San Antonio Express-News: Experts alarmed at shortage of COVID drug

A "woefully inadequate" national supply of the drug remdesivir to treat novel coronavirus infected patients during the summer surge of cases in San Antonio left hospitals and doctors having to ration its use, an expert in infectious diseases said Tuesday.

Remdesivir has been found to shorten the time it takes a COVID-19 patient to recover from 15 to 11 days and halt the progression of the disease, keeping more patients out of the intensive care unit and off of ventilators to breathe, said Dr. Tom Patterson, chief of infectious diseases in the Long School of Medicine at UT Health San Antonio and a leading researcher of clinical trials of the drug.

But there isn't enough remdesivir to go around, hurting both patients and hospitals overloaded by the coronavirus, he said.

"We admitted 1,000 patients at University Hospital, and we had received enough remdesivir to treat less than one-third of them," Patterson said. "We had to restrict its use to those patients it would benefit the most, based on the criteria from the various studies. But we felt like all the admitted patients probably would have benefited."

Patterson said that outlying hospitals, especially those in rural areas, had even less access to the drug. Because of the number of the patients during the surge, hospitals in San Antonio weren't able to take in referral patients from outlying facilities, he said.

"We know those outcomes can be bad," he said. If patients can be given remdesivir, allowing them to be discharged from hospitals sooner, that reduces the strain on the overall system, he added.

Patterson spoke during a video news conference organized by U.S. Rep. Lloyd Doggett, D-San Antonio, during which he and others implored President Donald Trump to use existing laws to increase access to the medication.

Almost 40 hospitals in 12 states have experienced shortages of the drug, forcing physicians to choose who will get the potentially life-saving medicine and who won't, one study showed.

Patterson said that "we have to do everything possible in the global community" to increase the supply of remdesivir.

"Unfortunately, we don't have a lot of other antivirals that have had a (positive) effect," he said. "Other studies are ongoing, so maybe in the future we will. But right now, remdesivir is the only drug shown in placebo-controlled trials to be effective."

Only one maker

Remdesivir, an anti-viral drug developed a decade ago, has been used to fight hepatitis C. In May, the Food and Drug Administration granted an emergency use authorization for remdesivir to treat COVID-19. Recently, it expanded use of the drug to moderately ill COVID patients, not just those who are severely ill.

It costs $520 per vial, or more than $3,000 per intravenous treatment course, for those with private insurance. It's a bit less expensive for those on government-sponsored insurance.

In June, the Trump administration secure large supplies of the drug from its manufacturer, Gilead Sciences Inc. The U.S. Department of Health and Human Services and state health departments allocated 500,000 treatment courses of the drug to hospitals nationwide, based on "hospital burden."

In announcing the agreement with Gilead, HHS Secretary Alex Azar said: "President Trump has struck an amazing deal to ensure Americans have access to the first authorized therapeutic for COVID-19. To the extent possible, we want to ensure that any American patient who needs remdesivir can get it."

Shortly after, U.S. Sen. Marco Rubio, R-Fla., a frequent Trump defender, criticized the government's roll-out of the drug, blaming a "bad disconnect" on shortages at Florida hospitals. Doctors and hospitals across the U.S. made similar complaints.

Zain Rizvi, law and policy researcher at Public Citizen, a consumer advocacy organization, said that existing laws enable the federal government to open up the manufacture and distribution of remdesivir to other companies.

"One corporation supplying the entire country with remdesivir is creating a monopoly on this drug," he said during the news conference. "The government has the power to create additional suppliers. There are supplies in China, India and all over the world, but we're relying solely on Gilead."

"These are policy choices," he said."These shortages are not inevitable."

In May, Gilead said it was seeking other partners around the world to help manufacture the drug on a faster timetable.

Doggett, chairman of the House Ways and Means Health Subcommittee, said Trump "could increase the supply and lower prices, and we'd have a surplus. Instead, we have physicians being placed in the horrible position of deciding who gets the drug and who is abandoned."

Patterson said that while new COVID-19 cases have decreased recently in Bexar County, he's worried about the fall and, with it, flu season.

"If we have another surge, we could be in a major bind, and not be able to give patients a medicine that results in better outcomes," he said.