Remdesivir treatment: how effective is it and how much does it cost?

On Thursday it emerged that President Trump and the first lady Melania had both tested positive for Covid-19. Trump’s infection with the virus is thought to be at least in part due to his close proximity to his aide Hope Hicks who tested positive on Wednesday.

Since the news broke, the President has been widely criticised for repeatedly doubting the effectiveness of measures recommended by the CDC; such as the use of masks and social distancing. Focus has turned to the fact that Trump had been running a campaign largely ignorant of official recommendations; his rallies regularly breaking various states’ guidelines relating to the spread of the virus.

How sick is Donald Trump?

Initially, the President and his team reported that he was without symptoms, but it wasn’t long before he was taken to hospital and administered a mixture of treatments for his developing symptoms, raising some doubts about the seriousness of his condition from the beginning.

It was later confirmed by his physician Dr. Sean Conley on Saturday that Trump’s symptoms on Thursday had been "a mild cough and some nasal congestion, fatigue.” Other details of Trump’s condition were kept vague, with the doctor refusing to answer how high the president’s fever had been, or details of his oxygen treatment.

Conley admitted that the president’s condition had been worse than he had initially let on. Conley said Trump’s blood oxygen levels had dropped in the previous days.

Confusion mounted when reports emerged from a White House source who told the pool reporters in a briefing Friday that “The President’s vitals over the last 24 hours were very concerning and the next 48 hours will be critical in terms of his care. We’re still not on a clear path to a full recovery.”

Among conflicting reports on Trump’s condition, it emerged that on being flown to the Walter Reed hospital the President had begun a five-day course of the drug remdesivir. Other treatments that the president has been given to date include oxygen, an experimental antibody cocktail and dexmethasone; a steroid only recommended for use in severe cases. More on what dexamethasone is and its potential side effects here.

What is remdesivir?

Remdesivir is a repurposed antiviral drug that was originally tested on hepatitis C and Ebola, and is thought to interfere with the way in which certain viruses multiply.

The drug was given emergency use authorisation in May 2020 for severe cases of Covid-19, following positive trial results showing the drug helped coronavirus patients recover 31% faster than a group that received a placebo.

An emergency use authorisation is not the same as a typical approval. Emergency use is only allowed during public health emergencies, and treatments face a lower bar of evidence than used for FDA approval.

"It is reasonable to believe that remdesivir may be effective in treating Covid-19," the FDA said in a letter authorising the drug's emergency use. "When used under the conditions described in this authorisation, the known and potential benefits of remdesivir when used to treat Covid-19 outweigh the known and potential risks of such products.”

Remdesivir is administered intravenously and is only used for hospitalised patients so is unlikely to become widely used.

The effectiveness of remdesivir as treatment for  this coronavirus is largely unknown. In an August 2020 trial carried out on 584 patients with moderate Covid-19, the conclusion was made that those patients who took a 5-day course of remdesivir had a significantly better clinical status compared with those given standard care, but the difference was of uncertain clinical importance. It should be noted that patients in the same trial who took the drug for a median of 6 days showed no more improvement than those on standard care.

How much does remdesivir cost?

Following its emergency approval, the drug’s manufacturer Gilead Sciences, priced remdesivir in the US at $520 per dose for patients who have private insurance, with some government programs getting a lower price. With the course involving a double-dose the first day, the total comes to $3,120 for the five-day treatment course.

For governments in developed countries outside the US it will cost $390 per dose, or $2,340 for the five-day course. How much uninsured patients would pay is unclear.

According to a fact sheet issued by the FDA possible side effects of remdesivir include:

Allergic reactions, including serious reactions, during and after infusion.

Increases in levels of liver enzymes, which may be a sign of inflammation or damage to cells in the liver.

Coronavirus patient and president: what are Trump’s risk factors?

Amid reports from his medical team that Trump could be discharged from hospital as soon as today, experts doubt that he will be fully recovered for some time.

Trump is 74 years old, obese and is taking medicine to combat high cholesterol. Trump has  had concerning levels of coronary plaque which indicates heart disease, he is being treated with statins and the levels have stabilised.

According to the CDC, patients in the 65-74 age range are five times more likely to be hospitalised and a 90 times more likely to die from Covid-19 compared to young adults between the ages of 18-29.

Reuters today reported that Covid-19 is often characterized as having two phases, the viral infection itself and in some cases an overreaction of the body’s immune system that can cause organ damage. “People sort of putter along for up to a week ...then everything goes downhill very quickly,” said Dr. Stuart Cohen, chief of infectious disease at California’s UC Davis Health. “It is always hard to predict who that is going to happen in.”

“Some people with Covid-19 develop worsening symptoms, shortness of breath and other complications about a week after they first develop symptoms,” said Dr. Rajesh Gandhi, an infectious disease physician at Massachusetts General Hospital in Boston.

See this report for more details on what would happen if the president were to become incapacitated.

Trump stunt: greets fans from car, doctors label “insanity”

As the tally of cases in America nears 7.5 milllion, the President, presumably still infectious on Sunday afternoon left the hospital in an SUV and drove past the gathered crowds. Concerns have been raised for the staff present in the car with him, and the event has been criticised as irresponsible.

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