MONTGOMERY, Ala. (WSFA) - States across the country are fighting for their fair share of the drug Remdesivir, an antiviral medication recently approved by the FDA to fight COVID-19.
The Alabama Department of Public Health received a small allotment of the drug Tuesday, which was promptly shipped overnight to hospitals across the state. The facilities selected to receive Remdesivir and the specific number of doses is unclear.
“Because the quantity is limited, the physician members of the Governor’s Coronavirus (COVID-19) Task Force determined a formula to distribute the allotment equitably among the state’s hospitals," stated Alabama Public Health Officer Dr. Scott Harris.
Remdesivir is seen by some as a life-saving measure for the thousands who are fighting the virus in hospitals across the country.
Despite the high demand, only 607,000 doses are available in the United States to treat the sickest patients, which were donated by the drug's manufacturer, Gilead. The Department of Health and Human Services, or HHS, is distributing those limited doses and came under sharp criticism for the lack of transparency regarding which hospitals received the first shipments of Remdesivir.
“The drug is reserved for people who are hospitalized and who have more than just mild illness, they’re people that have oxygen requirements or they’re on ventilators or other interventions,” Harris said.
Determining who will qualify for the small allotment of doses could pose a significant challenge.
“Certainly we are very concerned about where that is going to go and we’re having conversations about how many patients are out there and where they are located,” Dr. Don Williamson, M.D., Executive Director of the Alabama Hospital Association told WSFA on Monday.
UAB is one of dozens of sites participating in a government-funded Remdesivir study, which showed encouraging signs so quickly during phase one of the trial, some of those who received the placebo in many cases were unblinded and given the drug. This phase elevated Remdesivir as the standard of care for COVID-19.
Dr. Nathanial Erdmann, one of the principal investigators in the Remdesivir study at UAB says the initial trial unfolded at a rapid pace.
“It looks like people leave the hospital sooner,” Erdmann said describing the benefits of Remdesivir. “I would expect, although we haven’t seen this data confirmed yet, that it looks like it should improve mortality as compared to control.”
In terms of clinical experience, Erdmann says patients who are critically ill with advanced respiratory failure are not typically the best candidates for this antiviral, which doesn't treat respiratory disease.
“The ideal patient is one that clearly is progressing towards severe illness, but yet is relatively early in their presentation,” he explained. “Meaning they’re likely just entering the healthcare system, they had a rapid respiratory decompensation and those are the people that would likely benefit the most as best we can tell.”
Erdmann says UAB continuously analyzes its patients and dispenses Remdesivir to those who seem to best-qualify based on what they've seen during the study versus waiting for patients with very specific characteristics to be admitted.
“The amount of drug that’s available versus the number of potential patients is highly, highly mismatched and so how to figure out how to deal with this is going to be a process,” he explained. “And as much as it’s frustrating. I do think it’s worth emphasizing the fact that this is happening extraordinarily quickly, so trying to have some patience is really important. But if it’s you or your loved one who’s sitting in a hospital and getting worse, that is not a whole lot of comfort to hear that it’s a process and we’re working on it.”
Montgomery hospitals are experiencing a surge in patients. Tuesday, Baptist Health reported 70 patients with COVID-19 are being treated at their three local facilities. Jackson Hospital reports 44 patients are waiting for test results.
Baptist Health confirms it's completed the paperwork to receive doses of Remdesivir, but it's unclear whether it will be selected. Jackson Hospital's spokesperson says the method of determining treatments for patients would not change with regard to how they would narrow down which patients would receive Remdesivir if they receive an allocation.
Determining which patients receive Remdesivir is a both a medical and ethical question, according to Harris. Specifically, should this treatment be used on those who have advanced illness who may not recover or for those who are more likely to overcome COVID-19? HHS held a conference call Saturday with state health officers and a group of medical ethicists who are developing guidance on how to use the drug.
“We are very interested to see what they have,” Harris said.