Remdesivir: Panacea for Wall Street or Sick Americans?

Remdesivir has been fast-tracked by the FDA to be used as a "frontline" treatment against Covid-19. In an emergency-use authorization, they claim the benefits of using the drug, without having complete data from the NIH clinical trial, far outweigh the risks. Keep in mind, the NIH study upon which their decision is based is only one of many Remdesivir studies currently going on, and they made their decision before all the data was even released. A recent study from China, published in The Lancet, showed no difference between Remdesivir and a placebo. Experts say the results from a single study, like the NIH study, are rarely game changers and safest approach is to pool data from several equally rigorous studies, which has not happened yet.

So, what are these benefits?

The only benefit that has been shared from the study, as of this posting, is that patients hospitalized with severe symptoms had a 31% faster recovery time than patients who received a placebo (11 days versus 15 days). There was a statistically negligible improvement in mortality.

Of course we'd all like to be sick for a shorter period of time when we are sick. But this drug does nothing to prevent us from catching Covid-19, and it does little to nothing to reduce our chances of dying from it. It does nothing to flatten the curve, reduce the infection rate or make the world a safer place. It does nothing to lower the risks associated with a premature return to work or relaxing social distancing policies.

And there are risks, though these get little mention in the press. For example, many patients dropped out of the Chinese study because of side effects and adverse reactions. The drug is toxic to both the liver and kidneys.

So, what's the real benefit? Why fast track its approval before all the data are in? Particularly when the drug is produced by a private company, Gilead, which expects to turn a handsome profit on the drug, meaning many people who need it won't even be able to get it?

1. Big profits for Gilead and their investors
2. A propaganda victory for Trump (See, we've got a drug to keep you safe. So, go to work. Go get your tattoos and massages.)
3. Shorter recovery possibly means less time away from work, assuming the sick person had a job in the first place and still has one now

Once all the data are in, Remdesivir may, in fact, become a "game-changer" for sick patients, but the real game-changers will be drugs that cure people quickly and reduce mortality. Even better, how about a vaccine that is effective against the entire coronavirus family? 

While we don't know if the latter is even possible, the need is urgent. Epidemiologists have known for a while now that Coronaviruses and Influenza viruses were the most likely culprits in causing the next deadly pandemic. And they believe another deadly pandemic, like the current one, is likely.

One reason is that both virus families are spread easily through the air and remain viable on surfaces, making them easy to spread from person to person, even by strangers in public places, in contrast to Ebola and HIV, which require fairly intimate contact with sick individuals. Another reason is that both virus families reproduce by RNA, rather than DNA, and the enzymes used to replicate RNA make far more mistakes than the DNA enzymes, resulting in highly mutable viruses. Consequently, even if you gain immunity to one strain, either through illness or vaccination, you could still be susceptible to next year's strain. This is why we need to get a new flu vaccine each year.

A third problem is that there are already 50 new coronaviruses discovered in bats that have the potential to cause deadly pandemics in humans. Due to climate change and habitat destruction, humans are coming into contact with wild animals far more now than in the past, causing a rapid increase in zoonoses.

While we don't know which, if any, of these new coronaviruses will jump species and cause a pandemic, we certainly should be prepared. If SARS and MERS weren't sufficient warning, Covid-19 certainly is. A corona-family vaccine, effective against all coronaviruses, might be the best hope against a repeat of what we're going through now.

Whatever the final results of the NIH study show us, and regardless of how the emergency use authorization plays out for sick individuals, we still need to continue with social distancing, drug and vaccine research and development, rebuilding the health infrastructure to prepare for the next wave, produce sufficient PPE for frontline workers, and provide a much more effective and generous safety next for the millions of Americans who are struggling to survive.