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Everything You Need to Know About the COVID-19 Pandemic

Many countries around the world have successfully managed and slowed outbreaks of the coronavirus and the illness it causes, COVID-19. However, this virus is still impacting countries and communities in an unpredictable way as infections continue spreading. It’s still essential to take action to protect yourself, and heeding the most up-to-date warnings from trustworthy groups like the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) can help you do so.

In addition to regularly checking for updates from those organizations, follow these recommendations to continue protecting yourself during the COVID-19 pandemic.

General Recommendations for Protecting Yourself and Others

As Symptomfind notes , taking a few key steps and following some simple guidelines can help you limit your exposure to the COVID-19 virus. It’s important to remember that recommendations can change frequently, and new information can emerge quickly. Check with the CDC and WHO periodically to receive updates to guidelines and find out the latest details.

• Remain alert and proactive about your health. While older people and people with preexisting medical conditions (such as asthma, diabetes, and heart disease) are more vulnerable, anyone can be impacted by the virus. The best way to keep yourself from getting sick is to avoid exposure in whatever way you can.
• Wash your hands regularly with soap and water for 20 seconds every time. If you don’t have immediate access to soap and water, clean your hands using a coin-sized amount of hand sanitizer that’s at least 60% alcohol.
• Sneeze and cough into your elbow to avoid spreading germs into your hands. Immediately wash your hands after coughing or sneezing. If you cough or sneeze into a tissue, throw it away immediately.
• If you notice respiratory problems or are experiencing a fever, seek medical attention immediately.
• Follow all current state and local directives regarding the pandemic, such as wearing a mask in public and practicing social distancing. You may face legal consequences — and expose yourself to the virus — if you neglect to do so.

If you’re fully vaccinated — meaning you’ve received both doses of either the two-dose Pfizer or Moderna vaccine or you’ve received the single-dose Janssen vaccine — and it’s been at least two weeks since you received your final dose, the CDC has provided updated recommendations you can follow as a fully vaccinated person. Some, but not all, of these guidelines include the following:

• You may resume activities you engaged in before the pandemic began so long as you follow current health and safety guidelines.
• The CDC strongly urges vaccinated individuals to continue wearing masks indoors “to maximize protection from the Delta variant and prevent possibly spreading it to others”. Doubly so for anyone who lives in or is visiting an area with high transmission rates.
• You DON’T need to get tested for self-quarantine after traveling if you are fully vaccinated.

To review the full list of updated guidelines for people who are fully vaccinated, visit the CDC website .

Additionally, the WHO has provided updated recommendations to follow if you live in a community where COVID-19 is continuing to spread. In addition to practicing physical distancing, avoiding crowded areas, washing your hands frequently, and keeping rooms at your home and workplace ventilated well, the organization advises the continued use of masks to prevent the spread of the virus. To ensure that your mask protects you and others effectively, follow these guidelines from the WHO:

• Choose a mask that covers your nose, mouth and chin completely; there shouldn’t be gaps between the mask and your face.
• Avoid using masks with valves.
• Wash your hands before putting your mask on and after taking it off.
• Wash your hands any time you touch your mask while you’re wearing it.
• Dispose of single-use masks in the garbage immediately after removing them.
•  Wash your mask every day if it’s made of fabric.
• Don’t use masks that look damaged or fit loosely. 

What to Do If You’re Sick or Think You Might Be

If you currently have COVID-19 or are experiencing symptoms, the CDC suggests following these steps to take care of yourself and limit the spread of the virus to others in your household and your community:

• Stay at home unless you need to receive medical care. This means not leaving your house.
• Stay out of public areas as much as possible when you do need to leave. Don’t use public transportation such as buses and subways. Also, avoid taxis and ride-share vehicles.
• If possible, sequester yourself in a specific room in your home away from other people and pets and use a separate bathroom.
• Whenever you’re around other people in your home or in public, wear a cloth face covering. 
• Monitor your symptoms and contact your doctor immediately if they worsen.
• Seek emergency medical attention if you experience emergency warning signs of COVID-19. These include trouble breathing, a blue tint to your lips or face, lasting pain or pressure in your chest, and trouble waking up or staying awake. 
• When seeking medical care, whether from your primary care provider or emergency services, notify them ahead of time that you have COVID-19 or believe you might have it. This helps them better prepare for your visit and protect their staff members.
• Disinfect high-touch surfaces in your personal room and bathroom daily. These include phones, keyboards, remote controls, counters, tabletops, doorknobs, bathroom fixtures and bedside tables.
• Someone in your home who isn’t sick should disinfect high-touch surfaces in common areas of your home daily.
• Continue to cover your coughs and sneezes and wash your hands frequently or use alcohol-based hand sanitizer to clean your hands.

Learn More About COVID-19

These articles and resources can help you learn more about a variety of topics related to the COVID-19 pandemic.

COVID-19 Safety Tips and News Coverage

• COVID-19 Terms: The Difference Between Social Distancing, Physical Distancing & More
• Time for a Digital Detox? Here’s How to Regulate Your News Intake While Still Staying Informed
• What Can We Do to Protect Our Mental Health During the COVID-19 Pandemic?
• Need to Navigate Public Spaces During the Pandemic? Here Are Some Safety Tips
• Everything You Need to Know About COVID-19 Mask Care
• What Is Contact Tracing And How Does It Work?
• What Is Pandemic Fatigue, and How Can You Fight It?

Global Changes and Effects of the Pandemic

• How Have Local Farmers’ Markets Adapted to COVID-19?
• Life After COVID-19: Reflecting on How the Pandemic Changed Schools & Education in Lasting Ways
• How Did Life Change After the Spanish Flu (and How Might Ours Change Post-Covid-19?)
• Life After COVID-19: How Did the Pandemic Change Our Approach to Air Travel?
• How Has COVID-19 Changed Film Fests and Award Shows?
• How the COVID-19 Pandemic Has Changed Workplaces in Lasting Ways
• Life After COVID-19: Did Public Transit Change as a Result of the Pandemic?
• How Will the COVID-19 Pandemic Impact Our Approach to Art Museums?
• I Went to Europe This Summer so That You Don’t Have to — and Trust Me, You Don’t Want to Go
• What Can We Learn From Vaccine Passports Around the World? 
• Is an Airbnb Rental the Perfect COVID-19-Safe Getaway?
• Is TSA PreCheck Worth the Investment in a Post-Covid World?
• The Surprising Impact of COVID-19 Shutdowns on the Environment

Quarantine Entertainment Resources

• Virtual Vacation: Dive Into Our Marine National Monuments
• Virtual Vacation: Experience the Excitement, Flavors and Culture of Madrid
• Virtual Vacation: From Street Cats to K-Pop in Seoul, South Korea
• Virtual Vacation: Wander Through the Peaceful Village of Iseltwald in Switzerland
• Virtual Vacation: How to Spend the Perfect Day in Rio de Janeiro at Home
• Virtual Vacation: Explore the Azores From the Comfort of Your Couch
• Virtual Vacation: Travel to Bangkok Without Leaving Your Home
• Virtual Vacation: Check Out the Frozen, Crystal Magic of Reykjavik, Iceland
• Virtual Vacation: Indulge in the Passion and Energy of Buenos Aires, Argentina
• What Is “MasterClass” and Why Is It the Perfect Quarantine Rabbit Hole?
• From “Contagion” to “Station Eleven,” Why Are Folks Craving Apocalyptic Content During a Pandemic?
• Tips for Staying Connected With Loved Ones During the Pandemic
• Your Whole Family Can Enjoy These Virtual Museum Visits From the Couch
• How COVID-19 Inspired an Animation Renaissance
• Life After COVID-19: How Has the Pandemic Affected Independent Booksellers?
• What Makes the Perfect Watch — or Read — for Pandemic Times?
• What the Emmys Tell Us About a Year of Watching TV Continuously
• Move Over, “Animal Crossing” — Nintendo’s “New Pokémon Snap” Is the Latest Low-Stakes Video Game Escape
• Watch Met Opera Tonight and Learn Other Ways to Stream Arias from Home
• Visit These Atmospheric Video Game Worlds From The Comfort of Your Own Home
• How Are TV Shows Narrating Pandemic Times?
• All the Books, Films, Shows and Music We’ll Always Associate With the Pandemic

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• Science and Technology Directorate

Feature Article: Here’s What We’ve Learned About COVID-19—An Update

Much has been said about the pandemic. Scientists all around the world have been laser-focused on studying SARS-CoV-2, the virus that causes COVID-19, for nearly two years and the flood of information can be overwhelming. That’s why a trusted, unified resource that organizes our collective knowledge is so valuable.

