WHO
Landing Page
Q & A 

Government of Saskatchewan (including Ministry of Health)
Drug Plan

Health Care Professional Landing Page 

  • General info
  • Testing, screening, medical directives
  • Infection prevention and control
  • PPE
  • Blood services
  • Facility signage

General Public Landing Page 

  • Self-assessment tool
  • Testing information
  • Public Health measures

Government of Canada (Including Health Canada)
Landing Page   

  • Canadian statistics
  • Prevention and risk
  • Symptoms and treatment
  • Being prepared
  • Travel advice
  • Self-assessment tool

Saskatchewan College of Pharmacy Professionals
Landing Page  

  • Regulatory notices (e.g. Exemption to Section 56)
  • Days supply limits
  • Pharmacies compounding hand sanitizer

Canadian Pharmacists Association 

Non-Insured Health Benefits (NIHB)

As with all other treatment options, there is not enough evidence to support the use of either hydroxychloroquine or azithromycin, alone or in combination, for the treatment of COVID-19. Colleagues at Tools for Practice have nicely summarized:

"One nonrandomized study found that more hydroxychloroquine/azithromycin patients tested negative for virus at days 3 and 6 but clinical outcomes were not reported. One unblinded randomized trial showed no effect from hydroxychloroquine on viral or clinical outcomes. Without further evidence, hydroxychloroquine is not appropriate for patients with COVID-19 in primary care."

A joint statement from several Saskatchewan healthcare regulatory bodies has been published reminding practitioners of the lack of evidence and potential for further drug shortage exacerbation if these drugs are used for COVID-19.

No. There is no evidence that any supplements or natural health products are effective at preventing or treating symptoms of COVID-19.1 This includes, but is not limited to zinc, essential oils, colloidal silver, plant-based elixirs and formulas, Chaga mushroom blends, ultraviolet lamps, and oregano oil. In fact, the Government of Canada is warning Canadians against taking such products with false or misleading claims. 

Your best prevention measures are to reduce risk of transmission (spreading) and to practice healthy behaviours.

Ways to reduce risk of transmission:

  • Wash your hands often with soap and water; if soap and water are not available, use an alcohol-based hand sanitizer;
  • Practice physical distancing including avoiding unnecessary outings from your house;  
  • Practise proper cough and sneezing etiquette (into the bend of your elbow);
  • Avoid touching your eyes, nose and mouth with unwashed hands;
  • Maintain safe food practices; and
  • Avoid close contact with people who are sick.

Some healthy behaviours:

  • Try to choose nutritious foods. Not sure what that looks like? Eat Well Saskatchewan is a great resource for Saskatchewan residents. 
  • Be active. Adults should try to be active for at least 150 minutes per week. Kids need more!
    • Look online for activities/workouts that interest you that can be done at home. 
    • Go for a walk, run, rollerblade, bike ride, etc. by yourself or with members of your household.
  • Pay attention to your mental health and use resources to help you cope.
  • Keep physical distance but stay in touch virtually with your friends and family.

 

1. Examine.com. Coronavirus disease 2019 (COVID-19).©2011-2020. [updated 27 Mar 2020; cited 27 Mar 2020]. Available at www.examine.com

 

A study published in the NEJM looked at the viability of SARS-CoV-2 on various surfaces.  It is important to note that this study was done in a laboratory environment, and "real-life" results may vary.  The virus was detectable on plastics and stainless steel up to up to 72 hours after application, and up to 24 hours on cardboard.  It's also important to note that the amount of virus on these surfaces decreased signficantly over the time studied, and risk of transmission could also be expected to decrease.  The study also looked at viability on copper, and also viability when the virus was aerosolized into the air. 

For those concerned with food transmission:
There is currently no evidence that food is a likely source or route of transmission of COVID-19. 

The CFIA recommends that all Canadians continue to follow good hygiene practices during food handling and preparation, such as washing hands, cooking meat thoroughly and avoiding potential cross-contamination between cooked and uncooked foods.

At the moment, there is no specific information about how patients who are immunocompromised are affected by COVID-19. In general, these patients are at higher risk than the general population of contracting COVID-19 and at higher risk of more serious complications if infected by COVID-19.

