How Hospitals Will Decide Who Gets Remdesivir

Fourteen of Illinois’ more than 200 hospitals are now able to treat COVID-19 patients with remdesivir, the only drug that’s been authorized by the Food and Drug Administration on an emergency basis for such treatment.

Illinois Department of Public Health Director Dr. Ngozi Ezike on Monday called it “exciting, good” news that Illinois had received an initial shipment of the drug from the federal government.

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But the supply is limited – enough to treat only 700 patients. As of Monday afternoon, about 1,250 patients are fighting COVID-19 in intensive care units.

It’s up to hospitals to determine who among them will get the treatment.

More: Illinois Receives 1st Allotment of Remdesivir to Treat COVID-19 Patients: 90% Goes to Cook County

SwedishAmerican Hospital in Rockford received enough vials to treat 16 patients, though it’s possible more could be treated if some respond to a five-day regiment instead of a 10-day regiment.

“We are excited to receive medication, it is a very small amount,” said SwedishAmerican Director of Pharmacy Dr. Tom Carey. “We will have to do our best to make sure that we ration out to our ‘ideal’ patient type.”

Hospitals will decide which patients are the best candidates, though they will follow FDA rules.

Two of Hospital Sisters Health System’s facilities, St. John’s in Springfield and St. Elizabeth’s in O’Fallon, received vials of remdesivir.

Candidates for the treatment will be those with severe cases of COVID-19 pneumonia, but who don’t have kidney or liver failure.

HSHS chief physician executive Dr. Marc Shelton said remdesivir will be offered to patients on the early end of experiencing severe cases, as opposed to those who have long been on ventilators.

“And so this does limit the potential people who are eligible for it,” he said.

Hospitals are at varying points of readiness to use their allotments.

“AMITA Health is applying the data from the National Institute of Health sponsored clinical trial that supported the FDA’s emergency use authorization of remdesivir. Subsequently, we have established system-wide protocols for the clinical use and distribution of remdesivir,” AMITA Health’s spokeswoman said in a statement.

Mt. Sinai’s spokesman, Dan Regan, sent a statement saying, “We will be determining which patients will be receiving the medication through our multispecialty COVID rounds, and in accordance with guidance from the FDA.”

SwedishAmerican said it received vials of remdesivir on Saturday night, and on Monday was in the process of speaking to a first prospective patient about trying the therapy.

Rush University Medical Center has already been using remdesivir as part of a clinical trial of 50 coronavirus patients.

Infectious disease expert Dr. Shivanjali Shankaran is the principal investigator.

“Anyone who’s taking care of patients with COVID-19, we want to have something that we can offer our patients,” Shankaran said. “Ultimately that’s what’s needed, as many studies as we can get, to do true, evidenced-based data.”

She said remdesivir and other drugs that are part of such trials “definitely gives us hope, to have something that we can help our patients with.”

But she warns that the FDA’s emergency use authorization of the drug is not the same as approval.

There’s a lot about remdesivir, including its side effects and effectiveness, that remain unknown.

“As a health care provider, you want to make sure that you’re attempting to do everything you can and I think in a situation like this, there’s some degree of helplessness because at this point in time we just treat symptomatically,” Carey said. “We’re not really treating the infection that we otherwise would do. So we’re happy that we’re in this particular spot” of having remdesivir to try to help COVID-19 patients. 

While the trial results are certainly “not bad” he said: “We’re hoping for good or great.”

Each of the 14 hospitals that received initial allotments from the state will monitor, track and report patient responses.

Ezike said Illinois hopes to receive more remdesivir from the federal government.

Follow Amanda Vinicky on Twitter: @AmandaVinicky

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