When the Pennsylvania Department of Health announced Tuesday that 1,200 doses of the antiviral drug remdesivir — the first somewhat promising treatment for COVID-19 patients — was being shipped from the federal government to 51 hospitals in the state, it was big news.
“It is very exciting. I must have received at least 75 text messages as we shared this information,” said Christine Roussel, director of pharmacy at Doylestown Hospital and president of the Pennsylvania Society of Health Systems Pharmacists.
“Yesterday, I was with one of my nurse managers, and she literally started to cry, and she was like, ‘It’s a powerless feeling that you can’t do anything. …” Roussel said. “And she was honestly my second phone call to tell … we have redesivir, to try and be like, ‘Listen, this is going to bring your spirits up.’”
Pennsylvania medical professionals had been waiting and wondering when an allocation of remdesivir would come their way. Last weekend, the U.S. Department of Health and Human Services announced that the drug had been sent to various states including New Jersey, New York, Maryland, and Connecticut over two rounds. In a statement, HHS said it expected doses to be delivered to all 50 states and territories, the Veterans Health Administration, and the Indian Health Service.
On Wednesday, Roussel said, “The only issue is now there’s only a limited supply and we don’t know when we’re going to get another allocation, so I think the big thing is being judicious with what we have, which is … both exciting and sobering at the same time. We already have patients’ families asking [for the drug].”
The state Health Department said it decided how many doses to allocate based on how many COVID-19 patients a hospital had over a recent week, how severely ill those patients were, and whether they needed ventilators.
Getting the most doses are Thomas Jefferson University Hospital, Temple University Hospital, Albert Einstein Medical Center, and Lehigh Valley Hospital–Cedar Crest. The Health Department also said that it will keep working to get additional doses to serve patients across Pennsylvania, and that HHS has said there will be more shipments each week over the next several weeks.
Doylestown Hospital got 18 vials in this first shipment, enough for three COVID-19 patients over a five-day course of treatment. If it were up to her, Roussel said, she would ask for enough for 10 people, because it’s important to give the drug soon after new patients arrive with coronavirus infections.
The earlier patients can get the drug, the better, she said. That’s because as time goes on, COVID-19 patients suffer more from organ damage or other complications rather than from damage caused directly by the virus itself. For example, Roussel said, there are patients who are still on ventilators but test negative for the virus itself.
Two weeks ago, preliminary trial results of remdesivir showed it can help hospitalized patients recover faster. The full results have yet to be published in a peer-reviewed journal, but with clear evidence it works the Food and Drug Administration issued an emergency use authorization for remdesivir to treat severe COVID-19 patients.
Remdesivir, once studied for use in treating Ebola, has not been approved by the FDA to treat anything. The drug’s maker, Gilead Sciences Inc., has 1.5 million vials, enough for about 140,000 patients. The company has donated about 607,000 vials to the U.S. government for distribution, and said it is talking to pharmaceutical companies around the world to look into making more.
Unlike the Pennsylvania Department of Health, the U.S. Department of Health and Human Services has not announced how it decided which states got the drug first. That lack of transparency is frustrating when contrasted with what the state did, said David Showalter, system director for pharmacy service at Main Line Health.
“We have far more critical-care patients than what this initial shipment would cover … which … is why it’s a little disappointing to see what Pennsylvania was allocated versus some other states with less cases,” Showalter said.
For example, Rhode Island got the same amount of the drug as Pennsylvania did. Rhode Island has 11,835 cases of COVID-19; as of Wednesday, Pennsylvania had reported 62,101.
Last week, the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the HIV Medicine Association wrote open letters to Vice President Mike Pence asking for transparency about how the government decides who can get remdesivir and any other COVID-19 treatments and vaccines.
U.S. Rep. Brian Fitzpatrick, R-Pa., who represents Bucks County and parts of Montgomery County, had written a similar letter to the secretary of Health and Human Services. Doylestown Hospital’s Roussel thanked Fitzpatrick and State Sen. Maria Collett for their advocacy in getting Pennsylvania patients access to remdesivir.
The Wall Street Journal reported Monday that White House coronavirus response coordinator Deborah Birx wrote in an email to colleagues that the way the administration handled distribution of remdesivir the first time led to a “misalignment of the therapeutic and on-the-ground current need” and shouldn’t happen again in the future.