The COVID-19 pandemic that has put governments and medical bodies into overdrive, while infecting millions of people across the world, is still a mystery. Originally considered a virus that would be transmitted from person-to-person through droplets, it is now believed that the novel coronavirus could be airborne.
Another factor that is a challenge is the right medication that can be used to treat COVID-19. Two months ago, the United States, the United Kingdom, Israel, and India were some of the nations that had employed hydroxychloroquine, a drug normally used to treat malaria was administered into individuals in the early stages of COVID-19. Doctors, who spoke to Free Press Journal in the past agreed that the drug was safe if given in moderation, citing medical textbooks and journals that showed that the drug had antiviral properties.
While India has also been looking to develop a solution using alternative medicine sources such as homeopathy and Ayurveda, an allopathic drug – which is still in testing stage – has suddenly found its way into the Indian black market. The drug – remdesivir – has shown promise against other strains of coronavirus in the past, but there is no proof that it will have the same effect on COVID-19.
An Associated Press report stated that doctors in China had launched two studies to compare the effect of remdesivir on a COVID-19 patient versus usual care, but were unable to complete it.
Gilead Sciences, the pharmaceutical company that has manufactured remdesivir had conducted its own study, but the report called the study ‘weak’, as it had no comparison group. In another test conducted by the company, it was revealed that both patients and doctors knew which group would be administered the drug, so there was a chance that there would be a bias over its effect on the patient.
“In late April, a National Institutes of Health study showed remdesivir shortened the time to recovery by 31% — 11 days on average versus 15 days for those just given usual care. But many questions remain about how and when to use the drug,” the AP report added.
Much like hydroxychloroquine, there is not enough scientific stury to conclude if remdesivir is the go-to drug to cure COVID-19. The drug was available in India for a while, until stocks ran out. It is now reportedly available in the black market.
But how effective is the drug? In an article written in Science Magazine, columnist Derek Lowe says that since the onset of the pandemic, the therapy for patients suffering from COVID-19 needs to be biphasic The early part of the infection, he says, would require the patient to be administered with a hydroxychloroquine or a remdesivir that have antiviral properties. However, if the patient goes into severe respiratory disorder ‘that usually seems to be caused or exacerbated by the overactive immune response, which has to be treated as a separate issue.’
Who can be treated?
According to the Health Ministry, remdesivir is only for restricted emergency use on patients with moderate disease (those on oxygen support). The drug can not be administered to a pregnant or lactating mother and children below the age of 12 years. Also, the drug is not recommended to a patient with severe renal impairment and a high level of liver enzymes.
the dosage of remdesivir should be-- 200 mg IV on day 1 followed by 100 mg IV daily for 4 days (5 days in total). However, in the previous clinical protocol issued on June 13, the Health Ministry stated that the patient has to be administered with 200 mg IV on day 1 followed by 100 mg IV daily for 5 days, that was, 6 days in total.
Why is it being sold in the Indian black market?
A Forbes report at the end of June said that the United States had purchased 100 per cent of Gilead’s – the company that manufactures the drug – projected production for July, and 90 per cent August and September, in addition to an allocation for clinical trials.
Has remdesvir had any positive effects?
Dr Andre Kalil, the principal investigator for the ongoing drug trials told NBC News that from research he and his team conducted in May, it was deduced that the hospital time for those infected with COVID-19 reduced by four days. However, there was no impact on the drug with regard to death rate. However, the study did not reveal the intensity of the flu in the patients. More recent work by Kalil and his teammates that was published this week said that even if the United States was using all the world’s remdesvir, then it would need to be administered with a cocktail of other drugs. Currently, the team is checking the success of the drug when administered with baricitinib, an anti-inflammatory drug that is usually used to treat rheumatoid arthritis.
Interestingly, hydroxychloroquine is also used to treat rheumatoid arthritis, although the Food and Drug Administration has cautioned against a combination of HCQ and remdesvir, stating that the anti-malarial drug could reduce the anti-viral effect of remdesvir.
And while the fight to find the right drug combination to fight the novel coronavirus continues, the virus, which has no DNA and just RNA, will mutate further, resulting in the scientists going back to the good old drawing board.
With Agency Inputs