Is Remdesivir actually the remedy?
...And is this massive demand for the drug artificially created by private players?
CHENNAI: Forty-four-year-old Janarthan (name changed) had to run pillar-to-post to secure Remdesivir for his father, admitted due to Covid at a private hospital in Avadi, as the hospital told him to procure the drug himself. “I browsed Twitter posts and bought the drug for Rs 11,000 a dose -- several times higher than its original price,” Janarthan told Express. This is not a lone incident, as hundreds of people are posting desperate enquiries on social media for the drug to treat their family members. In this situation, two questions warrant attention -- is Remdesivir actually a life-saving drug for Covid patients? and is this massive demand for the drug artificially created by private players?.
The World Health Organisation (WHO) in its Covid guidelines has recommended against Remdesivir use citing that there is “no evidence” to prove that the drug improves survival chance or other outcomes in Covid patients. Experts and officials in Tamil Nadu also urge people not to panic over Remdesivir, stating that there is no evidence it saves lives and private hospitals must be capable to streamline the drug, and not ask relatives of patients to fetch it themselves. Director of Public Health Dr TS Selvavinayagam said that not all Covid patients need Remdesivir. “People must not panic over getting this drug.
Private hospitals must procure the drug on their own. If they can’t, they must send us patient details, and we will provide them the drug at its base price of `783,” he said, adding that action will be definitely taken against those selling it at higher prices. “Yes, some players are creating an artificial demand for the drug,” Dr Selvavinayagam acknowledged. Rajiv Gandhi Government General Hospital Dean Dr E Theranirajan said that only 30 to 40 per cent of patients needed Remdesivir at hospitals. “This drug must be given before the 10th day after admission and that too, only for those requiring respiratory support. In some cases, patients themselves are demanding the drug and this must be discouraged,” he said.
He also noted that the standard Covid care with clinical assessment and treatment with drugs such as Low Molecular Weight Heparin and Dexamethasone are still the key ways to recovery. “People need not panic about the drug and it must be left to the doctor to decide,” he said. Doctors also said that Remdesivir does not have effect for patients on CPAP ventilators and high-flow nasal cannula (HFNC). Infectious diseases specialists say that the benefit of Remdesivir is minimal and understanding the immunology is important before administering the drug.
“It is not the infection that causes distress to the body but it is the immune response. Through the drugs, we modulate immune response and Remdesivir is useful for patients who only require less amount of oxygen,” says Infectious Diseases Specialist Dr Subramanian Swaminathan of Gleneagles Global Health City. He added that the drug doesn’t help in the case of severe patients and for those, who do not require oxygen at all, underlining that it is questionable to call it a life-saving drug. “Even in our hospital, we do not give much importance to this drug. We use it if only it is available,” he said.
Dr Ram Gopalakrishnan, an Infectious Diseases Specialist with Apollo Hospitals, said that Remdesivir is a well-studied drug, unlike other drugs used in India without doing enough research. “The drug is useful if you have mild to moderate Covid symptoms. It helps you to recover quickly if you have low oxygen levels. However, it does not actually reduce your chances of dying if you have severe symptoms. The only way people can make the right decision on using the drug or not is to choose the right hospital.
Choose a hospital, where doctors are up to date about the latest Covid data. Remdesivir demand is high only due to its indiscriminate use,” he added. The weekly allocation of Remdesivir is controlled by the Centre, says Health Secretary Dr J Radhakrishnan. “Why can’t States import the drug themselves? Private hospitals could reach out to TNMSC for the drug and they will streamline it,” Radhakrishnan said. Chief Minister Edappadi K Palaniswami has also written to Prime Minister Narendra Modi seeking unrestricted supply of Remdesivir to the State.