When compared to a patient in their mid-30s, a 65-year-old patient infected with COVID-19 has a five-fold increased rate of hospitalization with a mortality rate 30 times higher.1  The Centers for Disease Control and Prevention reported that 8 out of 10 COVID-19 deaths in the United States are in adults 65 years or older.1  Aside from excess morbidity and mortality from COVID-19 among this high-risk population, another devastating problem is isolation and its effects on mental health.

The shelter-in-place orders obligated seniors to social distance and isolate themselves from loved ones, usual caregivers and clinicians to maintain their safety. According to Dr. Louise Aronson, a geriatrician at the University of California, San Francisco, social distancing and isolation increased cognitive decline and depression, which also fuels heart disease and stroke.2  A study by De Pue and colleagues3  found that the risk of cognitive decline during the pandemic was primarily due to social isolation and loss of activity, in addition to the normal cognitive decline with age in patients 65 years or older.3 

Performing routine activities like grocery shopping have become very challenging or impossible for many older adults. At the beginning of the pandemic, numerous stores offered dedicated hours of grocery shopping for this high-risk population. As the pandemic continued, senior shopping hours were compromised by young shoppers who were often seen entering stores during the allotted time, leaving many older adults anxious about risk of infection.4 

As a third-year student pharmacist when this project began and first-generation refugee from Iraq, I, along with my sister, Milano Sliwa, have faced and overcome many challenges. We have always vowed during our journey to advocate for those who are vulnerable. This built the grit and determination to serve our community during the COVID-19 pandemic. In March 2020, at the beginning of the pandemic and the shelter-in-place order in San Diego, my sister and I saw a photograph of an elderly man staring at empty grocery shelves on a Facebook post. The post of an elderly person at high-risk trying to buy groceries saddened us deeply, but it also inspired us to create and organize a COVID-19 Community Outreach program at the University of California (UC), San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences. The San Diego community is a diverse community comprised of 12.6% of the population who are 65 and older.5  With the collaboration from my classmate Afrooz Sabouri, we initiated a program with the goal of serving anyone over the age of 60 or immunocompromised, particularly those with language difficulties in obtaining groceries and medications during this unprecedent time. We created flyers that our faculty and colleagues disseminated throughout UC San Diego Health and the community. Individuals were able to contact us directly if in need of a variety of services including picking up and delivering groceries, prescriptions medications and protective equipment.

During the pandemic, it was a challenge for everyone, particularly older adults, to communicate in-person with their physicians, nurses and family members. However, pharmacists have been available for consultation at local pharmacies throughout and continue to be present to this day. One example of a pharmacy that adapted its practice to meet the fundamental needs of seniors is the El Dahmy Wellness Pharmacy in San Diego County. The pharmacists, technicians and delivery drivers sought to build a relationship of trust with their patients and ensure that their needs were met whether it be for groceries, over-the-counter medications or simply a check-in conversation to ease the feeling of isolation. A questionnaire identifying needs and followed by an action plan was developed that was ultimately rolled out by the pharmacist leadership to systematically determine the level of follow-up based on patient need and type of personnel, be it pharmacist, technician or driver. At any point in the service delivery, if clinical issues arose, the system triaged to a clinical pharmacist. This allowed for longitudinal follow-up as needed for each patient served.6 

With the help of our faculty mentors, Drs. Rabia Atayee and Jonathan Watanabe, our program quickly expanded throughout San Diego County. We were able to recruit several student pharmacists and individuals from our community to serve as volunteers. We established and provided training and personal protective equipment (PPE) for all volunteers. PPE included surgical masks, disposable gloves and sanitizer spray bottles for grocery bags. Surgical masks were required while disposable gloves were optional. We now have over 100 multilingual volunteers serving more than 25,000 of those in need. Verbal interpretation was available for 23 languages. Table 1 is a list of the languages. Our goal has been to mitigate the spread of COVID-19 and reduce the mortality rate among high-risk patients who struggle to speak English and experience reduced access to quality care by ensuring continued access to healthy foods and medications. Many of the faculty, staff and students donated money, time or both toward our community outreach efforts so that we could have adequate PPE and pay for the cost of the groceries and medications for those going through financial hardship. In fact, we raised thousands of dollars from generous donors in our community. As student pharmacists, the importance of medication adherence and reducing food insecurity has been emphasized in our training and our community outreach program that has allowed patients to continue following their chronic disease treatment regimens despite COVID-19 conditions and financial strains.

Table 1:

List of Verbal Interpretation of Languages Provided by Volunteers (in alphabetical order)

List of Verbal Interpretation of Languages Provided by Volunteers (in alphabetical order)
List of Verbal Interpretation of Languages Provided by Volunteers (in alphabetical order)

Local and national media outlets like NBC-7, FOX-5 San Diego and the American College of Clinical Pharmacy (ACCP) are just a few of the organizations that highlighted our work and further expanded our message to other communities.1012  Other student pharmacists across California have reached out for guidance so they could deploy similar outreach programs in their own communities. With the help of our faculty mentors, Drs. Atayee and Watanabe, we have continually revised protocols to ensure all volunteers adhere to the most stringent health and safety recommendations. Further, we have been able to share our updated protocols with others so they can maximize their efforts to protect the community.

Our community outreach program worked collaboratively with the UC San Diego student-run free clinic, which is a separate student-run project that serves over 1,200 chronically ill and underserved patients as well as over 5,000 homeless and uninsured patients in three locations in San Diego County for over 25 years. In May 2020, our team began assisting UC San Diego’s student-run free clinic by providing donated funds and masks to ensure patients’ safety. Approximately 500 free clinic patients were served within the 11 weeks of our biweekly food deliveries while assisting the rest of San Diego’s most vulnerable residents. The student-run free clinic partnered with Feeding San Diego to run the food projects, which help supplement patients’ food. They provide fresh produce and shelf-stable food to patients during each clinic visit or as needed. Because the number of people needing food assistance in San Diego increased so much due to COVID-19, Feeding San Diego was forced to temporarily not allow them to select the type of food they received. Our community service outreach program offered to provide assistance.

As we continued food and prescription deliveries, we learned about the pandemic needs of single mother refugees here in San Diego. After a call-for-donation post on social media in August 2020, we had an overwhelming number of donations including canned food, house supplies and clothing in all different sizes to support the refugee single mothers and their children. Even more pharmacists, physicians and other community members reached out to collaborate with this project to sustain the efforts for our vulnerable population. Another example of our continued effort is providing feminine hygiene products, canned foods and other sanitizing agents to local homeless shelters. In addition to the efforts within the community outreach program, we have openly shared our efforts on social media to increase awareness and encourage others to actively identify ways to assist those in need.

We realize that pharmacists are a critical part of protecting our highest-risk and most vulnerable patients and we will continue to grow and improve our efforts. Each day of the journey has brought new challenges, but we’re ready to meet every one of them. As front-line health care professionals, our pharmacy community outreach program continues to identify needs, beyond the initial needs at the beginning of the pandemic, within our San Diego community and serve those needs. We continue to recruit student pharmacists and pharmacists’ volunteers and raise donations so that we can continue to have a positive impact during these difficult times. As the pandemic evolves, we have recommitted our efforts as student pharmacists and pharmacists to lead various outreach programs. We cannot predict the future, but we do know that the pharmacy profession will continue to meet each challenge head on to serve the vulnerable members of our society.

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