Becker's Hospital Review

66 CMO / CARE DELIVERY Remdesivir could help treat COVID-19 — but who should get it? By Anuja Vaidya S tudies have shown that the drug remde- sivir can help treat novel coronavirus pa- tients, but there isn't enough of the drug for all the patients who are eligible, leaving clini- cians to decide who should get the drug without much direction, according to STAT. ere is little data showing which COVID-19 patients are most likely to benefit from remde- sivir, making decisions on how to use the lim- ited resource in an ethical manner a challenge. On April 29, the National Institute of Allergy and Infectious Diseases issued a news release that said novel coronavirus patients receiving remdesivir recovered quicker than those who'd received a placebo. Shortly aer, the FDA is- sued an emergency authorization for the drug. e federal government plans to distrib ute 607,000 vials, which would be enough to treat around 78,000 people, donated by Gilead Sciences in May and June. But the allocation of the drug has been heavily crit- icized, as some of the hardest-hit hospitals in the country are not going to receive the drug, STAT reported. State health agencies will coordinate the distribution of the drug. e paucity of the drug and related data showing which patients are most likely to benefit from it is leaving clinicians in a bind, and eligibility criteria for the drug from the government is not helpful, Erin Fox, PharmD, director of drug information and support services at the University of Utah Medical Center in Salt Lake City, told STAT. For example, the government's guidance says COVID-19 patients with severe enough dis- ease that their blood oxygen saturation level is down to 94 percent are eligible for the drug. "is could be somebody who is mildly short of breath and is uncomfortable and who might be more comfortable on a wee bit of oxygenation — some people don't even detect that their oxygen- ation is low at 94 percent," Rochelle Walensky, MD, chief of infectious diseases at Boston-based Massachusetts General Hospital, told STAT. But it could also be somebody struggling to breathe and in a life-threatening condition, she said. For now, at Massachusetts General, clinicians are considering basing allocation on how long the patient has been hospitalized, that is, using the drug on patients sick enough to be hospitalized, but not those who haven't been sick for too long. "At some point, there's going to be a lottery be- cause there are going to be too many patients for the drug," Dr. Walensky told STAT. n Study: 66% of COVID-19 patients needing ventilation die By Anuja Vaidya A bout two-thirds of COVID-19 patients requir- ing mechanical ventilation die, a 3,883-person study published in April found. Researchers examined data for 3,883 COVID-19 patients ad- mitted to intensive care units in England, Wales and Northern Ireland reported to the United Kingdom's Intensive Care Na- tional Audit and Research Centre. Of the 3,883 patients studied, 871 patients died, 818 patients were discharged alive from critical care and 2,194 patients were last reported as still receiving critical care. The data revealed 1,053 patients required advanced respi- ratory support via mechanical ventilation, of which 698 (66.3 percent) died. Of the 444 who required only basic respiratory support, 86 (19.4 percent) died. The data also revealed that a higher proportion of COVID-19 patients requiring mechanical ventilation died compared to patients without the novel coronavirus who had viral pneu- monia and who needed ventilation (35.1 percent). Previously, three studies reported a majority of COVID-19 pa- tients who needed mechanical ventilation died. These studies had far smaller study samples. n COVID-19 is 13 times deadlier than flu, study suggests By Mackenzie Bean C OVID-19 may kill about 1.3 percent of symptomatic patients, an infection fatality rate that is 13 times higher than the flu, according to a peer-reviewed study slated for publication in Health Affairs. Researchers analyzed 40,835 confirmed cases and 1,620 deaths across 116 counties using GitHub data from Balti- more-based Johns Hopkins University and The New York Times through April 20. Based on mathematical modeling, researchers estimate the national infection fatality rate for symptomatic COVID-19 pa- tients is 1.3 percent, with county-specific rates ranging from 0.5 percent to 3.6 percent. For reference, the fatality rate for seasonal flu is about 0.1 percent. If 35.5 million U.S. residents contract COVID-19 this year (which is how many people were sickened last flu season), about 500,000 deaths would occur in the absence of any mit- igation strategies. Researchers noted their estimate does not factor in as- ymptomatic COVID-19 patients, which would lower the fatality rate. n

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