URI pharmacy Professor Todd Brothers coordinates COVID-19 field hospital pharmacy, along with fellow professors, students

Several University of Rhode Island College of Pharmacy students and professors have stepped up to fight the COVID-19 pandemic at the Care New England Field Hospital in Cranston, including Clinical Assistant Professor Dr. Todd Brothers who is coordinating pharmacy efforts there.

“Seeing these people step up — not just pharmacy but nursing, physicians, everybody — everybody is rowing this boat in the right direction,” Brothers said. “We all work as a cohesive group and decide how to get things done promptly. It’s invigorating to be part of this.”

Brothers has been in the profession since 2002, having worked as a critical care pharmacist at Kent Hospital from 2004 to 2018, when he moved his clinical site to Roger Williams Medical Center in Providence. When Care New England needed someone to build a pharmacy at the field hospital set up to treat patients with COVID-19, the director turned to Brothers. In March, he started setting up the pharmacy before the curve of infections flattened, eliminating the initial need for it. However, just before Thanksgiving, it became clear that infections were rising and the hospital would be necessary again.

Brothers got back to work with the support of URI Pharmacy Dean Paul Larrat and Department Chair Kerry LaPlante. His first task was to start building a team to staff the pharmacy, not an easy task given the workload all health professionals are facing during the pandemic. He turned to Brett Feret, director of experiential education for the College.

“I reached out to Brett and told him I need you to bang on the drum because I don’t think many medical people are not already working,” Brothers said. “If students want to be involved, if faculty members want to be involved, I’d appreciate if they could help. We put out an APB to the state, and I had pharmacists step up from almost every hospital, as well as URI faculty members. URI students volunteered to serve as pharmacy techs. All these leaders stepped up and were willing, asking what we need.”

URI Pharmacy professors Margeret Charpentier, Britny Rogala, Kristina Ward, Michael Simeone and Jane Pawasauskus joined pharmacy students Joe Honig, Hannah Feratta and Morgan Chatterly, along with several URI graduates, in answering the call to serve. Faculty members are serving as full-service pharmacists, while students serve as pharmacy techs. They help fill orders and deliver medications to the “hot zones” in the massive field hospital Brothers describes as similar to big box superstore stripped of its aisles and merchandise. It is a large, empty space in which he was asked to build a pharmacy from scratch.

“The footprint of the building is football fields wide. I’m getting my steps in, I’ll tell you that,” he said. “It is a fully outfitted building, with a ventilation system and supplemental oxygen throughout the facility.”

The hospital went live Monday, Nov. 30, admitting COVID-19-positive patients. The number is expected to grow as coronavirus infections in Rhode Island are spiking ahead of an anticipated vaccine sometime in 2021. The hospital is designed to handle about 350 patients, divided into three pods each capable of serving more than 100.

The single pharmacy serves all three pods. In addition, part of one pod is reserved for nursing home residents who have tested positive for the virus and are experiencing mild to moderate symptoms. As many as 24 residents a day are transported to the facility to receive injections of monoclonal antibodies, proteins that mimic the immune system’s ability to fight harmful pathogens. The patients are observed in the field hospital for two hours to ensure they do not suffer serious side effects, before being transported back to their residences.

“We describe Pod B as an outpatient infusion unit because that’s pretty much how we’re running it,” Brothers said. “We’re essentially trying to run two pharmacies at once — a hospital setting and an outpatient facility. But each infusion is literally saving a life, so it’s up to us to determine the logisitics and get it done.”

Despite several logistical problems, which can be expected when building a pharmacy from the ground-up, Brothers and his team were ready, thanks largely to the pharmacy professionals of all backgrounds who have stepped up to help, from students just entering their pharmaceutical rotations to pharmacists who have been working for 30-plus years.

“I’m pulling from all these professionals and their experience, and we’re making it happen in a safe way,” Brothers said. “It’s helping me get through the lack of sleep, and the stress, and the responsibility to have these brave pharmacy leaders to support the effort. It’s just awesome. We all realize the community is relying on us. We can’t fail. It’s that simple.”

Even the students, who one might expect would feel overwhelmed working in the field for the first time under such circumstances, hit the ground running, ready to jump into the fray.

“I expected them to come in being concerned about being exposed or to be overwhelmed by the work, but they literally rolled up their sleeves and asked ‘What do you need me to do? I’m ready,’” Brothers said. “Eager is the right word. Eager to learn. Eager to see leadership in action. Eager to help out. It’s one thing to hear how to be a pharmacist, and learning all the drug information in the classroom. But to see the communication, the leadership, the way things actually work is an invaluable tool for them and their professional development.”

Brothers’ primary role has been to get the field hospital off the ground, train the professional and support staff and oversee the operations, in addition to working shifts in the pharmacy himself. He huddles each morning with department heads from the field hospital, Department of Health officials, the National Guard and the governor’s office to get the rundown for the day, and discuss any issues that have cropped up and find prompt solutions for them.

“What’s really amazing is we discuss really serious issues of patient safety and logistics, and then the conversation turns to, hey the Dumpster in back needs to be emptied, or the parking lot needs to be salted,” Brothers said. “You don’t think about those things but they need to be taken care of. The amount of cooperation is amazing. I wish my life worked this way — you get everybody in your life together every day and say, ‘OK, what’s the problem; let’s fix it.’ And the next day it’s fixed. We literally have every resource at our fingertips.”

Care New England is expected to keep operating the field hospital until enough people have been vaccinated and when scientists are confident there won’t be another significant bump in infections. The good news, Brothers said, is he was asked to submit the number of workers in the pharmacy for the vaccine list, a sign the vaccine is coming soon. But until then, he is still trying to ensure he has the staff to handle the surge.

“Right now, I can breathe because I have enough staff, but not if we get 350 patients,” Brothers said. “If we’re operating at full capacity, I can’t staff the pharmacy with one pharmacist and one pharmacy tech; I’m probably going to have to triple up. So I likely will need more staff.”

Anyone interested in a position at the field hospital can email Brothers at tbrothers@uri.edu. He is quick to throw all credit to those pharmacists, students and professors who have stepped up to help in such trying circumstances. That willingness is par for the course for health professionals who have dedicated their lives to saving others, he said.

“I’m the lead on this, but this is about all the people who are stepping up and helping,” Brothers said. “I had this opportunity because of circumstances and people I knew working at Kent. But I know if it wasn’t me, any other faculty member in the same position would have stepped up and done the same thing. We’re not any saviors. We’re not heroes. This is just what we do. Is this a whole other level of what we do? Yes. But this is what our training has prepared us to do.”

While those on the front lines certainly feel the stress and devastation of the pandemic, their training has also taught them how to deal with such difficulties, and how to keep things in perspective.

“One thing critical care has taught me in 20 years is that life is short,” Brothers said. “No matter what is going on in our lives, this has taught me life is precious. The gift of knowledge to care for our most vulnerable is why we get out of bed in the morning.”