The coronavirus disease 2019 (COVID-19) pandemic required pharmacists to respond rapidly and appropriately to various challenges, particularly regarding therapeutic drug management. This review describes the efforts of pharmacists at Tokyo Women's Medical University Hospital from the early stages of the pandemic and discusses current recommended therapeutic drugs. Initially, pharmacists played crucial roles in securing therapeutic drugs, evaluating off-label use of medications, managing disinfectants, and providing pharmaceutical care in COVID-19 dedicated wards. They also addressed COVID-19-associated pulmonary aspergillosis (CAPA) through antifungal stewardship initiatives, which showed improved compliance with treatment protocols over time. Currently approved therapeutic options include antiviral drugs such as remdesivir, nirmatrelvir/ritonavir, molnupiravir, and ensitrelvir fumarate, as well as immunomodulators like glucocorticoids, baricitinib, and tocilizumab. While the number of new COVID-19 cases has decreased, the experience gained during the pandemic highlights the importance of continuous professional development and preparedness among pharmacists. This review emphasizes the significant contributions of pharmacists in COVID-19 treatment and the need for sustained readiness in managing future infectious disease challenges.

In December 2019, the world's first coronavirus disease 2019 (COVID-19) case was reported, which subsequently resulted in a pandemic. In the early days, we witnessed a cluster occurred inside a cruise ship, the Diamond Princess, anchored at the port of Yokohama, and COVID-19 death cases. We experienced fear of its high infectivity and fatality rate even from the perspective of medical professionals.

The Tokyo Women's Medical University Hospital took countermeasures at early stage of the infection spread, and we have been diagnosing, treating, and nursing of patients with COVID-19 for approximately 5 years. Initially, the hospital staff had a strong fear and anxiety about COVID-19, which we have handled through careful discussions with the staff-in-charge. Furthermore, we were subjected to prejudice and false accusations from the public for dealing with the patients as healthcare professionals; however, we all had to perform our daily duties. Everyone cooperated to overcome the challenges across different positions because we had to treat one patient after another.

Looking back in the past five years, the Department of Infection Control has prepared an environment in which all hospital staff felt safe to perform their duties and aimed to respond to all the questions they had immediately by providing 24-h support in case the staff needed help. Nevertheless, we found out there were some important areas that were overlooked, in which each staff member took initiative using their expertise to aid in the intervention. Here, we elucidate our learnings in dealing with COVID-19 and our future challenges by summarizing our experience so far.

The patient was an 88-year-old woman who had been experiencing intermittent claudication of the right lower limb for several months. The right and left ankle brachial index (ABI) were 0.61 and, 1.12, respectively, with the right being predominantly decreased. Lower limb angiography revealed severe stenosis and calcification of the right common femoral artery (CFA). Exercise therapy was performed from about three weeks, however, the improvement was insufficient. To further improve the condition, after two weeks, cavitron ultrasonic surgical aspirator (CUSA) was used to remove the right common femoral carcification, and angioplasty with a bovine pericardial patch was performed to prevent restenosis. Postoperatively the ABI at rest normalized, and intermittent claudication did not occur. Postoperatively computed-tomography angiography showed that calcification of the right CFA had disappeared and stenosis had improved. There was no difference between the left and right ABI, and three-dimensional (3D) QFlow imaging showed a significant improvement in the popliteal artery blood flow to 12.65 mL/s. In Japan there have been no previous reports of angioplasty using a bovine pericardial patch after endarterectomy with CUSA. Here, we report a case in which improvement in blood flow was confirmed multilaterally using images and numerical values.