The benefit provided by and the risk of infection from the immunosuppressant varies from patient to patient. Variables that contribute to the benefit and risk include:

  • the immunosuppressant agent itself and the dose (immunosuppressants affect the immune system in different ways)
  • the severity of the condition being treated
  • other conditions that may increase a patient’s risk of infection

For the most part, patients should continue their immunosuppressive therapies unless otherwise discussed with the prescriber.

Patients should follow the practices recommended by public health agencies to reduce risk of infections:

  • Wash hands often with soap and water; if soap and water are not available, use an alcohol-based hand sanitizer;
  • Avoid touching eyes, nose and mouth with unwashed hands;
  • Maintain safe food practices;
  • Practice physical distancing

Should a patient become infected with COVID-19, the immunosuppressant may need to be temporarily stopped; however, this decision needs to be made in conjunction with the prescriber taking into account the variables discussed above. 


Some resources:

Crohn’s and Colitis Canada – COVID-19 and IBD -  Mar 18 
British Society for Rheumatology – COVID-19 – update for members - March 22 
European League Against Rheumatism – Guidance for Patients COVID-19 Outbreak  - Mar 17 

This is an active area of research but at the moment we don’t have evidence to support the use of any medications for treatment of COVID-19. Currently available antivirals are not effective. Several medications have been flagged as showing promise (usually by in vitro studies) but are considered investigational and should only be used in approved randomized controlled trials:

  • chloroquine/hydroxychloroquine - see CPhA's statement for more information.
  • lopinavir/ritonavir*
  • remdesivir (available only through the Special Access Programme)
  • colchicine^ 

The mainstay of treatment remains symptomatic and supportive care.

Note: In an effort to reduce inappropriate use and the possibility of shortages of chloroquine, hydroxychloroquine and lopinavir/ritonavir, the Saskatchewan Drug Plan has instituted interim EDS criteria

*A small randomized controlled study has been published that found no benefit of lopinavir/ritonavir (Kaletra®) for treatment of hospitalized patients with severe symptoms of COVID-19.

^The National Post and other news agencies have reported that Canadian researchers, led by Dr. Jean-Claude Tardif of the Université de Montréal, have launched a randomized, placebo-controlled trial to evaluate the effects of colchicine on the outcome of COVID-19 in people 40 years and older who test positive for COVID-19 and are not hospitalized.  The National Post reports people (presumably those who may be eligible for the study) can call 1-877-536-6837.

Currently, people being tested are those with symptoms (fever, cough, shortness of breath or difficulty breathing) and who, in the past 14 days, have travelled outside of Canada or have had contact with someone diagnosed as having COVID-19. NOTE: these criteria are subject to change as the situation in SK evolves.

A self-assessment tool is available.

If you fit the criteria of potential exposure, are exhibiting mild symptoms and suspect you may have COVID-19, you can obtain a referral to a community testing centre by phoning:

  • HealthLine 811.
  • Your local Public Health Communicable Disease Control office.
  • Your family physician.

Testing Centres

Testing centres have been set up across the province. They are for referrals only and not for walk-in testing. The testing centres will only provide testing. They are not for patient care. If you are not exhibiting symptoms, you do not need to be tested.  

To ensure a continued supply of prescription medications, the Ministry of Health has issued a directive that Saskatchewan pharmacists must limit the number and quantity of prescription drugs dispensed.

Effective immediately, Saskatchewan pharmacists may only provide:

A ONE MONTH supply (to a maximum of a 35 day supply) in a 28 day period for all drugs not on the Maintenance Drug Schedule;

A TWO MONTH supply in a 55 day period for drugs on the Two Month Drug List;

A 100 Day supply in a 95 day period for drugs on the 100 Day List.

This restriction applies to all prescriptions regardless whether the patient pays cash or has a private or public Drug Plan that pays for the prescription. The Ministry will be contacting private payers to notify them of this requirement.