The Science and Technology Directorate (S&T)’s Master Question List (MQL) is just that. This consolidation of recent, accurate COVID-19 information is regularly updated with the latest results and data relevant to weathering the pandemic. S&T started publishing the MQL in early 2020 as part of its COVID-19 response .

“The MQL is important for us because it identifies what we don’t know. And with finite lab resources, it ensures we don’t duplicate something that is already being studied elsewhere,” said Dr. Lloyd Hough, director of S&T’s Hazard Awareness and Characterization Technology Center , in S&T’s previous ‘ Here's What We’ve Learned About COVID-19 ’ article. “It’s really a matter of identifying the highest priority gaps—the things that are most impactful for better understanding the disease and helping us to respond to it.”

One current high-priority item is the highly infectious Delta variant, which is now responsible for most new COVID-19 cases in the United States. S&T published the first Delta Variant Supplemental Reference (SR) late last month to quickly summarize key information about it for government decision-makers and the public. The SR is one example of how our nation’s response has had to adapt as the COVID-19 pandemic evolves—which in the case of the Delta variant, is meant quite literally.

We’ve learned quite a bit since last year, but there are still many unknowns as we continue to navigate the national pandemic response. That’s why the MQL is so critical; S&T continues to support the nation’s scientific, medical, and academic communities with a central resource for tracking the most need-to-know information. In the last article , S&T provided asked-and-answered MQL questions that were not only critical for public awareness about COVID-19 but were a testament to the tireless work of our researchers.

The following is a new batch of answers to questions in S&T’s current MQL .

Are there effective vaccines?

According to the U.S. Centers for Disease Control and Prevention (CDC), the vast majority of U.S. COVID-19 hospitalizations (95-99.9%) and deaths (94-99.8%) are occurring in unvaccinated individuals. In the U.S., both Pfizer/BioNTech and Moderna vaccine efficacy has been estimated at 88% overall in a study published by the U.S. National Library of Medicine. Research shows that six months after the first dose of the Pfizer/BioNTech vaccine (in a fully vaccinated person), efficacy is greater than 95% in terms of preventing hospitalization and around 91% in terms of preventing symptomatic infection. Against the Delta variant, the Pfizer/BioNTech vaccine provides 93-96% efficacy against hospitalization and 64-88% efficacy against symptomatic infection , as reported by the New England Journal of Medicine.

The Pfizer/BioNTech, Moderna, and Johnson & Johnson/Janssen vaccines are safe according to extensive data from the CDC and other trustworthy sources . All three vaccines were granted Emergency Use Authorization by the U.S. Food and Drug Administration (FDA) to strengthen our nation’s public health protections during the pandemic crisis. The Pfizer/BioNTech vaccine received full FDA approval in late August. Moderna has completed its submission for full FDA approval and Johnson & Johnson is not far behind.

The FDA has rigorous scientific standards. Thorough evidence of safety and effectiveness from clinical trials with thousands of participants is required for any authorization and continuous monitoring is in place to rapidly detect any issues. The CDC’s tally shows that more than 180 million people in the United States are fully vaccinated.

How does the disease agent compare to previous strains?

The Delta variant of the SARS-CoV-2 virus emerged in India in September 2020, quickly spread to over 100 countries, and now accounts for more than 90% of new COVID-19 cases in the U.S., according to the CDC. The Delta variant is highly transmissible . A study published in the Journal of the Royal Society of London showed an estimated reproduction number (R0) of 5-9, which is far higher than the 2.2-3.1 R0 of the original, wild-type SARS-CoV-2. Another study showed that the Delta variant may lead to higher viral load in infected individuals compared to those with wild-type SARS-CoV-2 or other variants. The viral load of vaccinated individuals with breakthrough Delta variant infection was found by the CDC to be similar to infected, unvaccinated individuals , suggesting that breakthrough cases may be equally capable of transmitting to others.

The CDC has also found that the Delta variant may produce more severe illness and be more likely to cause reinfection—particularly for the unvaccinated. Household secondary attack rates of the Delta variant can be as high as 53% and may be higher in individuals younger than 10 years old. Early evidence published by the British Medical Journal suggests that the Delta variant spreads rapidly in schools .

Are there tools to diagnose infected individuals?

Diagnosis of COVID-19 is based on symptoms consistent with COVID-19, polymerase chain reaction (PCR)-based testing of active cases, and/or the presence of SARS-CoV-2 antibodies in individuals. Screening solely by temperature or other symptoms is unreliable. Nasopharyngeal swabs are the gold standard for COVID-19 diagnosis.

PCR is a method widely used to rapidly make millions of copies of a specific DNA sample. The timing of diagnostic PCR tests impacts results . As reported in the American College of Physicians (ACP) Journal, Annals of Internal Medicine , the false-negative rate is lowest between 7 and 9 days after exposure. PCR tests are more likely to give false-negative results before symptoms begin (within 4 days of exposure) and more than 14 days after exposure.

What are the long-term symptoms of COVID-19 infection?

Post-Acute Sequelae of SARS-CoV-2 (PASC) infection, also known as “long-haul COVID” or simply “long COVID”, affects 5-10% of patients and is a persistent infection lasting longer than four weeks. Another ACP study showed fatigue, loss of taste or smell, shortness of breath, and headache are the most common chronic symptoms and they can persist for months. Neurological impairment has also been reported and may affect the patient’s ability to return to work.

How easily is it spread?

Worldwide, COVID-19 has caused at least 225 million infections and claimed over 4.6 million lives . The U.S. alone has seen over 42 million cases and more than 670,000 deaths. These and other statistics are available via the Johns Hopkins University COVID-19 Dashboard .

COVID-19 has reportedly spread to numerous animals both in the wild and in captivity, including otters, deer, mink, ferrets, gorillas, tigers, and lions—though there doesn’t seem to be evidence of transmission to humans in these cases.

What personal protective equipment is effective, and who should be using it?

The CDC asserts that face masks are effective at reducing transmission of COVID-19. Numerous studies have supported this finding, including research published by the American Society for Microbiology   (PDF, 5 pgs., 1.62MB) , the Journal of the American Medical Association , and Nature Research . Wearing a mask protects others as well as yourself. Updated CDC guidance states that in general, mask-wearing is not necessary in outdoor settings. For the unvaccinated, or if COVID-19 cases are high in the area, mask-wearing in crowded outdoor settings should be considered. Wearing a mask in indoor public places maximizes protection. To be effective, a face mask must fully cover the nose and mouth; masks should fit snugly against the sides of the face and not have gaps.

There is a path forward.

