As the number of novel coronavirus (COVID-19) cases continues to rise in the United States, community pharmacists and retailers are struggling to keep products such as hand sanitizers on the shelves.

According to CDC estimates earlier this week, there are now more than 400 confirmed cases and 19 deaths across the United States.1 Washington, California, and New York have the most reported cases, with between 101 and 200 per state.1 Globally, the number of infections has reached more than 113,000 with over 4000 deaths according to the World Health Organization (WHO).2

Frequent hand-washing is still the key recommendation to prevent the spread of the virus, according to the CDC.3 The concerns over clean hands has resulted in increased sales of hand sanitizers, and now pharmacists are reporting that they’re struggling to keep the products in supply.

Troy Trygstad, PharmD, MBA, PhD, vice president of pharmacy programs for Community Care of North Carolina, said hand sanitizers are “essentially gone.” Trygstad added that it is not entirely different from a drug shortage, in that it’s also difficult to obtain products from wholesalers.

Trygstad pointed out that in addition to the inability to provide hand sanitizers, pharmacists are concerned about the potential to transmit the virus to and from the pharmacy staff.

“Keep in mind though that the sink is generally in the back at the pharmacy and the staff have access to it,” Trygstad said in an email to Pharmacy Times. He concluded that not only should the public focus on washing their hands, but pharmacists should ensure the staff are also washing their hands regularly for their own protection and for the protection of patients.

In an effort to solve the shortages, New York State has announced that it will begin producing up to 100,000 gallons of hand sanitizers each week, which will be made available for free to residents.4 Distribution of the sanitizers will be prioritized by the most affected and high-risk communities, according to a press release.4

As of Monday, New York State has 142 confirmed cases.4

In a press conference on Monday, New York Governor Andrew Cuomo (D) announced that the New York State-produced hand sanitizer will be 75% alcohol—well above the 60% alcohol recommendation by the WHO and CDC.4

Cuomo added that the sanitizer will be distributed to New Rochelle, which he called a “hotspot” of COVID-19 cases.4 State officials have created a 1-mile “containment area” around the New York City suburb, where large gathering places such as schools and community centers will be closed for 2 weeks beginning on Thursday.5

Cuomo also announced a paid sick leave bill to specifically protect those who stay home from work as a result of COVID-19 quarantines.4

“I think it’s especially important that if [the] government is ordering a quarantine, even a voluntary quarantine, that places a personal hardship on a person,” Cuomo said. “That person should get paid, and we’re going to be sending up a bill to the legislature.”4

Cuomo concluded the press conference by emphasizing that the public should not panic. The citizens at the highest risk—those 60 years of age and older, those with a compromised immune system, or anyone with an underlying illness—should adjust their social interactions and stay home as much as possible, Cuomo said. Others, however, should remain calm and ensure basic hygiene such as hand-washing and coughing etiquette.4

“The fear and the hysteria [are] outpacing the reality of the situation, but the reality of the situation is people in that target group should be careful, so let’s be realistic on the overall hysteria and hype that we’re now living through,” Cuomo said.4

Experts are continuing to focus on reducing the spread of the illness, though some studies have suggested that the number of cases could be much higher than current estimates.

According to a recently published study by Cedars-Sinai, more than 9000 people in the United States may have been infected by March 1, 2020.5 According to a press statement on the study, the researchers used “very conservative” methods to estimate the number of cases.5

The study authors modeled COVID-19 cases that were imported directly to the United States from Wuhan, China, prior to January 23, 2020, when Chinese authorities locked down the city. They then calculated the scale in the United States based on air traffic data, totals of confirmed cases released by the CDC, and transmission dynamics as estimated from previous research.5

Based on their data, the researchers estimated the total number of infections in the United States to be between 1043 and 9484. The first figure assumed that current preventive procedures, such as quarantines and screening international travelers at airports, had reduced as much as 25% of the transmissibility in unidentified cases. The second figure assumed no intervention procedures.5

The authors urged continued mitigation efforts, including “social distancing,” personal hygiene, and restricting large-scale gatherings.5

“Our model suggests that even moderately effective population interventions to reduce transmission can have a profound impact on the scale of the epidemic,” said Dermot P. McGovern, MD, PhD, a senior author of the study, in a statement. “This finding supports the role of public health interventions in controlling the disease.”5

REFERENCES
  1. Coronavirus Disease 2019 (COVID-19), Cases in the US. Centers for Disease Control and Prevention; Updated March 9, 2020. CDC website, https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html. Accessed March 10, 2020.
  2. Coronavirus disease 2019 (COVID-19) Situation Report 49. World Health Organization; March 10, 2020. WHO website; https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200310-sitrep-50-covid-19.pdf?sfvrsn=55e904fb_2. Accessed March 10, 2020.
  3. Coronavirus Disease 2019 (COVID-19), Protect Yourself & Family. US Centers for Disease Control and Prevention; Page Last Reviewed March 6, 2020. CDC website, https://www.cdc.gov/coronavirus/2019-ncov/protect/index.html. Accessed March 10, 2020.
  4. At Novel Coronavirus Briefing, Governor Cuomo Announces State Will Provide Alcohol-Based Hand Sanitizer to New Yorkers Free of Charge [news release]. Governor Andrew Cuomo website; March 9, 2020. https://www.governor.ny.gov/news/video-audio-photos-rush-transcript-novel-coronavirus-briefing-governor-cuomo-announces-state-0. Accessed March 10m 2020.
  5. Governor Cuomo Accepts Recommendation of State Health Commissioner for New Emergency Measures to Contain Novel Coronavirus Cluster in New Rochelle [news release]. Governor Andrew Cuomo website; March 10, 2020. https://www.governor.ny.gov/news/video-audio-photos-rush-transcript-governor-cuomo-accepts-recommendation-state-health. Accessed March 10, 2020.
  6. Study Estimates COVID-19 May Have Infected Over 9,000 in US [news release]. Cedars-Sinai Health System; March 9, 2020. https://www.cedars-sinai.org/newsroom/study-estimates-covid-19-may-have-infected-over-9000-in-us/. Accessed March 10, 2020.