As a pharmacy student in the 1990s, I distinctly remember sitting in my Disease and Therapeutics class and thinking to myself, “I need to avoid taking medications if at all possible.” While my knowledge of the adverse effects and drug interactions has not kept me from occasional antibiotic use and medication for migraines, my use of prescription drugs has been minimal as I’ve opted for healthy lifestyle and a decades long endeavor to get back to my high school weight after having two children. All of this did not keep me from getting the flu vaccination on a yearly basis after having a particularly severe bout of the flu in college. That is, until Covid happened.
As a pharmacist working for a large retail chain, my team and I were of course essential personnel, and our workplace was open during the shutdown. After the governor of our Midwest state announced the impending shutdown, panic ensued and customers came in large numbers to try to get their medications filled. Doctor offices closed, and I was honestly angered at the ease with which pet owners were able to get care for their pets (though likely handing their pet off to a masked veterinary tech at the car). No offense to pet owners, but animals were getting health care and humans were not.
Early on, we were getting phone in prescriptions from a few physicians who were trying to get supplies of Hydroxychloroquine and Azithromycin on hand for personal or family use. The Hydroxychloroquine was on manufacturer backorder very early on, so often was not an option. We received guidance from the State Board of Pharmacy in late March that any prescriptions for either presumptive positive patients or prophylactic use of Hydroxychloroquine related to Covid-19 was prohibited. While this was an attempt to keep supplies available for those patients who use Hydroxychloroquine for other disease states, such as lupus and rheumatoid arthritis, it put pharmacists in a role of policing its use.
We were in a similar circumstance later regarding Ivermectin, though in this case, the state and corporate guidance just mirrored the CDC recommendations that Ivermectin was not effective in treating Covid-19. Some pharmacists interpreted this as a direct order to interrogate physicians regarding reason for use and then justify the refusal to fill the prescription. Personally, I did not refuse to fill prescriptions for Ivermectin, as we fill prescriptions for off label use all the time (often without knowing the actual diagnosis of the patient) and furthermore, if these medications had even just a ten percent chance in helping the infected person stay out of the hospital, why not try it?
I was not particularly afraid of getting Covid, given my lack of co-morbidities. I treated brief interactions with Covid positive patients the same as I would any respiratory virus. My daughter was sent home from college with Covid in September 2020 as the virus quickly spread on campus at the beginning of that fall semester. She stayed mostly in her room, and neither I, nor her high school age brother, contracted it. One could certainly argue that keeping the students on campus, rather than sending them home to infect their families, would have been a better course of action. In our case, the elderly grandparents live hundreds of miles away, so her brother and I were the only ones potentially exposed.
The preparation for the vaccine roll out ensued, including training on vaccine administration by pharmacy technicians, who had been emergency authorized by the state to administer due to the massive scale of this endeavor. This included vaccine administration clinics at nursing homes and assisted living facilities to vaccinate the elderly, which then also required repeated trips for second dose. I did not volunteer for these clinics, but had technicians who did. As the vaccine quantities increased, we began clinics in stores, with multiple technicians administering vaccines by appointment, nine to ten hours a day. The line of high risk individuals zig zagged through the store—everyone socially distanced, of course. There were also seats set up for the required fifteen minutes of observation following administration. It was a coordinated process of check in, vaccine administration, and observation.
The Covid mRNA vaccine had six doses per vial, and we were encouraged to not waste any doses. The phones would ring off the hook for those who wanted to jump the line and receive a vaccine late in the evening if we had vaccine leftover. During this time, I saw the scarcity mindset in action, and could see how people fall prey to it, even myself at times tempted to take one such extra dose when available. Logic prevailed though, and my baseline assumption was that there is no way they can know that a brand new vaccine technology is safe. Soon enough, it would prove to not be effective either.
I wish I had been journaling at the time, because if I had been, I would have tracked the changes in storage requirements. Initially, the product was sent in reusable shipping containers packed with dry ice. We would don gloves and goggles when opening the container to remove the vials that we expected to use that day, or over the course of a few days, and the rest remained in the container. We would periodically receive separate shipments of dry ice to replenish the container. As we removed the product to then be placed in the fridge, it was marked with date and time (down to the minute) and the date and time that it could not be used after. After the vial was punctured, it had to be used within 12 hours, if I remember correctly, thus the high focus on having a wait list of people willing to come in the evening on short notice.
Somewhere in there, though, the storage requirements changed. All of the sudden, the product was more stable. It no longer arrived on dry ice, coming in regular cooler containers instead. We were to keep it at fridge temperature, and the unopened product was now stable in the fridge for weeks. I have never understood if they changed the original emergency authorized product (i.e. a new formulation) or if they decided the product was more stable than they originally thought, but I suspect it was the former. This was all while it was the emergency authorized product. Now it was arriving under a new name, it comes in prefilled syringes that have expiration dates twelve months out.
As talk of vaccination mandates began, we received word from corporate in August 2021 that the vaccine would be required for all pharmacists by November. Having not received the vaccine, I followed the steps for a reasonable accommodation based on religious reasons, which was denied. There was no reason given for the denial, and no opportunity for appeal. Here I was, a divorced mother of two, doing the math on my finances, calculating how long my savings might last if I got fired for refusing the vaccine. This was a hill I was preparing to die on. I was a healthy 48 year old, and nothing in the prior eight or nine months had convinced me that I was at high risk of hospitalization, nor that there was any need for me to get vaccinated. I contracted Covid in September 2021, supposedly the Delta version, and was required to be off work for ten days. I had many classic symptoms: cough, loss of taste, energy and appetite, and I felt awful and run down, but I never had a fever or difficulty breathing. I spent a lot of time outdoors, getting sunlight and fresh air, and I distanced myself from my teenage son best I could. He did not contract Covid at that time.
I applied for a new reasonable accommodation, this time for medical reasons given my recent recovery from Covid, and this request was accepted. I was then forced to do twice a week witnessed Covid tests for some time, until the company first abandoned the attempt to force vaccination on hourly employees, and then larger mandates were abandoned as well.
In my case, I retained my employment and income. Had I been ten years older at the time this insanity ensued, I’d have hung up my lab coat and retired, avoiding any part in it. Over the years, I have seen comments on social media attempting to villainize those involved with administering these vaccines, and I get that. I’d have walked away if I could, but I had kids to put through college. As a side note, my son’s college search was made more complicated due to the ambiguousness on the part of colleges on whether they would be dropping vaccine mandates by the fall semester of 2023. It was very difficult to get straight answers from college officials.
The truth is, if anyone came in and asked my opinion on the vaccines, I would tell them, but honestly, I can probably count on one hand the number of times someone has walked in and actually asked. The ones showing up for the Covid vaccination initially were scared for themselves or their family members. As it was opened to wider populations, people wanted to get it so they could travel or go to a concert. Ultimately, people were often coming in because they were forced to by their employer. Their minds were already made up in the first two scenarios, and the third scenario I could certainly identify with.
There are certainly many more things about my Covid era experience I could share, as it was truly traumatizing in many ways. From the isolation and watching my kids and others’ children robbed of experiences, to the tensions within families, to the added workplace pressures in an already grueling field of work - it was much to endure. I look forward to the day I can retire from this career and step away from the grind of retail pharmacy, which has only grown more frustrating in light of the events over the past six years.
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