Not a question, but a final note of hope and encouragement: we have made great strides in conquering this crisis, though plenty remains to be done. There are a number of recommended treatments depending on disease severity, but none of them are a guarantee of recovery. The best thing we can all do is follow the recommendations of the CDC and our local public health authorities.

“I urge anyone who is concerned about their health and the health of their loved ones from COVID-19 to refer to CDC’s guidance, to talk to their doctor, and to educate themselves using official, trustworthy scientific sources,” added Dr. Hough. “We’re doing the science to help keep people safe, and it is incumbent upon all of us to do our part and stay informed.”

If you’d like to learn more about any of the science presented here, check out the MQL or the new Delta Variant SR . You can find comprehensive public health guidance on the CDC website . For related media requests, contact [email protected] . 

• Science and Technology
• Coronavirus (COVID-19)
• Information Sharing

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Feature Article: Wondering about Coronavirus?

Published on Mar 05, 2020

Parents PACK

Editor’s Note: This article, and the associated PDF, is being updated as more information becomes available. The date at the bottom of this webpage, and on the PDF, will indicate the most recent edits.

In recent weeks, the news has been dominated with stories about coronavirus. The virus, now called COVID-19, first sickened people in Wuhan, China, in late 2019. Since then, many thousands of people around the globe have fallen ill, and some have died.

What is coronavirus?

Coronaviruses are a family of viruses that contain RNA (instead of DNA, like people have). The viruses are circular in shape with spikes on the surface, which appear like a halo when the virus is viewed with a microscope. This halo of spikes is what led scientists to name these “coronaviruses.”

Coronaviruses were first discovered in the 1930s, and as with other families of viruses, some coronaviruses are more worrisome than others. The earliest discovered coronaviruses infected farm animals, causing lung infections in chickens and digestive illness in pigs. Later, scientists found a couple of types that infected people, causing symptoms of the common cold. 

This family of viruses garnered more attention in the early 2000s with the epidemic known as severe acute respiratory syndrome, or SARS. The SARS virus infected civet cats and then gained the ability to infect people, leading to the epidemic. In 2012, a similar occurrence led to the Middle East respiratory syndrome, or MERS, epidemic. In this situation a coronavirus that infected camels gained the ability to infect people. Currently, scientists think that COVID-19 also originated in an animal and then infected people, but, right now, it remains uncertain as to which animal.

Why is COVID-19 such a big deal?

When a virus that normally infects animals gains the ability to infect people, two things can happen:

• Animal-to-person transmission only — In some cases, although people in close contact with animals that carry the virus get ill, the virus cannot easily spread from one person to another. In these situations, public health teams and animal scientists will work to decrease the chance for individuals to get infected. Because fewer people are likely to be in close enough contact with infected animals, controlling this situation is easier to accomplish and, therefore, less concerning than what happens in the second scenario. However, scientists do need to monitor these situations because at any point, the virus can change again and gain the ability to spread among people.
• Animal-to-person and person-to-person transmission — In this case, not only can the virus spread from infected animals to people, but it also can spread from one person to another. This situation is much more urgent for two reasons. First, it is significantly more difficult to stop the spread of infection between people. Second, because this is a new virus, virtually everyone in the world is susceptible. As a result, it has the capacity to cause a worldwide epidemic, called a pandemic.

The second of these scenarios is what is currently occurring with COVID-19.

What are scientists and public health officials doing about it?

When a new virus emerges, scientists and public health officials have a long “to do” list that includes:

• Trying to learn about the virus and the disease — This includes understanding who the virus infects; how it spreads; how long people are ill; how soon after exposure people show signs of illness; whether they can spread the illness when they are infected but don’t have symptoms; what symptoms they have; what complications may occur; how long people are sick; how often the disease is fatal; and more.
• Preventing widespread disease — When the virus is new and virtually everyone can get ill, it is important to try to contain the spread of the virus. This is what you have been seeing in news reports related to COVID-19. This is a crucial component of the public health response, and in order to do their job effectively, public health officials need to ensure that people are aware of the risk. However, these efforts can also inadvertently elevate societal anxiety disproportionately to the risk. (See “What should I worry about?” below.)
• Determining treatments — Healthcare providers can treat symptoms of viruses, and public health officials and scientists can work with them to evaluate whether existing treatments are effective, but this takes time. Often, even though the virus is new, these teams of experts can use information learned from similar viruses as a good place to start. Currently, teams around the world are doing this for COVID-19.
• Developing vaccines — Likewise, if vaccines exist for similar viruses, scientists can try those methods of vaccine development for the new virus, but any new vaccine needs to be carefully tested. As a result, prevention through vaccination may or may not be an option in the period right after a new virus develops. For example, researchers were able to develop an effective vaccine against the 2009 H1N1 influenza virus because influenza vaccines were already being produced; they just needed to apply the technology to the new virus. However, in the cases of both SARS and MERS, vaccine development was not able to offer an effective protective measure. For COVID-19, researchers are relying on understanding gained from both SARS and MERS, since they are also coronaviruses, but a vaccine is not likely to be available to help prevent cases during the current situation.
• Responsibly responding to media and alerting the public — Communicating what is known and unknown about a new virus is likely one of the most difficult aspects of the “to do” list. People are anxious, learning is ongoing, and situations are changing rapidly. This task is compounded by the speed with which information spreads, the quantity of misinformation that exists, and the presence of disruptors, who intentionally spread disinformation to further their own goals. For these reasons, it is important to evaluate where the information you are hearing came from, who provided it, when it was shared, and what the motives of the person, or persons, sharing it may be.

We have watched this scenario of “people versus novel virus” play out many times in history, such as during the 1918 influenza pandemic, during the 1980s with the AIDS epidemic, and more recently, related to SARS (2003), H1N1 influenza (2009) and MERS (2012). The good news is that public health officials and scientists who work with infectious diseases have learned from each of these events. The bad news is that new viruses are unknown and, therefore, less predictable.

What should I worry about?

In situations such as the current COVID-19 pandemic, it is important not to “FORGET” these points:

F – Follow advice of officials — Officials are continuing to monitor the spread of COVID-19, and as necessary, they are adjusting recommendations and protective health practices. The best approach is to listen to this advice since they have the latest information available. Check the latest CDC guidance.

O – Observe the big picture — While tens or hundreds of thousands of cases of COVID-19 have occurred, only a few thousand people have died. While this sounds scary, let’s consider the big picture. Public health officials have estimated that about 1% of those infected have died.

To put this in context in the U.S., between the beginning of December 2019 and the end of January 2020, more than 28,000 people have died from influenza and pneumonia. This represents almost 7% of the total deaths that occurred in the U.S. during this two-month period. So, the big picture in the current situation is that you, or a family member, is significantly more likely to be exposed to, get sick with, and, possibly, die from influenza than from coronavirus.

R – Remain calm — It is completely understandable for people to be upset and worry about coronavirus, especially when hearing about it regularly, but it is important to manage emotions. This is especially true for parents of children old enough to understand the news. If you are upset, your children are likely to sense that and be upset too. Situations like this offer “teachable moments” in which we can discuss the situation with our children in an age-appropriate way, reassure them that adults are monitoring the situation to keep them safe, and remind them about the importance of good preventive measures, such as handwashing, covering coughs, and getting vaccinated when vaccines are available.

G – Get reliable information — Misinformation, and even scams, are rampant. So much so, in fact, that the World Health Organization (WHO) had to post a scam alert on their website . Don’t just retweet or repost if you are not sure of the source. Don’t rely solely on social media or online news feeds to get information. Go to reliable sources, like the WHO or the Centers for Disease Control and Prevention (CDC) to get answers to your questions. Both have special website sections they are keeping updated with information.

