.
“My plea to the public would be to just be prudent,” said Vickers. “Don’t go crazy like people have with other products, like toilet paper. ... I have had a lot of conversations, been reaching out to suppliers, warehouses, and the indication is, they have a pretty good backlog of medications. We have to make sure we preserve that.”
Contributing: Lisa Riley Roche