Antiviral Remdesivir will receive Emergency Use Authorization; Fauci says it's the New Standard of Care
"A hopeful result, if still not an anti-COVID-19 silver bullet," concludes Reason magazine after quoting this article from STAT <click here to go to statnews.com>. While we should be happy hospitals have a new antiviral in their toolkits, remdesivir in its current form is only for hospital use. That's a problem.
According to Massachusetts General Hospital’s Advances in Motion newsletter:
Several groups have measured respiratory SARS-CoV-2 RNA throughout the course of COVID-19. The viral load seems to peak during the asymptomatic phase or the phase of nonspecific symptoms, then decrease in the proinflammatory phase when acute respiratory distress syndrome (ARDS) can develop. There appears to be a correlation with higher peaks and worse clinical outcomes.
Drugs with antiviral activity interfere with a virus’ ability to replicate and spread. Assuming the description of the arc of the disease above is correct, it makes sense to start such a drug in the early stages of COVID-19, well before symptoms create a life threatening crisis. Dr. Josh Farkas of University of Vermont writes:
In prior animal studies of remdesivir, investigators felt that early administration of remdesivir would be critical to the drug’s efficacy. Thus, remdesivir was used either prophylactically or within 12-24 hours of virus inoculation.
Of course, in real-world clinical practice, remdesivir was given at a far later timepoint:
- There is a time delay between infection and the development of symptoms (the incubation period).
- There is a subsequent delay between the development of symptoms and presentation to the hospital (a median of ten days in this study).
This leaves open the possibility that earlier administration of remdesivir could be more effective. [ref. https://emcrit.org/pulmcrit/wang-remdesivir]
The authorization is a good thing; we want our hospitals to have an effective antiviral to put in patients' IV drips. But without a pill form or a more convenient injection protocol, remdesivir is likely to remain of limited utility in the battle against COVID-19 unless we start hospitalizing people at an earlier point in the disease (not something this writer is yet prepared to advocate). There is the possibility of community clinics, urgent cares, and walk-in centers administering IV drips, but we would have to make sure the personel staffing those facilities are adequately trained, equipped, and protected.
A consequence of remdesivir becoming hospital standard-of-care is that the various anti-inflammatory medications being studied as treatments for COVID-19 symptoms will be administered and studied in combination with remdesivir, which makes sense. Beyond that there is very little in previous articles I've written that is made obsolete by this announcement, including that we still desperately need an antiviral medication in pill form.
Readers can expect my next article to be about medicines one can take at home as an outpatient upon testing positive for COVID-19.