ICU Pharmacist: Watching COVID-19 Patients Suffer is ‘Heartbreaking’

As a critical care clinical pharmacy specialist at Baptist Medical Center Jacksonville in Florida, Amanda Yassin works closely with doctors and other clinicians who treat COVID-19 patients.

Unlike your neighborhood pharmacist, whom you can reliably find behind a supermarket or drug store counter, Yassin makes rounds with doctors, nurses, nurse practitioners and other providers who care for COVID-19 patients. Yassin joins the clinicians as they evaluate such patients.

“I make recommendations for drug therapy, and help educate (other members of the clinical team) about what they need to know about the medications; how they interact with each other,” she says.

[Read: Unsung Heroes Fight the COVID-19 Pandemic.]

With COVID-19 patients who require supplemental oxygen to breathe — including people who have been on a ventilator — Yassin will typically recommend that doctors prescribe dexamethasone, a corticosteroid. The immune system of people with severe respiratory problems caused by COVID-19 can become overactive; dexamethasone can help manage the response and curb potentially lethal inflammation.

While it can be helpful for some patients, dexamethasone is far from a cure for COVID-19. Researchers are conducting hundreds of clinical trials to develop safe and effective treatments and vaccines for COVID-19, but current therapeutic options are limited.

Research suggests the drug remdesivir can provide benefits to some COVID-19 patients. A preliminary report published in the New England Journal of Medicine in May suggests the medication helped reduce the median recovery time of people with COVID-19 from 15 days to 11 days.

Based on her experience and research, remdesivir may not be a good option for people who are in severe enough condition to be in the ICU, Yassin says. According to a meta-analysis published in July in the journal Infectious Diseases and Therapy, “The current data do not suggest benefit for patients who have further progressed in their illness to requiring high-flow oxygen or noninvasive or invasive mechanical ventilation, and alternative therapeutic options should be further assessed in these patients.”

That doesn’t mean that she’d never recommend remdesivir for a patient in the ICU, Yassin says. “The question frequently comes up, ‘Is there anything else we can do?’ If remdesivir is the only therapy we have left that we haven’t yet tried, and if it won’t harm the patient, assuming we have it, we’ll try it,” she says. Remdesivir could be harmful to people with certain conditions, such as liver disease.

Other than dexamethasone for patients who needed help getting oxygen, Yassin doesn’t have many proven therapeutic options for COVID-19 patients in the ICU.

[Read: Speech-Language Pathologists Join the COVID-19 Front Lines.]

Researchers at Baptist Medical Center are conducting studies on a handful of drugs, which are so new they don’t yet have names. The team can ask COVID-19 patients if they’d be willing to try an experimental medication as part of a clinical study. In these studies, some patients receive the medication being tested, while members of a control group get a placebo, so there’s no guarantee that patients who agree to participate in the research will get the new drug.

Having such limited therapeutic options to offer suffering COVID-19 patients can be frustrating for her and her fellow ICU clinicians, Yassin says.

“I think a lot of us feel very helpless,” Yassin says. “It’s like nothing we’ve ever experienced. We’re feeling a lot of sympathy for these (COVID-19) patients who can’t see their family members. There’s nothing more heartbreaking than watching somebody slowly die, knowing there’s nothing you can do for them. Sometimes, it just gets to you.”

Yassin, 38, lives in Jacksonville. She became a critical care clinical pharmacy specialist in a roundabout way.

At age 16, Yassin began working as a DJ for a classic rock radio station. A few years later, Yassin decided playing rock songs wasn’t the right long-term career for her. One day, she and a friend were at a restaurant when Yassin saw a photo on the wall of a pharmacist in a white coat. “My friend pointed at (the photo) and said, ‘You should do that,'” Yassin says. “And I looked at it for a little bit and thought, ‘That may not be a bad idea.’ So I decided to look into it and there you go.”

[Read: Mother-Daughter Nurse Team Both Treating Coronavirus Pandemic.]

She graduated from college in 2009 and got her pharmacy degree three years later. Yassin did two years of residency in a hospital setting. The first year was a general residency and the second was a specialty in critical care.

The pandemic is not only affecting Yassin’s work life, but her personal life as well. “My mom is in her 70s, she lives in Iowa,” Yassin says. “Because I’m constantly in the ICU, around COVID-19 patients, I don’t feel comfortable visiting her, putting her at risk (of contracting the virus). It’s so hard staying apart.”

Despite her occasional feelings of helplessness, Yassin tries to keep in mind that while all of the COVID-19 patients she sees in the ICU suffer from the effects of the terrible disease, most eventually survive and recover.

“The majority do get better,” she says. “You tend to remember the ones who don’t.”

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