E – Expect information to change — Public health officials, scientists and healthcare providers are learning as they go, so new information should be expected, not viewed as poor communication. Certainly, there may be specific situations or reports that, in retrospect, people will feel could have been handled better, but understand that these experts are all doing the best they can under the circumstances.

T – Take preventive health measures — Even though COVID-19 has not become widespread in the U.S. at this point, it could. And we are in the midst of cold and flu season, so preventive health measures, like handwashing, covering coughs, and staying home when ill are all good practices to follow, and to reinforce with children.

Download a printable version of this article in PDF format.

Additional resources

• Centers for Disease Control and Prevention (CDC)
• World Health Organization (WHO)

Last updated: March 12, 2020

Categories: Parents PACK March 2020 , Feature Article

Materials in this section are updated as new information and vaccines become available. The Vaccine Education Center staff regularly reviews materials for accuracy.

You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family's personal health. You should not use it to replace any relationship with a physician or other qualified healthcare professional. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult your physician or, in serious cases, seek immediate assistance from emergency personnel.

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Everything you should know about the coronavirus pandemic

The latest information about the novel coronavirus identified in Wuhan, China, and advice on how pharmacists can help concerned patients and the public.

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Open access article

The Royal Pharmaceutical Society has made this feature article free to access in order to help healthcare professionals stay informed about an issue of national importance.

To learn more about coronavirus, please visit:  https://www.rpharms.com/resources/pharmacy-guides/wuhan-novel-coronavirus .

A novel strain of coronavirus — SARS-CoV-2 — was first detected in December 2019 in Wuhan, a city in China’s Hubei province with a population of 11 million, after an outbreak of pneumonia without an obvious cause. The virus has now spread to over 200 countries and territories across the globe, and was characterised as a pandemic by the World Health Organization (WHO) on 11 March 2020 [1] , [2] .

As of 3 May 2021, there were 152,534,452 laboratory-confirmed cases of coronavirus disease 2019 (COVID-19) infection globally, with 3,198,528 reported deaths. The number of cases and deaths outside of China overtook those within the country on 16 March 2020 [3] .

As of 3 May 2021, there have been 4,421,850 confirmed cases of the virus in the UK and 127,539 of these have died (in all settings, within 28 days of the test).

This article gives a brief overview of the new virus and what to look out for, and will be updated weekly. It provides answers to the following questions:

What are coronaviruses?

Where has the new coronavirus come from, how contagious is covid-19, how is covid-19 diagnosed, what social distancing measures are being taken in the uk, what is happening with testing for covid-19, what should i do if a patient thinks they have covid-19, what can i do to protect myself and my staff, what about ‘business as usual’ during the pandemic, will the government provide financial help during the pandemic, how can cross-infection be prevented, there has been a lot of talk in the news and on social media about how certain medications can exacerbate the symptoms of covid-19, what is the current advice around these medications, where can i find information on managing covid-19 patients, is the coronavirus pandemic likely to precipitate medicines shortages, are there national clinical trials of potential drugs to treat covid-19, is there a vaccine for covid-19 and, if so, will pharmacy staff be involved in its roll out.

SARS-CoV-2 belongs to a family of single-stranded RNA viruses known as coronaviridae, a common type of virus which affects mammals, birds and reptiles.

In humans, it commonly causes mild infections, similar to the common cold, and accounts for 10–30% of upper respiratory tract infections in adults [4] . More serious infections are rare, although coronaviruses can cause enteric and neurological disease [5] . The incubation period of a coronavirus varies but is generally up to two weeks [6] .

Previous coronavirus outbreaks include Middle East respiratory syndrome (MERS ), first reported in Saudi Arabia in September 2012, and severe acute respiratory syndrome (SARS), identified in southern China in 2003 [7] , [8] . MERS infected around 2,500 people and led to more than 850 deaths while SARS infected more than 8,000 people and resulted in nearly 800 deaths [9] , [10] . The case fatality rates for these conditions were 35% and 10%, respectively.

SARS-CoV-2 is a new strain of coronavirus that has not been previously identified in humans. Although the incubation period of this strain is currently unknown, the United States Centers for Disease Control and Prevention indicate that symptoms may appear in as few as 2 days or as long as 14 days after exposure [6] . Chinese researchers have indicated that SARS-CoV-2 may be infectious during its incubation period [11] .

The number of cases and deaths outside of China overtook those within it on 16 March 2020

It is currently unclear where the virus has come from. Originally, the virus was understood to have originated in a food market in Wuhan and subsequently spread from animal to human. Some research has claimed that the cross-species transmission may be between snake and human; however, this claim has been contested [12] , [13] .

Mammals such as camels and bats have been implicated in previous coronavirus outbreaks, but it is not yet clear the exact animal origin, if any, of SARS-CoV-2 [14] .

Increasing numbers of confirmed diagnoses, including in healthcare professionals, has indicated that person-to-person spread of SARS-CoV-2 is occurring [15] . The preliminary reproduction number (i.e. the average number of cases a single case generates over the course of its infectious period) is currently estimated to be between 1.4 to 2.5, meaning that each infected individual could infect between 1.4 and 2.5 people [16] .

Similarly to other common respiratory tract infections, MERS and SARS are spread by respiratory droplets produced by an infected person when they sneeze or cough [17] . There is also some evidence that SARS-CoV-2 can spread by airborne transmission. Measures to guard against the infection work under the current assumption that SARS-CoV-2 is spread in the same manner.

As this coronavirus affects the respiratory tract, common presenting symptoms include fever and dry cough, with some patients presenting with respiratory symptoms (e.g. sore throat, nasal congestion, malaise, headache and myalgia) or even struggling for breath.

In severe cases, the coronavirus can cause pneumonia, severe acute respiratory syndrome, kidney failure and death [18] .

The case definition for COVID-19 is based on symptoms regardless of travel history or contact with confirmed cases. Diagnosis is suspected in patients with a new, continuous cough, fever or a loss or changed sense of normal smell or taste (anosmia). A diagnostic test has been developed, and countries are quarantining suspected cases [19] .

Box 1: Who qualifies as a suspected COVID-19 case?

Individuals with:

• New continuous cough AND/OR
• Temperature ≥37.8°C AND/OR
• Anosmia (a loss or changed sense of normal smell or taste)

Individuals with any of the above symptoms but who are well enough to remain in the community should  stay at home for 10 days from the onset of symptoms and get tested. Households should all self-isolate for 10 days if one member shows symptoms.

Source: Department of Health and Social Care

The government launched its coronavirus action plan on 3 March 2020, which details four stages: contain, delay, mitigate, research [20] . On 12 March 2020, the UK moved to the delay phase of the plan and raised the risk level to ‘high’.

On 16 March 2020, Johnson announced social distancing measures , such as working from home and avoiding social gatherings, as well as household isolation for those with symptoms [21] , [22] .

Further social distancing measures were announced on 18 March 2020, including closing all schools in the UK except for vulnerable children and those of key workers, such as pharmacists and other health and social care staff, teachers and delivery drivers. Restaurants, cafes, pubs, leisure centres, nightclubs, cinemas, theatres, museums and other businesses were also told to close.

On 22 March 2020, Johnson announced that the most clinically extremely vulnerable people, including those who have received organ transplants, are living with severe respiratory conditions or specific cancers, and some people taking immunosuppressants, should stay in their homes for at least the next 12 weeks (see Box 2).

