Nevada hospitals have received thousands of vials of the only drug with proven effects against COVID-19, enough to treat up to 216 people.
Remdesivir, a previously little-known antiviral medication, attracted nationwide attention in late April when the National Institute of Allergy and Infectious Diseases (NIAID) announced that the medication shortened the recovery time for patients hospitalized with advanced stages of COVID-19. Director Anthony Fauci compared the results of the randomized controlled trial to the discovery of the first drug to help patients with HIV.
He later warned that the drug had modest effects — shortening recovery time to a median 11 days for patients who took the drug, versus 15 days for those who took the placebo.
The U.S. Food and Drug Administration (FDA) issued an emergency use authorization May 1 for COVID-19 patients with severe symptoms including low blood oxygen levels and those who needed more intensive breathing support like a mechanical ventilator.
Nevada has since received part of a shipment distributed by the U.S. Department of Health and Human Services through a donation from Gilead Sciences, the manufacturer of the experimental drug.
Since May 12, the state has received three shipments of the drug for a total of 48 cases, each case containing 40 vials of the drug. Nevada expects 50 more cases through the month of June which will be distributed to hospitals based on the percentage of ICU beds located in the hospital compared to the total of ICU beds in Nevada, according to the Nevada Department of Health and Human Services.
Doses of the drug have been distributed to 25 hospitals in Nevada so far, according to data provided by The Nevada State Board of Pharmacy which collaborated with the Nevada Division of Public and Behavioral Health, the Nevada Hospital Association, and Nevada Rural Hospital Partners to coordinate the hospital allocation plan.
In Northern Nevada four hospitals received the drug, including the Carson Tahoe Regional Medical Center, the Northern Nevada Medical Center, Saint Mary’s Regional Medical Center and the Renown Regional Medical Center in Reno, which received the largest share in the region at 248 vials.
In Southern Nevada 18 hospitals received a total of 1,872 vials. Sunrise Hospital & Medical Center got the most, at 282 vials.
Rural Nevada got the least with Banner Churchill Community Hospital, Carson Valley Medical Center, and Northeastern Nevada Regional Hospital each receiving six vials of remdesivir.
Under the emergency use authorization issued by the FDA Covid-19 patients requiring mechanical ventilation may be treated with an 11-vial regimen while Covid-19 patients not requiring mechanical ventilation may be treated with a six-vial regimen. But ultimately, doctors determine how to administer the drug and which patients qualify for treatment, said David Wuest, executive secretary of the Nevada State Board of Pharmacy in an email.
Remdesivir is the only antiviral medicine shown to slow down the life cycle of the virus itself, making the drug especially desirable as hospitals respond to severe cases of COVID-19.
Angie Honsberg, division chief for The UNLV School of Medicine Pulmonary and Critical Care Medicine and the Medical ICU director at University Medical Center (UMC), said the hospital has treated five to six patients using the drug.
The hospital has received 225 vials of remdesivir from the Nevada State Board of Pharmacy.
Honsberg said UMC has used the drug on patients who were “reasonably healthy” before contracting COVID-19 but deteriorated quickly, exhibiting low blood oxygen levels and evidence of severe pneumonia in both sides of the lung with a high risk of getting worse.
Initially, limited doses of the drug were offered to patients by Gilead through compassionate use requests early on in the crisis. Honsberg said UMC was able to obtain enough remdesivir to treat three patients earlier in the pandemic.
One patient during those early treatments showed signs of improvement after receiving a dose of the drug along with antibodies and other medication shown to keep the immune system from attacking itself in other diseases, said Honsberg, leading to expanded use of the drug by UMC.
Based on the small number of patients, however, Honsberg said it’s difficult to draw conclusions on the drug’s effectiveness from initial observations.
“It’s not completely clear if the medication really helps save lives,” Honsberg said. “Meaning does it keep someone with severe COVID-19 from dying?”
As a doctor in training when HIV first appeared in the U.S., Honseberg said she never imagined the rise of another disease with no known treatment leaving hospitals ill equipped to treat the huge influx of patients.
“We are all hoping for that drug that very clearly keeps people from dying or having such severe disease. We’re hoping that remdesivir shortening the length of time helps, but the study (that) approval of the drug was based off did not completely support that it decreased the chance of someone dying.”
Honsberg noted that remdesivir was not a “miracle drug” and that people should continue to wear face masks, wash their hands and practice social distancing.
“It’s really important for everyone to understand that remdesinvir is not a cure for COVID-19 based on what we’ve seen so far,” Honsberg said. “It’s a really important take home message.”
Outside the HHS shipments, remdesivir is only available through clinical trials — which NIAID largely halted after initial results showed the drug benefited patients — or by applying to Gilead through its expanded access program.
The HHS supply of the drug will run out at the end of June, CNN reported Monday.
Other medications, including hydroxychloroquine, the anti-malarial drug repeatedly touted by President Donald Trump, have shown lackluster results during in-patient trials. Hydroxychloroquine, especially, can cause significant heart problems while having little effect on the virus, according to health experts citing a study published in the Journal of the American Medical Association.
In an Emergency Use Authorization fact sheet provided to hospitals, the U.S. Food and Drug Administration lists various possible side effects for remdesivir but notes that the experimental drug “is still being studied so it is possible that all of the risks are not known at this time.”
“Given there are no adequate, approved, or available alternative treatments, the known and potential benefits to treat this serious or life-threatening virus currently outweigh the known and potential risks of the drug’s use,” wrote the administration in a release.
UMC and other hospitals are closely monitoring patients being treated with remdesivir as directed under the FDA’s emergency use authorization, said Honsberg, adding that she has not seen any adverse outcomes that could be connected to the drug under her care.
“Unfortunately for COVID-19 we don’t really have other great available treatments,” Honsberg. “We definitely don’t have medications or interventions that will clearly help someone.”