Like most Americans, I’ve closely followed press briefings by the White House on the national response to COVID-19, looking for hints of public health expertise. What caught my attention most were comments from Ambassador-at-Large, Deborah L. Birx, coordinator of the U.S. Government Activities to Combat HIV/AIDS, and now a leading voice on the White House COVID-19 taskforce.
Rightly so, Ambassador Birx has earned a leadership role during this critical time, given her extensive leadership role in our global HIV prevention and treatment strategy. Her most astute comment, I believe, highlighted how “communities are at the center of this,” and that the virus should be stopped “at the community level.”
Providing COVID-19 screening access to the American people across all geographic and socioeconomic areas is critical, particularly given our collective and shared knowledge that exposure to COVID-19, like the flu, does not discriminate. Hospitals and urgent care clinics are apparent sites for screening.
In Westchester County, N.Y., drive-up screening for residents greatly improved access to screening and now similar drive-ups are being implemented in other states. But in places like Harlem, where I live, and neighborhoods like South Bronx and East New York-Brooklyn, as well as the vast non-urban areas across New York State and the nation, going to the hospital for a test may not be the most viable strategy.
They definitely should not be emphasized as our only community-reaching frontline effort. While drive-up screening aligns with the concept of social distancing, it is not accessible or practical for Americans living in densely populated urban centers, regardless of social, economic level, due to the high likelihood of gridlock.
As we conceptualize a comprehensive community COVID-19 strategy that gives all Americans access to screening services, I believe we must prioritize attention on increasing the number and types of screening access points. Simple math would tell us that with more access points and greater geographic distribution, the higher the ability for social distancing.
What has not been mentioned and exists in plain sight is the expanded public health role for pharmacies, which includes independent small business and minority-owned pharmacies. Many of us are familiar with pharmacies extending their practice beyond filling prescriptions to include blood pressure screening, flu vaccinations, and even co-located primary care clinicians.
A successful pharmacy practice innovation that arose out of the HIV epidemic and included a large proportion of independent, small minority-owned pharmacy businesses, were on-site HIV screening services in high risk, lower-income communities. The research revealed strong evidence of such practical and feasible screening services being able to reach those systematically disconnected from traditional healthcare access points.
Pharmacies are frequented by all segments of the population and typically located within 5 miles for 95 percent of all Americans. They usually have flexible hours and capacity to properly store and dispense all forms of pharmaceuticals, provide medication counseling and medical advice, and are known for their strong ties in their communities, particularly independently-owned pharmacies.
Taking this idea a step further, the rationale for pharmacy-based COVID-19 screening also supports the capacity for pharmacists to create linkage to treatments readily available and forthcoming, which are likely to arrive much sooner than a vaccine. Currently available COVID-19 treatment includes fever reducers, supplemental oxygen, and respirators – all of which are safely stored in pharmacies and could easily be scaled up.
While “big box” corporate chain pharmacies are being considered for a frontline role as suggested, it is critical to place more (or at least equal) attention on supporting the part of the independent, small business-owned pharmacies, who are frankly being overlooked. Independent pharmacies represent 36 percent of all U.S. retail pharmacies, with over 22,000 locations. These pharmacies are typically located in geographic areas where large chains are absent, including rural and lower-income urban areas across the U.S.
At a time when the administration is taking unprecedented actions to remove bureaucratic barriers and support small businesses in general, legislation should prioritize economic support for independently-owned pharmacies to purchase pharmaceuticals and supplies related to administering COVID-19 screening services. The White House should also prioritize policy that gives small pharmacy business owners access to high-cost medications that are exclusive to large corporate conglomerates.
Falling short in our public health response will not only extend the mounting fear, and disruption of American life, but will essentially weaken the positive impact of critical public health efforts employed thus far such as travel restrictions, school, and college closings, bars and restaurant closings, bans on crowded events, and social distancing.
We must think innovatively about COVID-19 screening access at the community level. The more viable and practical screening and treatment access points we put in place, the higher the likelihood of minimized chaos, crowded waiting lines, and an expedited return the social freedoms that we all took for granted will become possible again.
Crystal Fuller Lewis Ph.D. is an infectious disease epidemiology from Johns Hopkins Bloomberg School of Public Health and is currently an associate professor at NYU School of Medicine, Department of Psychiatry. Lewis has spent two decades conducting NIH funded research to expand access to HIV prevention and related social and medical services to high-risk communities.