Since this date, shielding in England, Scotland and Wales has been eased and brought back in several times in line with lockdown restrictions. And on 16 February 2021, a new risk assessment model was introduced in England to help clinicians identify adults with multiple risk factors that make them more vulnerable to COVID-19, resulting in an additional 1.7 million people being added to the shielding list. Shielding ended in England and Wales on 1 April 2021 and in Scotland on 26 April 2021.

Box 2: Shielding from COVID-19

Those classed as “clinically extremely vulnerable” may include the following (disease severity, history or treatment levels will also affect who is in this group):

• Solid organ transplant recipients
• People with cancer who are undergoing active chemotherapy
• People with lung cancer who are undergoing radical radiotherapy
• People with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
• People having immunotherapy or other continuing antibody treatments for cancer
• People having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
• People who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs
• People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary
• People with rare diseases that significantly increase the risk of infections (such as severe combined immunodeficiency, homozygous sickle cell)
• People on immunosuppression therapies sufficient to significantly increase risk of infection
• Adults with Down’s syndrome
• Adults on dialysis or with chronic kidney disease (stage 5)
• Women who are pregnant with significant heart disease, congenital or acquired
• Other people who have also been classed as clinically extremely vulnerable, based on clinical judgement and an assessment of their needs. GPs  and hospital clinicians have been provided with guidance to support these decisions

A strict lockdown started in the UK on 23 March 2020, with people told to stay at home except to buy essential food and medicines, one form of exercise a day, any medical need, and travelling to and from essential work. Gatherings of more than two people in public was not allowed and all shops selling non-essential goods, libraries, playgrounds, outdoor gyms and places of worship closed. All social events, including weddings, baptisms and other ceremonies, but excluding funerals were cancelled.

A relaxation of the lockdown was announced by Johnson on 10 May 2020. The government published a 60-page ‘ recovery strategy ’ on 11 May 2020, which sets out the next phases of the UK’s response to the virus, including easing some social restrictions, getting people back to work and reopening schools.

Local lockdowns were introduced at the end of June 2020 to try to control the spread of coronavirus in particular regions in England but cases continue to rise and a second national lockdown was imposed from 5 November 2020 for four weeks. A three-tier system of restrictions will follow the national lockdown in England. In Scotland, a five-level alert system was introduced on 2 November, which will allow different restrictions to be imposed in local areas depending on the prevalence of the infection. A fire-break lockdown came into force in Wales from 23 October 2020, and ran until 9 November 2020.

On 19 December 2020, new tier-four restrictions were imposed in London, Kent and Essex and other parts of the South East of England, meaning that individuals in those areas had to stay at home and not meet up with other households. On 31 December 2020, further areas of England including the Midlands, North East, parts of the North West and parts of the South West were also escalated to tier four.

A new national lockdown was imposed in England and Scotland from 5 January 2021, and similar restrictions were introduced in Wales shortly after. The lockdowns began to lift in steps from the end of March 2021.

Tests can now be accessed by anyone with symptoms via nhs.uk/coronavirus .

An NHS test and trace service was launched across England on 28 May 2020, with similar services starting in Scotland and Wales around the same time. Anyone who tests positive for the virus is contacted to share information about their recent interactions. People identified as being in close contact with someone who tests positive will have to self-isolate for 10 days, regardless of whether they have symptoms.

Testing is also now available to care home staff and residents in England, and NHS workers where there is a clinical need, whether or not they have symptoms.

Pharmacy staff in England and Scotland should book tests online via gov.uk and they will be conducted at drive-through testing sites across the country, as well as via home testing kits.

Pharmacy staff in Wales with symptoms of COVID-19 are able to access testing through their Local Health Board.

The government has also announced the start of a new national antibody testing programme, with plans to provide antibody tests to NHS and care staff in England from the end of May 2020. Clinicians will also be able to request the tests for patients in both hospital and social care settings if they think it is appropriate.

Regular testing of asymptomatic patient-facing staff delivering NHS services using lateral flow antigen tests was introduced in NHS trusts in November and expanded to primary care services in December 2020.

Patients have been advised not to go to their community pharmacy if they are concerned that they have COVID-19. Those with a new, continuous cough or a high temperature or anosmia (a loss or changed sense of normal smell or taste) who live alone should self-isolate for 10 days from the onset of symptoms. Households should all self-isolate for 10 days if one member shows symptoms [22] . There is no need for people with minor symptoms to telephone NHS 111.

However, given the outbreak has coincided with the cold and flu season, it is likely that patients may present in the pharmacy with queries about the virus, or with concerns about their cold or flu symptoms.

Community pharmacies were told by NHS England and NHS Improvement on 27 February 2020 that, in the unlikely event that a suspected case does present, they must prepare a “designated isolation space” [23] .

If the pharmacy does not have a suitable room to isolate a suspected patient, an area that would keep a patient at least two metres away from staff and other patients in the pharmacy should be prepared so that it can be cordoned off.

Patients who present with a new, continuous cough or a high temperature or anosmia should be told to return home immediately and self-isolate. If, in the clinical judgement of the pharmacist, the person is too unwell to return home, they and any accompanying family should be invited into the designated isolation space where emergency services should be contacted.

The Royal Pharmaceutical Society is publishing ongoing guidance on contingency planning for COVID-19, which includes measures to protect the pharmacy team, such as limiting the number of people within the pharmacy at the same time, keeping at least two metres apart from staff and people coming into the pharmacy, and sectioning the pharmacy to encourage social distancing with floor markings (using tape) or barriers. The RPS has also produced a table to help pharmacists distinguish between COVID-19, a cold, the flu and hayfever.

Those with cold and flu symptoms that are not indicative of COVID-19 should be managed as usual, or using the pathway developed by The Pharmaceutical Journal .

The General Pharmaceutical Council said on 3 March 2020 that it recognises pharmacists may need to depart from established procedures in order to care for patients during the coronavirus outbreak and that regulatory standards are designed to be flexible and to provide a framework for decision-making in a wide range of situations.

In a  joint statement with ten other health regulators, the GPhC said: “Where a concern is raised about a registered professional, it will always be considered on the specific facts of the case, taking into account the factors relevant to the environment in which the professional is working”.

An  updated standard operating procedure (SOP) for community pharmacies, published on 22 March 2020, sets out measures to protect pharmacy staff, including advising customers to keep a distance of at least two metres from other people, limiting entry and exit to the pharmacy and installing full screens to protect members of staff from airborne particles (see Learning article section ‘Enforcing social distancing’ for further details).

Following some confusion early on in the pandemic about whether community pharmacists should wear personal protective equipment (PPE), Public Health England updated its guidance on 23 July 2020 to say that pharmacy staff, both in clinical and non-clinical roles, should wear a type I, type II or type IIR facemask if the environment is not COVID-19 secure, using social distancing, optimal hand hygiene, frequent surface decontamination, ventilation and other measures where appropriate.

This brings the PHE guidance in line with that from the RPS, which says that pharmacy staff working in community pharmacies and general practice should wear fluid-resistant surgical masks if they are unable to maintain a social distance of 2 metres from patients and staff, and emphasises that it is still important to try to maintain social distance when wearing surgical masks wherever possible. The RPS also advises that gloves, apron and surgical masks should be worn by staff in direct contact with a patient, for example, when a person is too unwell to go home and is being cared for in the designated isolation space.

PPE can be ordered for free via the government’s  PPE portal.

On 5 June 2020, the DHSC announced that all staff in hospitals in England will have to wear surgical masks from 15 June 2020, regardless of the clinical area in which they work.

