How a Rural Alabama Pharmacy Became a Frontline in the Fight Against COVID

The latest COVID surge has put a strain on many businesses, including Section Pharmacy, which serves patients in Jackson and DeKalb counties in the hills of northeastern Alabama.

COVID has forced staff members to self-quarantine. But instead of closing, pharmacist and owner Monica Payne extended her hours and services. She converted a room in the pharmacy into a four-bed infusion center that opens as early as 6:30 a.m. to serve COVID-positive patients before opening its doors to the public.

Sometimes the pharmacy stays open at night to accommodate patients’ schedules.

“There were a lot of nights with my parents taking care of my kids so we could be here taking care of the patients,” Payne said.

The nurses and staff of the Pharmacy Section administered at least 150 monoclonal antibody treatments. Payne said the infusion center was particularly busy during the week between Christmas and New Year’s Day.

Keith Mueller, professor of health management at the University of Iowa, has studied rural pharmacies and health care systems for years. His research for the Center for Rural Health Policy Analysis found higher COVID death rates for rural residents, who often have less access to treatment for the virus.

“We looked at why death rates are higher in non-metro areas than in metropolitan areas,” Mueller said. “We don’t know for sure because it’s hard to tell from the databases we have. The availability of monoclonals is one of the things I put on my list because it requires different levels of ability. It’s not as available in rural areas as it is in urban areas, so I’m glad to hear of a pharmacy offering this.

Rural pharmacies have played a pivotal role in the fight against COVID, but it has happened against a backdrop of instability, Mueller said. Research by Mueller and other investigators found that 1,230 independent rural pharmacies have disappeared since 2003. In an effort to help strengthen their role, his organization has identified thousands of rural pharmacies that could help distribute vaccines outside of the large chain initially operated as federal partners.

They found that 30 rural ZIP codes in Alabama lost independent pharmacies between 2003 and 2018. This poses a problem for rural areas that often struggle to retain hospitals and health care providers.

Pharmacists are a key part of the healthcare system. Patients depend on them to manage prescriptions and offer advice on over-the-counter treatments. Sometimes they also help nearby nursing homes and medication management, Mueller said.

Payne said patients trust his expertise, which makes it easier to answer questions about COVID-19 vaccinations.

“If we sit down and look at their track record and say that’s what the studies show, they’ll follow our recommendation,” Payne said.

Section Pharmacy opened nearly 31 years ago in a small town atop Sand Mountain with a population of less than 800 people. Payne said the business has thrived for decades providing care to the community.

“I know everybody and everybody knows me,” Payne said. “They all have my cell phone number, and they all have my other pharmacist’s cell phone number and I guess that’s more than just a job for us. We are here to take care of the community.

Mueller said many independent rural pharmacies struggled after the Medicare Modernization Act passed in 2003. That act changed the way beneficiaries paid for prescriptions, diverting some profits from pharmacies. The change helped many people covered by Medicare, but hurt small pharmacies that couldn’t adapt as quickly as big chains, Mueller said.

Pharmacy closures have been particularly painful in the Midwest and West, where rural areas often have very few residents who live several miles from major cities. The situation is not as dire in rural Alabama.

Payne started working at Section Pharmacy when she was 17 and quickly transitioned from sweeping floors to cash register and counting pills. What started as a part-time job slowly turned into something else.

“I worked here for six months and I thought, ‘Who would want to do this all their life?’ and I cried every day,” Payne said. “But it turned out that I wanted to do this for the rest of my life.”

The pandemic demanded additional sacrifices. In March 2020, during the first stay-at-home order, Payne and her husband, an ER nurse, sent their children to stay with their grandparents and did not see them for 12 weeks. Keeping her family safe has proven to be more stressful than the extra hours and duties demanded by work during the pandemic.

Payne remains hopeful that vaccines will make the virus more manageable in the future. Every week, she places an order for monoclonal antibodies. Sometimes she gets them and other times she doesn’t. Payne said she never planned to work during a pandemic, but will continue to do what she can to serve her community.

“These are my people and I’m going to take care of them,” Payne said. “That’s why I’m here.”

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