Studies have shown that the drug remdesivir can help treat novel coronavirus patients, but there isn't enough of the drug for all the patients who are eligible, leaving clinicians to decide who should get the drug without much direction, according to STAT News.
There is little data showing which COVID-19 patients are most likely to benefit from remdesivir, making decisions on how to use the limited resource in an ethical manner a challenge.
On April 29, the National Institute of Allergy and Infectious Diseases put out a press release saying that novel coronavirus patients receiving remdesivir recovered quicker than those who'd received a placebo. Soon after, the FDA issued an emergency authorization for the drug, allowing clinicians to begin using it to treat COVID-19.
The federal government has plans to distribute 607,000 vials, which would be enough to treat around 78,000 people, donated by Gilead Sciences over the next six weeks. But the allocation of the drug has been heavily criticized, as some of the hardest-hit hospitals in the country are not going to receive the drug, STAT reports. State health agencies will coordinate the distribution of the drug.
The paucity of the drug and related data showing which patients are most likely to benefit from it is leaving clinicians in a bind, and eligibility criteria for the drug from the government is not helpful, Erin Fox, PharmD, director of drug information and support services at the University of Utah Medical Center in Salt Lake City, told STAT.
For example, the government's guidance says COVID-19 patients with severe enough disease that their blood oxygen saturation level is down to 94 percent are eligible for the drug.
"This could be somebody who is mildly short of breath and is uncomfortable and who might be more comfortable on a wee bit of oxygenation — some people don't even detect that their oxygenation is low at 94 percent," Rochelle Walensky, MD, chief of infectious diseases at Boston-based Massachusetts General Hospital, told STAT. But it could also be somebody struggling to breathe and in a life-threatening condition, she said.
For now, at Massachusetts General Hospital, clinicians are considering basing allocation on how long the patient has been hospitalized, that is, using the drug on patients sick enough to be hospitalized, but not those who haven't been sick for too long.
"At some point, there's going to be a lottery because there are going to be too many patients for the drug," Dr. Walensky told STAT.
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