Guidance has been issued by pharmacy organisations on how community pharmacies in England can accept patient returns of unwanted medicines while minimising risk to pharmacy teams. Since coronaviruses can survive on certain surfaces for up to five days, it recommends that all returns should be double bagged and placed directly in waste medicines bins. Controlled Drugs should be double bagged and placed in the CD cabinet for five days before denaturing. A suggested procedure is detailed within the guidance.

Staff who have symptoms of COVID-19 should stay at home and get tested as soon as possible. NHS England and Improvement confirmed in a letter to community pharmacies on 9 June 2020 that NHS staff “must self-isolate” for 14 days (reduced to 10 days from 14 December 2020) if the NHS test and trace service advises them to do so because they have come into close contact with a person with COVID-19. However, the letter adds that close contact “excludes circumstances where PPE is being worn”. If a member of the pharmacy team tests positive and there is a risk to the provision of pharmaceutical services then advice regarding the individual circumstances should be sought from the local Health Protection Team.

Staff who fall into one of the vulnerable groups at particular risk of complications from COVID-19 should not see patients face-to-face, regardless of whether the patient has possible COVID-19. Remote working should be prioritised for these staff.

NHS staff from a black, Asian or minority ethnic (BAME) background and others who who may be particularly vulnerable to COVID-19 — including those working in community pharmacies — should be risk assessed. In a letter dated 29 April 2020 , NHS England said that “emerging UK and international data” suggest that people from BAME backgrounds are “being disproportionately affected by COVID-19”.

The Faculty of Occupational Medicine later published a risk reduction framework — backed by NHS England — to assist with the risk assessments on 14 May 2020. This was updated on 28 May 2020 to include guidance from the Health and Safety Executive to “help organisations identify who is at risk of harm”.

All NHS staff can access free wellbeing support and frontline health and care staff can access NHS volunteer responders support for themselves by calling 0808 196 3646.

Pharmacies are on the frontline of the fight against coronavirus and demand for services is high. An updated standard operating procedure published on 27 October 2020 enables regional NHS England and NHS Improvement teams to notify pharmacies that they are able to adjust their opening hours to cope with increased demand. Pharmacies will be able to work behind closed doors for up to 2.5 hours a day before 10am, between 12 and 2pm or after 4pm.

A number of contractual services have been put on hold and others have been brought forward (see Learning article section ‘Adjusting opening hours and pharmacy services’ for further details). The Hepatitis C testing service in England will now launch on 1 September 2020 and the discharge medicines service is expected to start in February 2021.

During the first full lockdown in the spring of 2020, community pharmacies ensured that those who were shielding from COVID-19 (see Box 2) were able to receive their prescription medicines, either through friends and family, volunteers, or via pandemic delivery services but these were paused when cases dropped. The pandemic delivery service in England  resumed for four weeks from 5 November 2020 to 3 December 2020, and again from 5 January 2021 to 31 March 2021, owing to sustained community transmission of COVID-19; it was expanded to patients told to self-isolate by NHS Test and Trace on 16 March 2021 until 30 June 2021. In Scotland, a pandemic delivery service started on 18 January 2021 and will continue until the end of March 2021.

Another new advanced service, distributing COVID-19 lateral flow test kits, was announced on 29 March 2021 for community pharmacies in England. Pharmacies will be able to earn up to £972 per week by providing the test kits to asymptomatic patients as part of NHS Test and Trace.

The need for patients to sign the back of prescription forms has been  suspended until 30 June 2021 so as to reduce cross contamination and minimise handling of paperwork. Patients must still pay the prescription charge or prove their eligibility for exemption. Pharmacy staff should mark the relevant box for exempt patients and annotate all forms with COVID-19 in place of a signature.

Amendments to legislation to allow community pharmacies to close, with the permission of NHS England, “to focus on the delivery of flu or COVID-19 vaccinations” will come into effect on 9 November 2020 to allow for “flexible provision of immunisation services during the pandemic”. These changes follow the government’s decision to allow pharmacists to deliver unlicensed — in addition to licensed — vaccinations , such as a COVID-19 vaccine when one becomes available, with further work under way to expand the workforce able to deliver flu vaccines.

The amendments also allow community pharmacists in England to dispense COVID-19 treatments without a prescription under pandemic treatment protocols that will be issued by the government if a COVID-19 treatment became available that was suitable for distribution via community pharmacies and it was not found to be necessary for an authorised prescriber to decide to treat.

The General Pharmaceutical Council has stopped all routine inspections of pharmacies. Submission of revalidation records is postponed for registrants who were due to submit between 20 March 2020 and 31 August 2020, and requirements have been reduced for those due to submit between 1 September 2020 and 31 December 2020.

On 26 March 2020, the GPhC announced that the pharmacy registration assessments for June and September 2020 have been postponed. The GPhC confirmed on 30 November 2020 that online registration assessments would take place at centres around the UK on 17 and 18 March 2021.

More than 6,200 pharmacy professionals who left the register within the past three years have been given  temporary registration so that they can to return to work during the COVID-19 pandemic, if they wish to do so. And in guidance published on 9 April 2020, final year pharmacy students were told they can join their arranged preregistration workplace ahead of the scheduled start date to help deal with the COVID-19 pandemic.

The PSNC announced on 31 March 2020 that community pharmacies in England will be given cash advances totalling £300.0m over the next two months to help with cashflow during the pandemic, but no extra funding has been negotiated so far. Further advanced funding of £50m and £20m at the end of May 2020 and June 2020, respectively, has since been announced by the PSNC. As with the £300m previously announced, the £70m is not additional funding and will be reconciled in 2020/2021.

Advance payments have also been agreed for community pharmacies in Scotland and Wales.

Additional funding of an initial £5.6m was agreed in Scotland on 7 April 2020 to support unparalleled levels of activity within community pharmacy during the pandemic. The funding will cover equipment costs, adaptations to premises, additional staffing and locum fees. Further additional funding of £4.5m for staffing costs for May and June 2020 was announced on 27 November 2020.

On 2 April 2020, the government announced that it had written off £13.4bn of debt as part of a major financial reset for NHS providers.

The  WHO has created a range of infographics to illustrate how patients can protect themselves and others from getting sick; however, most of the advice is similar to what would be provided for colds and flu (see Figure) [24] .

Figure: Infographic – How to reduce the risk of coronavirus infection

Source: Source: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO.

There is no specific treatment for COVID-19. Although vaccines can be developed to treat viruses, owing to the novel nature of this infection, no vaccine has currently been developed and the process to develop one may take 12 to 18 months [18] . As an example, many antiviral agents have been identified to inhibit SARS in vitro , but there are currently no approved antiviral agents or vaccines available to tackle any potential SARS or SARS-like outbreaks, such as MERS or SARS-CoV-2 [25] .

On 16 March 2020, the British Cardiovascular Society and the British Society for Heart Failure published a statement saying that patients should continue treatment with angiotensin converting enzyme inhibitors and angiotensin receptor blockers unless “specifically advised to stop by their medical team”.

The advice was issued following concerns circulated on social media that these medicines could predispose them to adverse outcomes should they become infected with COVID-19.

Both societies recommended that patients taking these medicines who present as unwell, or with a suspected or known COVID-19 infection, should be assessed on an individual basis and their medication managed according to established guidance. Inappropriate cessation of therapy could lead to a decline in control of blood pressure, heart failure or any other condition the individuals takes these medicines for.

Similar concerns have also arisen around the use of ibuprofen following unverified claims, backed by Oliver Veran, France’s health minister, that ibuprofen may exacerbate symptoms of the virus.

On 14 April 2020, the Committee of Human Medicines (CHM) — an advisory body of Medicines and Healthcare products Regulatory Agency — and the National Institute for Health and Care Excellence both published reviews, which concluded that there is insufficient evidence to establish a link between use of ibuprofen, or other NSAIDs, and susceptibility to contracting COVID-19 or the worsening of its symptoms.

