Is Remdesivir a wonder drug for Covid patients as it is made out to be?

Dr Sandeep Gore, Director Emergency Medicine in Fortis Hospital in Mumbai has been leading a team of emergency doctors handling Covid patients. Ever since the pandemic broke, Dr Gore and his team have been treating hundreds of Covid patients in Mumbai, which is one of the world’s Covid hotspots.

The Probe’s Editor in Chief Prema Sridevi speaks to Dr Gore on Remdesivir: the antiviral drug which is being hoarded and black marketed across India as it is being portrayed as a wonder drug for Covid patients. What are the facts related to Remdesivir? Here’s a deep dive interview:

Prema Sridevi: The World Health Organisation had conducted a Solidarity Trial of 4 antiviral drugs including Remdesivir. This study was conducted in 405 hospitals in 30 countries. Around 11,000 adults underwent randomisation amongst which 2750 patients were given Remdesivir. The Solidarity Trial’s interim results found that Remdesivir had little or no effect on overall mortality, initiation of ventilation and duration of hospital stay in hospitalised patients with Covid-19. If such is the case, if Remdesivir doesn’t have any effect on Covid patients, why is this drug being projected as a miracle drug?

Dr. Sandeep Gore: There is a myth that Remdesivir is a life saving drug. The Public feels that this is an elixir. It is absolutely wrong. The study conducted by WHO clearly says that the injection of Remdesivir does not reduce the stay of the patient in the hospital neither it prevents the patient from going to the ventilator nor it reduces mortality. It has very little effect on patient outcome. We have to go by evidence in front of us. With a lot of responsibility I am saying that Remdesivir has little role in Covid management. Through The Probe, I would like to appeal to the people to not give the status of a miracle drug to Remdesivir. It is not an elixir.

Prema Sridevi: The World Health Organisation’s Chief Scientist Dr Sowmya Swaminathan was recently seen speaking about 5 international clinical trials. She had said that in those 5 trials, it showed that Remdesivir did not reduce the need for mechanical ventilation amongst those suffering from Covid and it didn’t help curtail mortality. If that is the case, then why is there so much of hue and cry over this drug in India?

Dr Sandeep Gore: In March 2020, there was a similar hype over Hydroxychloroquine. We saw the same media hype during that period over this drug but as days passed everyone understood that it was a wrong hype. It’s time for the media to be very responsible and only propagate news based on evidence based knowledge. The evidence suggests that Remdesivir has very little role in Covid management. Media has to now create awareness amongst the people.

Prema Sridevi: If Remdesivir is not really helping Covid patients in a big way then what is actually working on Covid patients? You have been treating hundreds of Covid patients since the start of the pandemic. Please tell us from your experience, what is working on patients? 

Dr Sandeep Gore: So far, from my experience and the experience of my colleagues, only two things are currently working on Covid patients. The first is oxygen and the second is steroids. Whenever there is a drop of oxygen, the person needs ventilatory support. When it comes to steroids, timely administration is important. It should only be given at the appropriate time otherwise it will be detrimental. I am saying detrimental because if we administer steroids in the earlier stage, that can harm the patient. It is like a double-edged sword. So, these are the only two things that can save the patients from death and all this should only be administered under medical supervision. 

Prema Sridevi: If you look at what has been happening in the country in the last few days, in Gujarat a top executive of a Daman-based pharmaceutical company and his aide were arrested for allegedly black marketing Remdesivir drugs. In Bangalore also three people were arrested for illegally stocking and black marketing Remdesivir drugs. If there is no evidence from international trials that Remdesivir in fact helps Covid-19 patients, then why is a false narrative being created around the drug? Who is doing this and for whose benefit? 

Dr Sandeep Gore: I think most of it is media hype. Media has been wrongly portraying that people have been dying due to the lack of Remdesivir. This is not right because Remdesivir has very little to do with mortality. We must spread awareness so that we can bring down the panic that is spreading across the country. Once this panic goes, automatically the hoarding and black marketing will stop. We are practicing modern medicine and it is based on evidence. The most recent evidence suggests that Remdesivir has no or very little role in Covid management. As a responsible journalist, you must spread awareness and as a responsible medical professional the onus is also on people like me to give the right suggestions to patients and their families.

Prema Sridevi: The Centre on April 11 banned the export of Remdesivir. Many State Governments have directed hospitals to administer the drug only to those suffering from a severe case of Covid-19 infection. When none of the top-rated scientists or trials have validated Remdesivir as the best choice for treatment then why are both State and Central Governments making this out as one of the most sought after drug? Does this not clearly show a lack of medical knowledge or understanding of the medical science behind Covid treatment from the part of the establishment?

Dr Sandeep Gore: I think most people have the knowledge but that is not being percolated at the grassroots level. Everyone in the medical fraternity knows about the Solidarity Trial but the public is not aware of this. This is where the media’s role comes to play. You have a large responsibility in creating awareness.

Prema Sridevi: We are facing shortage of oxygen cylinders. There are no beds in many hospitals across the country. No ventilators. I am afraid to even think about the plight of the dead. There’s no space to bury the dead but the fact is for the patients who are living with Covid and suffering, they are in dire need of help. As an emergency doctor who has been treating Covid patients everyday and who is leading a team of emergency doctors who are in the thick of Covid duties, what should be the focus now? Instead of focusing on Remdesivir, what according to you should be the focus of the Government at this point?

Dr Sandeep Gore: This is the most crucial period. Next 2 to 3 weeks are most crucial. Everything depends on how we handle this. I think there is a need for complete lockdown. The disease is spreading very fast. Right now more than 95% of the medical infrastructure is getting filled with Covid management. If the number of patients double-up, then it will be very difficult for us to handle the situation. If we don’t control this now, there will be a disaster in the next 3 to 4 weeks. People should also behave responsibly. They should wear masks. People should absolutely avoid political, religious and social gatherings. They should protect their own lives and the lives of their near and dear ones.

Prema Sridevi: Our country’s production of Remdesivir has gone up from 2.8 million to 4.1 million vials per month during the last week. Many companies producing Remdesivir in India have slashed the price of the drug. There is so much happening around this drug. All focus is on the drug and not on the burning issues. Isn’t this a classic case of misplaced priorities?

Dr Sandeep Gore: People are panicking due to ignorance and this is leading up to the scenario that you just spoke about. The first thing that we need to do is reduce the panic and that can only be done when we spread awareness. Even the NHS has removed Remdesivir from the treatment management. These are the facts. So, we must now focus on issues that require our immediate attention.

Prema Sridevi: Even the World Health Organisation issued a conditional recommendation against the use of Remdesivir in hospitalised patients. Regardless of the disease severity, they have said that there is no evidence that proves that Remdesivir improves the survival and other outcomes in Covid patients. With more mutations and variants of the virus doing the rounds, how grave is the situation this time around?

Prema Sridevi: As we always say, prevention is better than cure. With newer variants and mutations of the virus doing the rounds, what new precautions should we take to keep ourselves and our near and dear ones safe from the virus?

Dr Sandeep Gore: The precautions are the same. Avoid unnecessary outings. People should only go out for essential things. When they go out, they must wear a mask. If possible they must use a double mask. No one should go out of home without masks and they must maintain at least 6 feet distance from people. Moreover, vaccination is going on, we must encourage vaccination. Vaccination is the most effective way to reduce the severity of the current situation.