Queensland Health reveals plans for its COVID testing pilot in community pharmacies following backlash from pharmacists and other groups
Queensland Health has been working with pharmacy organisations to iron out the details of the COVID-19 testing pilot since it was first announced by Premier Annastacia Palaszczuk in August.
At that time, Deputy Premier and Minister for Health and Ambulance Services Steven Miles said community pharmacies across the state could take part in the pilot project over the next few months.
“Each year there are over 458 million patient visits to community pharmacies – approximately 8.8 million per week,” he said.
With 97% of Queenslanders living within 2.5km of their local community pharmacy, and 65% in regional areas, COVID-19 testing will be more accessible throughout the pilot, read the statement from the Pharmacy Guild Queensland branch.
The initial announcement was welcomed by the Guild, but met with concern from the PSA, the pharmacists’ union PPA, doctors’ groups and even members of the public.
PSA national president Associate Professor Chris Freeman argued the announcement sent the wrong message to people who should be at home self-isolating when displaying symptoms of COVID-19, and raised concerns “for the safety and wellbeing of pharmacists, pharmacy staff and the general public”.
“We have continually asked members of the community not to enter a pharmacy if they are unwell and displaying COVID-19 symptoms,” he said.
“We do not want people who potentially have COVID-19 wandering into a pharmacy to get tested. The concern is that this decision will put not only pharmacists at risk but those with chronic health conditions who regularly visit a pharmacy and are at higher risk of contracting COVID-19.”
Within a few weeks of the announcement, A/Prof Freeman said a number of PSA members reported telephone calls, and even people already presenting to Queensland community pharmacies, asking for a test. He said that the Queensland Government had not consulted broadly with pharmacists and pharmacy groups prior to making the announcement. By September, PSA was calling for a moratorium to the trial.
The Guild defended its support for the trial, arguing that Queenslanders were already presenting in community pharmacies seeking treatment for symptoms.
“Queenslanders are already presenting in community pharmacies with possible COVID-19 symptoms. It makes sense to opportunistically test those members of the community with possible symptoms, as they are already attending the pharmacy for their medications and healthcare advice,” said branch president Trent Twomey.
“The pilot is an opt-in program to test patients when they attend a pharmacy seeking treatment for their cold and flu like symptoms. This will only bolster Queensland’s ability to respond quickly to potential outbreaks and gives pharmacies certainty around possible cases,” a spokesperson from the Guild Queensland branch added.
A Queensland Health spokesperson told AJP on Friday it now anticipates that up to five pharmacies will initially be selected for a “limited pilot” to commence in late 2020.
Participation in the program is voluntary and open to all community pharmacies in Queensland. However the initial trial will be limited to regions with no evidence of active community transmission.
“Pharmacies will be selected on the basis of their ability to provide an appropriate and safe environment for testing, including appropriate infection prevention and control measures, as well as compliance with workplace health and safety requirement,” said the Queensland Health spokesperson.
“Under the proposed COVID-19 pharmacy testing model, customers will not directly request a COVID-19 test. Participating pharmacies will be able to offer a test to customers requesting a product used for the relief of upper respiratory symptoms.
To ensure only incidental customer encounters are captured, it is anticipated that the participating pharmacies will not be publicly identified.
A two-week COVID testing pilot was also run in South Australia in July this year, with up to five metropolitan pharmacies taking part. Eligible pharmacy customers with mild respiratory symptoms were asked if they wanted to get tested while they were in the pharmacy.
At that time, the PSA welcomed the trial. A/Prof Freeman explained: “The SA Branch of PSA was consulted early and worked closely with SA Health throughout the entire process to ensure the pilot was implemented as safely as possible for pharmacists, pharmacy staff and the community.
“To ensure the South Australian pilot captured incidental customers only, the pilot was not overtly promoted and was limited to a very small number of carefully selected, unidentified sites, which is in stark contrast to that of the Queensland Government.”
He added that the PSA has since been consulted by the Queensland Government and is currently working with them to ensure if the trial does go ahead that Queensland pharmacists, pharmacy staff and the community are kept safe.
The Queensland Health spokesperson told AJP it is “committed to securing the safety of pharmacists, pharmacy staff and the community while ensuring the need for increased surveillance of COVID-19 is met”.
“Our message to the public remains the same. Anyone experiencing COVID-19 symptoms should stay home and get tested at an established fever clinic, respiratory clinic or visit their GP.”
Looking outside the country
COVID-19 testing by community pharmacists is a concept that has been trialed or rolled out in other countries during the pandemic.
For example, testing across the approximately 67,000 community pharmacies in the US was authorised by the government back in April. However a review of US pharmacy chains by AJP reveals the majority of testing is appointment only and provided in a contactless fashion.
For example, through Walgreens, Walmart and CVS Health, individuals attend a drive-through where a pharmacy team member with appropriate PPE merely guides the person in the car to self-perform a test – all while standing six feet (1.8 metres) away with the car windows closed.
Either nasal swabs or in some locations a saliva test are provided, with both forms being self-administered by the patient. Tests do not take place inside the community pharmacies.
Meanwhile COVID-19 testing became available in Ontario, Canada pharmacies in September, and select pharmacies in Alberta, Canada in July following a trial. Importantly, in Alberta, these tests are only for those who are asymptomatic and have no known exposure to the virus.
Any Albertan with symptoms of COVID-19 must book testing through Alberta Health Services.
Similarly, people can only get tested in select Ontario pharmacies if they are not showing symptoms, and are eligible for testing as part of a targeted testing initiative as determined by the Ministry of Health.
The appointment-only tests pharmacy tests are being offered to select asymptomatic individuals, such as those with loved ones in long-term care homes, close contacts of a case or high-risk workers.
The testing programs in both the US and Canada differ significantly from the Australian plan to opportunistically test people attending community pharmacies with respiratory symptoms.