A rapid policy statement published by NHS England on the same date, highlighted that there had been some reports of possible adverse effects of the use of NSAIDs in acute respiratory tract infections more generally, which had led to suggestions to use paracetamol preferentially for fever/pain in such situations. However, it said that there was currently no evidence that the acute use of NSAIDs caused an increased risk of developing COVID-19 or of developing a more severe COVID-19 disease.

The Royal Pharmaceutical Society has collated resources for hospital pharmacists on the clinical management of patients with COVID-19, including treatments, use of experimental therapies, and evidence-based summaries.

The resources also include information on critical care services during the pandemic and guidance on COVID-19 in special populations, such as children, pregnant women, patients taking warfarin and those with cancer, respiratory conditions, diabetes, rheumatological conditions and HIV.

The National Institute for Health and Care Excellence has produced COVID-19 rapid guidelines covering a number of areas as well as rapid evidence summaries on COVID-19 treatments. NHS England and NHS Improvement has also published several specialty guides aimed at specialists working in hospitals during the pandemic. These resources have all been brought together on the NICE website .

NICE and the Scottish Intercollegiate Guidelines Network are working with the Royal College of General Practitioners (RCGP) to develop a guideline on the effects of long COVID on patients.

The government banned the parallel export of chloroquine, as well as the antiretroviral lopinavir/ritonavir, on 26 February 2020 because they are being tested as possible treatments for COVID-19. There has been a lot of attention in the media on the potential benefits of chloroquine and hydroxychloroquine in treating patients with COVID-19 but the Medicines and Healthcare Regulatory Agency has warned that these medicines are not licensed to treat COVID-19 related symptoms or prevent infection and, until there is clear, definitive evidence that these treatments are safe and effective for the treatment of COVID-19, they should only be used for this purpose within a clinical trial.

On 20 March 2020, the government banned from parallel export more than 80 medicines used to treat patients in intensive care units. The restrictions cover crucial medicines such as adrenaline, insulin, paracetamol and morphine and are designed to prevent medicines shortages. A further 52 medicines, including a number of respiratory medicines, antibiotics, analgesics and insulin products, were banned from export on 1 April 2020. And a further 33 medicines were banned from export on 24 April 2020, including further respiratory medicines and some drugs that are being trialled for COVID-19, such as azithromycin, dexamethasone, ruxolitinib, sarilumab and tocilizumab.

Community pharmacists have been experiencing huge demand for paracetamol and many have reported shortages of paracetamol tablets 500mg as pharmacy and general sales list packs. The National Pharmacy Association and the GPhC have both said that  pharmacies are able to break down larger packs to prepare supplies of a non-prescription items for retail sale.

Shortages of Chiesi’s Clenil and Fostair inhalers, along with inhalers from other brands, have been noticed by pharmacists as patients begin to panic and order inhalers they potentially do not need. The wholesaler AAH Pharmaceuticals placed 11 inhalers on its “out of stock” list on the 30 March 2020. NHS England wrote to healthcare professionals working in primary care on 31 March 2020, asking them not to overprescribe or over-order during this time, as this will create further pressures on the supply chain.

There are three major randomised controlled trials of medicines to treat COVID-19 being funded by the UK government: PRINCIPLE, RECOVERY and REMAP-CAP (see Feature and trials briefing ), and several other trials are being nationally prioritised .

Preliminary results from the RECOVERY trial suggest that low-dose dexamethasone offers significant reductions in mortality for those patients with COVID-19 who require oxygen or ventilation, and it has been approved for use on the NHS.

Results from the REMAP-CAP trial have suggested that  tocilizumab and sarilumab reduced the risk of death from COVID-19 by 24%  when administered in the first 24 hours of a patient entering intensive care, and these drugs should now be considered by the NHS for hospitalised patients.

Results from the RECOVERY trial also suggest that tocilizumab reduces deaths in patients hospitalised with COVID-19.

An interim analysis of the PRINCIPLE trial suggests the corticosteroid budesonide shortens recovery time from COVID-19 by a median of three days, compared with usual care, in older people treated in the community.

In addition, on 28 April 2020, the Accelerating COVID-19 Research & Development ( ACCORD ) platform was launched , a collaboration between government, industry and research organisations that aims to reduce the time taken to set up clinical studies for new COVID therapies from months to weeks. ACCORD will rapidly test potential drugs through early stage clinical trials and, if they show promise, will feed them into the UK’s large-scale COVID-19 studies, such as RECOVERY. Bemcentinib, an AXL kinase inhibitor, will be the first to begin phase II studies across the UK within the next few days.

Further potential treatments will be rapidly fed into ACCORD as the programme rolls out over the next few weeks.

A Yellow Card website dedicated to reporting side-effects or incidents from medicines being used to treat COVID-19 has been set up by the Medicines and Healthcare products Regulatory Agency (MHRA).

The UK has pre-ordered 357 million doses of different potential COVID-19 vaccines from seven manufacturers. The portfolio includes two adenoviral vector vaccines (Oxford/AstraZeneca and Janssen), two mRNA vaccines (BioNTech/Pfizer and Moderna), an inactivated whole virus vaccine (Valneva), and two protein adjuvant vaccines (GSK/Sanofi, Novavax) (see feature ).

Three of the vaccines being backed by the UK —BioNTech/Pfizer, Moderna and Oxford/AstraZeneca — released positive results from phase III trials in November 2020. The Pfizer/BioNTech vaccine was approved by the Medicines and Healthcare products Regulatory Agency (MHRA) on 2 December 2020 and the Oxford/AstraZeneca vaccine was authorised for use by the MHRA on 30 December 2020 and the Moderna vaccine was authorised on  8 January 2021 (see feature ).

Hospital pharmacists are overseeing ‘safe handling’ of COVID-19 vaccines in vaccination centres and hospital hubs as part of the mass vaccination programme, which started on 8 December 2020.

NHS England wrote to pharmacy contractors on 27 November 2020, saying that it is planning for designated pharmacy sites to be ready to administer COVID-19 vaccines under a local enhanced service from late December 2020 or early January 2021. However, “complex logistics” in the vaccine’s supply chain mean NHS England does not expect the majority of contractors’ sites will be able to meet a specific set of requirements, such as administering a minimum of 1,000 vaccines per week, with the fridge space, physical layout and staffing necessary to support that.

Community pharmacy contractors can also collaborate with their local primary care network to support them to deliver maximum vaccine uptake via the GP enhanced service or with vaccination centres, which started vaccinating patients on 14 December 2020.

Vaccination sites led by community pharmacies started administering COVID-19 vaccines to patients on 11 January 2021, with about 200 joining the first wave.

In a  letter to contractors  dated 16 February 2021, NHS England officials said it would reopen the application process to improve vaccination provision in a list of “priority locations”.

Community pharmacies able to administer up to 400 COVID-19 vaccines per week can now apply to become designated vaccination sites.

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[18] World Health Organization. 2020. Available at: https://www.who.int/news-room/q-a-detail/q-a-coronaviruses (accessed January 2020)

[19] World Health Organization. 2020. Available at: https://www.who.int/docs/default-source/coronaviruse/wuhan-virus-assay-v1991527e5122341d99287a1b17c111902.pdf?sfvrsn=d381fc88_2 (accessed January 2020)

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One Year Into The COVID-19 Pandemic, Six Stories That Inspire Hope

March 11 marks  one year since COVID-19 was officially declared a pandemic . While the past year has been  tremendously challenging , there have been remarkable stories of human resilience, ingenuity, and creativity.

