There are two problems that I have with all of the studies using remdesivir for treatment of COVID-19: it's an antiviral and it's only given IV.
As a respiratory virus, people with early COVID-19 will generally have a mild course identical to other respiratory viruses, and that, by the time they get sick and require hospitalization, the virus is less the problem than the patients' own immune systems. So, it wouldn't make sense that remdesivir would make a lick of difference for these patients if you start it only when hospitalization becomes necessary.
Which leads me to the second problem: it's only given IV. Therefore, in the population of patients where this would be expected to work (i.e., very early on, before the viral load peaks), they are not included because they are not going to get IV medications if they're not sick enough to be in the hospital in the first place. Indeed, as Mike and Sanjay point out in the commentary for this article, it's much more likely that any patient treated at this very early point in the infection would be subject to way more harms than benefits.
Nevertheless, there is a good chance that it might "work" in this population if there was a study that looked at administering IV medication in a very not-sick population given that the animal studies which proved efficacy of this medication a few years back (I think for Ebola?) started this therapy in the subjects on day 0 or 1 following inoculation.
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Evan C. - December 13, 2020 2:16 PM
There are two problems that I have with all of the studies using remdesivir for treatment of COVID-19: it's an antiviral and it's only given IV.
As a respiratory virus, people with early COVID-19 will generally have a mild course identical to other respiratory viruses, and that, by the time they get sick and require hospitalization, the virus is less the problem than the patients' own immune systems. So, it wouldn't make sense that remdesivir would make a lick of difference for these patients if you start it only when hospitalization becomes necessary.
Which leads me to the second problem: it's only given IV. Therefore, in the population of patients where this would be expected to work (i.e., very early on, before the viral load peaks), they are not included because they are not going to get IV medications if they're not sick enough to be in the hospital in the first place. Indeed, as Mike and Sanjay point out in the commentary for this article, it's much more likely that any patient treated at this very early point in the infection would be subject to way more harms than benefits.
Nevertheless, there is a good chance that it might "work" in this population if there was a study that looked at administering IV medication in a very not-sick population given that the animal studies which proved efficacy of this medication a few years back (I think for Ebola?) started this therapy in the subjects on day 0 or 1 following inoculation.