Some U.S. states facing a surge in coronavirus cases are now running low on remdesivir, the only drug approved to treat COVID-19, while other parts of the country have ample supplies of the potentially life-saving medication. The regional shortages are forcing doctors already struggling with an onslaught of cases of the disease to make tough decisions, including whether to ration or even withhold the drug from some patients.
Hospitals having to ration doses of remdesivir include medical centers in Florida, where nearly 4,800 people have died of the virus and more than 315,000 have been infected. On Thursday, the state reported a record 156 deaths from the virus, along with roughly 14,000 new confirmed cases and nearly 9,000 hospitalizations.
"In hard-hit areas like Florida, Arizona and Texas, some hospitals have run out of remdesivir," said Helen Boucher, chief of infectious diseases at Tufts Medical Center in Boston, Massachusetts. "It's not clear if it's just a distribution issue, or whether there isn't enough, period."
"Heart-wrenching thing to do"
"Remdesivir... has been difficult to get for us the last week or so," said Eliot Godofsky, a physician and infectious disease specialist in Bradenton, Florida. "There is too much of the drug in places that don't need it and not enough in places that do."
While not a cure, remdesivir canpatients and possibly improve their odds of survival, according to initial data released last week by its manufacturer, Gilead Sciences, based in Foster City, California.
"No one treatment has looked to be a blockbuster, and doctors are having to make hard decisions about triaging," said Godofsky of the task of assigning degrees of urgency involving patients and available therapies.
"It's a heart-wrenching thing to do," he added. "Doctors are having to uncomfortably pick and choose sometimes — it's not easy," he said of his practice, which is overseeing care for about 100 COVID-19 patients at three local hospitals.
The main reason for the shortages of remdesivir is that the system for obtaining the drug is complicated and subject to change, some doctors said. It was at first run through the Federal Emergency Management Agency, or FEMA, and then left in the hands of local health departments before HHS took the reins. The patchwork approach has hampered coordination, Godofsky said.
The federal government is overseeing distribution of remdesivir, with allocations of the drug based on patient data provided by hospitals to the U.S. Department of Health and Human Services (HHS). Medical facilities get bi-weekly deliveries based on their case counts in previous weeks. That lag time between when people are hospitalized and remdesivir shipments arrive is proving an especially acute problem for clinicians in virus hotspots.
"There is concern with these rapid upticks that we're seeing, and the way HHS is asking us to report cases this week and then send next week, that it may be too slow," Boucher said.
Ideally, states and hospitals would receive shipments of drugs such as remdesivir based on data and projected trends, rather than previous caseloads, said Michael Ganio, senior director of pharmacy practice and quality for the American Society of Health-System Pharmacists. "There are certainly lessons learned that we need to start applying now."
New York sends drug to Florida
More positively, the situation is much improved since early May, when just a handful of medical centers around the U.S. received shipments of remdesivir. Initially, three Massachusetts hospitals got shipments of the drug despite other parts of the state facing much more severe outbreaks. The facilities returned their supplies for them to be reallocated around the state.
"That worked for a time, and now we find ourselves in this predicament," said Boucher, adding that "we all want to save as many lives as possible."
An HHS spokesperson told a CBS affiliate in Chicago that hospitals should first contact their state health department to reallocate their supply of remdesivir, and then the state would have to work with HHS to transfer it across state lines.
New York on Friday said it would send Florida enough remdesivir to treat 280 patients. Governor Andrew Cuomo said he wanted to return the favor after getting medical supplies and staff from other states when New York needed it. A spokesperson for Cuomo's office confirmed the shipment had been received Saturday by Florida health officials.
"We need a fair and transparent process," tweeted Michael Ison, an infectious disease physician at Northwestern University's School of Medicine in Chicago, who referenced the "chaos" about the distribution of remdesivir.