On this grim anniversary, we wanted to bring you stories from around the world that inspire. The following six stories are not billion-dollar projects, but the tales of everyday entrepreneurship and innovation happening on a small scale with a big impact. The World Bank Group is continuing to support the poorest countries as they look to a build a sustainable, resilient, and inclusive recovery.

1. Lao PDR: Unlocking the Full Potential of Small- and Medium-Sized Enterprise

The village of Phailom is situated about an hour’s drive outside the capital, Vientiane. In recent years village’s network of talented woodworking artisans have become renowned suppliers of souvenirs to tourists wishing to remember their visit to the Lao People’s Democratic Republic. 

Among these artisans is Vorachith Keoxayayong, who has been continuing this village’s long tradition of wood sculpture since he was a child.  

His art is not just a hobby, however. His company, Vorachith Wood Carving, employees 23 people – providing meaningful and sustainable employment in his community.  Small enterprises, like his, as well as medium-sized enterprises account for more than 80 percent of employment and some 94 percent of all registered firms in Lao PDR, according to the  Lao Statistics  Bureau. 

With the onset of COVID-19 and decreased tourism, the artisans of Phailom — like other small- and medium-sized enterprises (SMEs) across Lao PDR — have been hit hard. 

The pandemic has created new challenges for these enterprises, many of which were already struggling for other reasons.  Despite their highly-refined skills and popularity with tourists, Mr. Vorachith and other entrepreneurs behind SMEs across the country struggle to access credit, and this limits their ability to expand operations and grow their employee base. 

The situation has started to change, however. The World Bank Group’s  SME Access to Finance Project  has unlocked formal funding that was once out of reach for many of these firms. 

“In the past, expanding was tough as we had to take out informal loans with very high interest rates. I feel much more at ease borrowing money from a bank,” explained Mr. Vorachith. 

While their economic recovery will be a long process, the World Bank and the Lao government are building on the success of the SME Access to Finance project, forging pathways to help small companies weather the effects of the pandemic and get their firms back on solid financial ground as travel restrictions are gradually lifted.

Read more .

2. Costa Rica: Women Firefighters on the Frontlines of Resilient Recovery 

As Costa Rica – like countries the world over – looks to mount a sustainable, resilient recovery after COVID-19, the country’s brigadistas will be on the frontlines.

These female firefighters are gaining increasing recognition for fighting stereotypes just as effectively as they fight the country’s pervasive forest fires.  Protecting the country's forests is a central to Costa Rica's efforts to promote sustainability and tackle climate change.

“There is always that myth or macho thought that a woman cannot grab a machete, a back pump, a leaf blower, that she can't go up a big hill,” says one brigadista, Ana Luz Diaz.

Women in Costa Rica play key roles in conservation and the sustainability of forests and farmland. But they – as is the case in many countries – face gender stereotypes and disproportionately burdensome caregiving responsibilities. These factors can limit their ability to play bigger roles in green activities and projects.

However, efforts are underway to address these disparities, and better recognize the unique ways that men and women contribute to efforts related to the environment, forestry, and climate action.

“I want to be someone, to be seen, not be invisible. I want both men and women to see each other and the support that we too can give,” said another brigadista, Melissa Aviles.

In 2019, Costa Rica, with funding from the Forest Carbon Partnership Facility (FCPF), a World Bank Group program, developed a Gender Action Plan (GAP) that supports the country’s efforts to reduce emissions stemming from forest degradation and deforestation.

The GAP will play a central role in shaping Costa Rica’s recovery into one that is not just sustainable and resilient, but inclusive as well, and the country is sharing its experience and knowledge with others so that they may benefit as well.

3. Pakistan: Prioritizing Patients by Phone

Pakistan’s rural population, like so many people around the world, struggles to find affordable access to health services.  Journeys into populated cities to seek care are costly – especially when multiple trips are required. And when the pandemic struck these problems were magnified.

But what if healthcare could be made more accessible? What if routine services could be conducted by phone?

That’s where Pakistani entrepreneur Maliha Khalid enters the story.  She and her team run Doctory, a hotline service that helps patients avoid the multiple referrals often required for treatment by connecting people to the right doctor immediately.  The innovative company, alongside six others, beat out 2,400 other applicants to win the World Bank Group’s  SDGs & Her  competition last year.

When the pandemic reached Pakistan, the Doctory team sprang into action, launching Pakistan’s National COVID-19 Helpline, connecting people across the country to fast, high-quality care – saving them countless amounts of time and money.

4. Kenya: Creating Sustainable Jobs for Youth

When the Kenyan government implemented lockdown measures to help contain the spread of COVID-19, the economic side effects were felt especially by poor communities.

Finding opportunity in crisis, the government created the National Hygiene Program – known colloquially as Kazi Mtaani (loosely translated as “jobs in our hood”) – which finds meaningful employment for the most vulnerable, especially youth, in jobs that improve their environments.

These programs include bush clearance, fumigation, disinfection, street cleaning, garbage collection, and drainage clearance.  

Byron Mashu, a resident of the Kibera settlement, express his gratitude for the program, saying that it allowed youth to “fend for our families and settle our bills, but it is also ensuring that young people are less idle as they are engaged at work during the day which has significantly minimized crime rates in our area”.  

The program was kickstarted through World Bank Group’s Kenya Informal Settlements Improvement Project, which has seen jobs created across 27 settlements in eight counties across the country.  

Don Dante, a youth leader in the Mukuru Kwa Njenga settlement, told the Bank that as a result of the program, “We have seen the reduction of petty crimes and dependency on other people and our environs are clean”.

Given the project’s success and popularity, the Kenyan government is working to expand it using its own financing – extending jobs to 283,210 workers across 47 counties.

5. Greece: Supporting Small Food Producers and Supplying the Vulnerable

Melina Taprantzi arguably has more experience with economic crises than most.

The Greek entrepreneur lived through the Greek Financial crisis, witnessing suffering and rising poverty. From those experiences she decided to dedicate her work towards addressing social needs.  

Her business, Wise Greece, connects small-scale food producers with those in need by providing a six kilogram box of basic food and supplies. Melina won the SDGs and Her competition in 2020.

When COVID-19 entered the scene, Wise Greece didn’t sit idly by.  Instead, they moved quickly to partner with multinational companies to provide these boxes not just to those in need, but also to the elderly and vulnerable who can’t leave their homes.

Since 2013, the company has contributed some 50 tons of food supplies.  During the pandemic alone, it has made at least 6 tons available to vulnerable communities.

6. Chad: Kickstarting Sanitizer Production

With the pandemic sparking unprecedented demand for sanitizing products, supply chains around the world were hammered.

“People waited in line sometimes for hours to procure the alcohol-based sanitizer,” reported the World Bank’s Edmond Dingamhoudou in Chad’s capital, N’Djamena. “Some went so far as to cross the border to stock up in Kousseri, a Cameroonian city some 20 kilometers from N’Djamena on the opposite bank of the Logone River.”

With these critical supplies difficult to find, officials and scientists came together in record time. A laboratory constructed with support of the International Development Assocation was repurposed for the quick and effective manufacturing of gel hand sanitizer – launching Chad’s first ever local production of the product.

As of mid-April 2020, the facility was able to produce approximately 900 liters of hand sanitizer per day, with 20 to 25 technicians overseeing production, quality control, and packaging.

• The World Bank Group’s Response to the COVID-19 (coronavirus) Pandemic
• Infographic: World Bank Group COVID-19 Crisis Response
• World Bank Group COVID-19 Crisis Response Approach Paper

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