COVER STORY: The COVID-19 Pandemic

TheHistory During Global of Phar Crisis macy

Nathan Karlan, PharmD Candidate, Class of 2021 | University of Iowa College of Pharmacy

The role of the profession of pharmacy has changed drastically over the course of the last century, yet the commitment to providing great patient care when needed most has always remained constant. The current COVID-19 pandemic has placed pharmacists on the front lines of one of the deadliest pandemics in the last 100 years, and, although putting themselves at risk, they have stepped up in heroic ways to provide care to their communities. However, this is certainly not the first time the profession of pharmacy has had to adapt during a global crisis. From the 1918 Spanish Flu pandemic to World War II, the way pharmacists conduct themselves during times of global crisis plays a tremendous role in advancing the profession for the future. The current COVID-19 pandemic is no exception. The way pharmacists across the country are currently adapting to provide care to patients and their communities will undoubtedly shape and advance the profession for years to come.

1918 Spanish Flu Pharmacies in the early 1900s looked significantly called at the time, often owned small retail shops focusing on compounding non-sterile medications such as magnesium citrate and salicylates. These drug stores were staples in small town communities, allowing people to pick up their medications as well as a variety of other supplies such as handmade gifts, soda, and even groceries. While greatly respected by members of the community at the time, the role of pharmacists as solidified healthcare providers was brought about by the spread of the 1918 flu pandemic. At the time, very little was known about infectious disease in general, and the influenza virus was not a reportable disease. Spreading from avian origin, the so-called Spanish Flu ravaged soldiers fighting in World War I over in Europe, and it eventually spread to the U.S. in the spring of 1918. By the end of the year, an estimated 28% of the American population had contracted the flu, with deaths reaching 650,000 people. The death toll worldwide was even more

Alexander Fleming at Work Courtesy, St. Mary’s Medical School Hospital, London

staggering with 500 million (a third of the global population) contracting the virus, killing over 50 million. Drawing parallels with the current pandemic, hospitals at the time were overwhelmed, and makeshift hospitals were erected to manage overflow. The government issued nation-wide lockdowns, schools different than they do today. Druggists, as they were

closed, and people looked to pharmacies to provide essential medications and other services.

Various articles written in a popular pharmacy newsletter at the time, The Druggist Circular, described the ways in which pharmacies across the country adapted to patients’ needs during the pandemic. Given the time period’s limited knowledge of infectious disease, pharmacies began providing holistic approaches to help prevent the flu’s spread, including the widespread use of camphor as an odorant. Because doctors were so consumed with treating pandemic patients, people were often sent to their pharmacy to receive treatment for everyday ailments. Pharmacies rearranged the nonmedication sections of their stores to allow for greater compounding of prescriptions. Medications such as magnesium citrate, phenacetin, and salicylates were in high demand, and pharmacists met these demands head-on. Pharmacists also played an instrumental role in public health by advising people to stay home, limit their contact with others, and self

isolate if they became sick. This increased demand for pharmacy services led to an increased interest in the profession, and the number of colleges of pharmacy rose steadily. Perhaps the greatest change to result from the 1918 Spanish Flu pandemic was the shifting view of the profession from essentially a retail store-owner who simply provided medical goods and services to a solidified healthcare provider. People across the country began to trust pharmacists with their medical needs and began seeking counsel on medications and medical conditions. A quote from a pharmacist in The Druggist Circular summed it up best by saying, “[The pandemic] served to establish in the estimation of the public the practice of pharmacy as a profession. That pharmacists saved lives, many lives, is indisputable and that they conducted themselves with conspicuous and self-sacrificing devotion to duty and to humanity is equally conclusive.”

World War II The outbreak of World War II in 1939 saw another instrumental change in the career of pharmacy as the upheaval of American life, coupled with the growing understanding and use of primitive antibiotics,

began to shape the modern practice of pharmacy as we know it today. The attack on Pearl Harbor that entered the U.S. into World War II greatly changed American life, and pharmacies were not exempt to this change. It is estimated that 10,000-14,000 American pharmacists were drafted during the war, leading to a massive loss of pharmacy manpower. Around 15% of pharmacies across the country were forced to close their doors, and the ones that remained open saw a massive increase in demand for prescriptionfilling while dealing with widespread drug shortages of quinine, alcohol, and glycerin. This change in the workforce opened the doors for the advancement of women in the profession, and colleges of pharmacy and employers began actively recruiting women. Prior to the war, only 4% of pharmacists in the country were women, with those numbers increasing by as much as 15% during and after the war. This change in the pharmacy workforce was accompanied by a nation-wide push for citizens to prioritize their health in case their number was called in the draft, once again overwhelming hospitals and doctor’s offices. Similar to the 1918 Flu Pandemic, doctors began referring patients to their pharmacists in order to alleviate some of this demand. This further solidified pharmacists as trusted

healthcare providers who can provide clinical services outside of simply filling prescriptions.

The war also brought about another crucial change in the profession: the widespread use of antibiotics. Scottish scientist Andrew Fleming’s work on isolating penicillin from mold cultures in the late 1920s paved the way for pharmaceutical development and the process of new drug discovery that so many pharmacists play a vital role in today. By 1941, 39 pharmaceutical companies in the U.S. began synthesizing inorganic penicillin, and by D-Day in 1944, some 300 billion units of penicillin were available for armed forces of several countries. As the distribution of antibiotics made its way back to civilians, pharmacists once again saw themselves at the forefront of a new age of infectious disease.

The profession of pharmacy has changed dramatically since the early 1900s, yet pharmacists’ ability to adapt and meet new challenges has always remained constant. The COVID-19 pandemic of today will surely shape and change the profession for years to come, but if history tells us anything, pharmacists across the country will face these challenges headon while continuing to provide quality care to patients who need it most. ■

Sources 1. McCartney, David. “Transcription and Digitalization of

Daily Iowan Newspaper August 1918 - May 1919”. The

University of Iowa Libraries. 27 May 2020. 2. “Penicillin: Medicine’s Wartime Wonder Drug and Its

Production at Peoria, Illinois.” John S. Mailer, Jr., and

Barbara Mason Historical Research and Narrative. www.lib.niu.edu/2001/iht810139.html. 3. Sundin, Sarah. “Pharmacy in World War II: The

Pharmacist.” 9 May 2016. www.sarahsundin.com/ pharmacy-in-world-war-ii-the-pharmacist-2/. 4. “1918 Pandemic (H1N1 Virus).” Centers for Disease

Control and Prevention. 20 Mar. 2019. www.cdc.gov/ flu/pandemic-resources/1918-pandemic-h1n1.html 5. “150 Years of American Pharmacy: 1918 Influenza

‘Puts Pharmacists to the Test’.” Drug Topics, 5

Nov. 2007. www.drugtopics.com/pharmacy/150- years-american-pharmacy-1918-influenza-putspharmacists-test.

Japanese-Americans Dr. K. H. Taria and pharmacist Tom Arase at work, Jerome War Relocation Center, Arkansas, 17 Nov 1942 (US National Archives