Source: Deputy Minister of Health Letter to Saskatchewan Pharmacists

There is no good evidence at this time to suggest that NSAIDs are causal in worsening COVID symptoms. The idea originated in France from the health minister suggesting that there were grave adverse effects with taking NSAIDs. His comments seem to have stemmed in part from remarks attributed to an infectious diseases doctor in south west France. She was reported to have cited four cases of young patients with covid-19 and no underlying health problems who went on to develop serious symptoms after using non-steroidal anti-inflammatory drugs (NSAIDs) in the early stage of their symptoms.

Recommendations:

  1. Using a medication to reduce fever does not improve or shorten the duration of fever. These agents provide comfort; fever rarely needs to be treated.
  2. If it is decided to treat fever, until further information is available, preferentially use acetaminophen (Tylenol®) if possible.
  3. For those already using non-steroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation who develop COVID, weigh the risk versus benefit. The risk of NSAIDs worsening COVID is unproven at this time and based on observation of very few patients; research is actively taking place. NSAIDs do not provide pain relief in everyone and it may be reasonable to discontinue the NSAID (in consultation with doctor or nurse practitioner if it has been prescribed) to determine if it has been helping and/or if other modalities such as massage and exercises can provide similar benefit.

Some resources:

Mar 20 – Health Canada - No scientific evidence that ibuprofen worsens COVID-19 symptoms
Mar 18 – Therapeutics Initiative - Acetaminophen vs. NSAIDs during Covid-19 pandemic 
Mar 17  - Canadian Pharmacists Association - Use of NSAIDs in patients with COVID-19: what is the evidence?

Angiotensin converting enzyme inhibitors (ACEIs) such as ramipril (Altace), perindopril (Coversyl) and trandolapril (Mavik) as well as angiotensin receptor blockers (ARBs) such as candesartan (Atacand), losartan (Cozaar) and valsartan (Diovan) are agents commonly used in patients with high blood pressure, heart failure, diabetes, and other conditions. 

Concerns have been raised on social media that those taking ACEIs or ARBs may be at increased risk of infection and increased risk of more serious complications from COVID-19 compared to the general population. This idea is based on principles of how the medications work and preliminary information about changes that may take place during COVID-19 infection. (See below for more details.)

There is no evidence that those taking ACEIs or ARBs are at any increased risk from COVID-19 and these medications should be continued.

Several agencies and organizations have published statements including:

Hypertension Canada’s Statement on: Hypertension, ACE-Inhibitors and Angiotensin Receptor Blockers and COVID-19. 13 Mar 2020 
HFSA/ACC/AHA Statement Addresses Concerns Re: Using RAAS Antagonists in COVID-19. 17 Mar 2020
International Society of Hypertension. A statement from the International Society of Hypertension on COVID-19.
European Society of Cardiology Council on Hypertension. Position statement of the ESC Council on Hypertension on ACE-inhibitors and angiotensin receptor blockers. 13 Mar 2020
 

More detail about the proposed mechanism:

The Council on Hypertension of the European Society of Cardiology states that “Based on initial reports from China, and subsequent evidence that arterial hypertension may be associated with increased risk of mortality in hospitalized COVID-19 infected subjects, hypotheses have been put forward to suggest potential adverse effects of angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs). It has been suggested, especially on social media sites, that these commonly used drugs may increase both the risk of infection and the severity of SARS-CoV2 (the virus that causes COVID-19). The concern arises from the observation that, similar to the coronavirus causing SARS, the COVID-19 virus binds to a specific enzyme called ACE2 to infect cells, and ACE2 levels are increased following treatment with ACEIs and ARBs. This speculation about the safety of ACEI or ARB treatment in relation to COVID-19 does not have a sound scientific basis or evidence to support it. Indeed, there is evidence from studies in animals suggesting that these medications might be rather protective against serious lung complications in patients with COVID-19 infection, but to date there is no data in humans.”

Reference:

1. European Society of Cardiology Council on Hypertension. Position statement of the ESC Council on Hypertension on ACE-inhibitors and angiotensin receptor blockers. [13 March 2020; cited 19 Mar 2020] https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-council-on-hypertension-on-ace-inhibitors-and-ang