Wolfe would love to share some of his remdesivir with doctors like Godofsky, since it is the only medication licensed by the US Food and Drug Administration to treat Covid-19.
But as coronavirus makes its way in the United States, with sudden increases in some areas and decreasing numbers in others, there is no mechanism for hospitals to switch the drug to where it is most needed.
The federal government oversees the distribution of remdesivir, and Wolfe, Godofsky, and other doctors say the system needs a review.
Godofsky says he feels “handcuffed” because he cannot give his patients in Bradenton, Florida a remdesivir, a medication that can speed recovery and possibly reduce the risk of death for patients.
“It has been very frustrating,” said Godofsky, an infectious disease specialist. “Patients suffer and you feel terrible.”
“This is crazy,” said Wolfe, an infectious disease expert at Duke University Medical Center. “It has been really disturbing to see how this has developed.”
On Friday, a spokesman for the US Department of Health and Human Services told CNN that in the next week, the remdesivir allocations to the states “will emphasize locations with large recent increases.”
The spokesperson gave amounts to be shipped to four critical states (Arizona, California, Florida and Texas) that are much smaller than the number of patients hospitalized in those states.
The spokesperson also said that the company contracted to distribute remdesivir will contact each hospital that received the medication to confirm that it still needs it.
The department “is committed to equitable and efficient distribution of the drug with the goal of reaching as many patients as possible in every state and territory in the United States,” according to the spokesperson.
Distribute remdesivir
In May, the FDA granted emergency authorization to withdraw hospitalized patients with Covid-19. Initially, Gilead Sciences, the company that makes the drug, donated the supply, but starting next week, hospitals have to buy it.
On Friday, Gilead presented data at a medical conference indicating that patients who received remdesivir had a mortality rate of 7.6% compared to a mortality rate of 12.5% for those who did not receive the medication. The analysis also showed that 74.4% of patients treated with remdesivir recovered within 14 days compared to 59% of patients who did not receive remdesivir.
The data has not been published in a peer-reviewed medical journal, making it less reliable.
Although not a cure for Covid-19, doctors say that most of their hospitalized patients could benefit from remdesivir. However, shipments that went to critical states in the coming week don’t even come close.
As of July 10, Texas had 10,002 patients hospitalized with Covid-19, but the lot that headed to Texas will only have enough remdesivir for approximately 3,507 patients; Florida had 6,974 patients, but only enough for 2,733; California had 7,896 patients but only enough for 2,080; Arizona had 3,432 hospitalized patients, but enough for 2,080 patients, according to state and federal data.
HHS will make another shipment in two weeks.
The University of Texas Health Sciences Center at San Antonio has admitted more than 250 Covid patients since mid-June, but their most recent remdesivir assignment was enough medication for just 53 patients, according to Dr. Thomas Patterson , head of infectious diseases at the hospital.
“It is frustrating not being able to administer a medication that we believe will benefit the overall outcome,” said Patterson.
The Memorial Hermann healthcare system in Houston is almost out of remote control.
“Our estimates indicate that we have a couple of days left before the supply runs out,” according to a statement from Dr. Angela Shippy, chief medical and quality officer.
Manatee Memorial Hospital in Brandenton, Florida, has a “small supply” of remdesivir available to treat patients, according to hospital CEO Kevin DiLallo.
Looking for a plan for a limited resource
On Friday, New York Governor Andrew Cuomo announced that his state would send enough remdesivir to Florida to serve 280 Covid-19 patients.
The HHS spokesman said that once a hospital purchases remdesivir, “that hospital owns the medication and is free to handle it as it sees fit, which could include transferring or selling to other hospitals within or outside of your state or territory.” .
But Dr. Michael Ison, an infectious disease specialist at Northwestern Medicine in Chicago, said Illinois health officials have warned hospitals not to send drugs across state lines for legal reasons.
Even if they could send where they wanted, doctors and hospitals shouldn’t make decisions about where it’s going, Ison said.
“What we don’t want is for someone to say, ‘Oh, I have a friend at Hospital X, so I’m going to send it all over to them,'” he said.
Instead, Ison said the government should have a systematic way of looking at which hospitals have a surplus and which hospitals are in greatest need, and coordinate shipments accordingly.
“No one has an idea of where there is excess and where there are deficiencies,” he said. “This is a limited and scarce national resource. There must be some process for this.”
He added that there should be transparency in the process.
On Friday, the HHS spokesperson told CNN that the agency will use data from three systems to determine remdesivir assignments: the US Center for Disease Control and Prevention Health Care Safety Network; HHS Protect; and a private company called Teletracking.
The remdesivir is assigned proportionally. “For example, if state A has 10% of the national total of patients admitted with COVID-19, state A gets 10% of remdesivir for a given week of distribution,” the spokesperson wrote to CNN.
But the spokesperson did not explain exactly what data is used from the three sources and how proportionality is determined.
“There should be transparency on how remdesivir is available and when it is available,” said Ison. “Without transparency, it makes people less reliable in the overall process.”
CNN’s Wes Bruer, Dana Vigue, John Bonifield, Gisela Crespo, Amanda Watts, and Chuck Johnston contributed to this report.
.
