Some U.S. states facing an increase in coronavirus cases are now running out of patches, the only drug approved to treat COVID-19, while other parts of the country have an ample supply of life-saving drugs. The regional shortage is forcing doctors who are already struggling with an avalanche of cases of the disease to make difficult decisions, even if to ration or even withhold the medication from some patients.
Hospitals that have to ration doses of remdesivir include medical centers in Florida, where nearly 4,800 people have died from the virus and more than 315,000 have been infected. On Thursday, the state reported a record 156 deaths from the virus, along with approximately 14,000 new confirmed cases and nearly 9,000 hospitalizations.
“In affected areas like Florida, Arizona and Texas, some hospitals have been left without regrets,” said Helen Boucher, chief of infectious diseases at Tufts Medical Center in Boston, Massachusetts. “It is not clear if it is just a distribution problem, or if there is not enough, period.”
“A heartbreaking thing to do”
“Remdesivir … has been hard for us to get over the past week or so,” said Eliot Godofsky, an infectious disease doctor and specialist in Bradenton, Florida. “There is too much drug in places that don’t need it and not enough in places that do need it.”
While not a cure, remdesivir can accelerate the recovery of COVID-19 patients and possibly improve their chances of survival, according to initial data released last week by its manufacturer, Gilead Sciences, based in Foster City, California.
“No treatment has appeared to be a box office success, and physicians have to make difficult decisions about triage,” said Godofsky of assigning degrees of urgency to patients and available therapies.
“It is heartbreaking,” he added. “Doctors have to choose uncomfortably sometimes, it’s not easy,” he said of his practice, which oversees the care of about 100 COVID-19 patients at three local hospitals.
Patchwork subject
The main reason for the shortage of remdesivir is that the system for obtaining the drug is complicated and subject to change, some doctors said. It was first run through the Federal Emergency Management Agency, or FEMA, and then left to local health departments before HHS took over. The mosaic approach has made coordination difficult, Godofsky said.
The federal government oversees the distribution of remdesivir, with drug-based allocations of patient data provided by hospitals to the US Department of Health and Human Services (HHS). Medical facilities receive biweekly deliveries based on their case counts in previous weeks. That delay between the time people are hospitalized and the remdesivir shipments arrive is proving to be an especially serious problem for doctors at critical virus points.
“We are concerned about these rapid increases we are seeing, and the way that HHS is asking us to report cases this week and then send them in next week, which may be too slow,” Boucher said.
Ideally, states and hospitals would receive shipments of medications such as remdesivir based on data and projected trends, rather than previous cases, said Michael Ganio, senior director of pharmacy practice and quality for the American Society of Health System Pharmacists. “There certainly are lessons learned that we need to start applying now.”
New York sends drugs to Florida
More positively, the situation has greatly improved since the beginning of May, when only a handful of medical centers in the United States received shipments of remdesivir. Initially, three Massachusetts hospitals received shipments of the drug despite other parts of the state facing much more serious outbreaks. The facility returned its supplies for reallocation throughout the state.
“That worked for a while, and now we are in this situation,” Boucher said, adding that “we all want to save as many lives as possible.”
A HHS spokesperson told a CBS affiliate in Chicago that hospitals must first contact their state health department to reallocate their supply of remdesivir, and then the state would have to work with HHS to transfer it through state lines. .
New York said Friday it would send enough remdesivir to Florida to treat 280 patients. Governor Andrew Cuomo said he wanted to return the favor after obtaining medical supplies and personnel from other states when New York needed it. A spokesperson for the Cuomo office confirmed that the shipment had been received by Florida health officials on Saturday.
“We need a fair and transparent process,” tweeted Michael Ison, an infectious disease physician at Northwestern University School of Medicine in Chicago, who referred to “chaos” over remdesivir distribution.
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