COVID-19: Use Remdesivir rationally and in hospital settings, medical fraternity urges

India is facing a massive shortage of antiviral drug Remdesivir after its production reduced when COVID-19 cases dipped towards the end of last year.
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Antiviral drug Remdesivir is experiencing a massive shortage in hospitals than it did in 2020. As families of COVID-19 patients are scrambling to get their hands on the injection, it has led to black market sales and hoardings in several parts of the country amid the unprecedented second wave. However, medical professionals and COVID-19 task forces are reiterating that the antiviral drug is not a life-saving drug but is used to reduce the recovery process. They have also urged the medical fraternity to use Remdesivir rationally and judiciously.

Medical professionals are reiterating that Remdesivir is an experimental investigational drug that has emergency use authorisation for COVID-19 treatment. The antiviral drug injection, which inhibits the replication process of the virus, is advised for COVID-19 patients who are moderately sick and relying on oxygen supply. As the Indian Medical Council for Research (ICMR) has stated earlier that the drug should be administered within the first 10 days of the infection, it is beneficial only during the second to the ninth day of the illness and not after that, said the Maharashtra COVID-19 task force, headed by Dr Sanjay Oak.

"It only arrests the replication of the virus and therefore reduces the hospital stay and convalescence (recovery) of the patient by one-two days. This leads to a reduction in the hospital stay by two days at the most. It is possible to save patients even without Remdesivir," the task force said in the advisory. It added that though it would like to leave the decision to use the drug to the discretion of the treating doctor, it strongly advises against the rampant, irrational abuse of this drug.

Medical professionals worldwide have said that the Remdesivir should be administered in a hospital or a health care setting.

The Indian Medical Association (IMA) also recently urged the medical fraternity to ensure judicious use of Remdesivir in COVID-19 patients. The second wave of the pandemic has created an unprecedented demand for Remdsivir injection resulting in demand and supply mismatch and an artificial panic is created, the doctor's body said.

"This is resulting because of the non-judicious use of this drug in many places beyond the scope of its evidenced-based benefits. The public as well as the medical community must be aware of the absolute indication of the drug and need to use it judiciously so that the drug is used for those patients who will be benefitted," it said in a statement.

Early diagnosis on the pretext of contact or presumptive symptoms and immediate consultation with the doctor or hospital is the need for early recovery in COVID-19, it said.

"There has been a cap on the cost of the drug by the government, which is now available at a much less cost compared to 2020. The affordability of the drug makes the public demand its use for their kith and kin, even when there is not an absolute indication to use. This unjustified request must be resisted by the medical professionals, as the availability of the drug will be of more benefit to a patient who has an absolute indication," the IMA said.

It is the social responsibility of the citizens and medical ethics of the professional to maintain the availability of this drug for the citizens of the country, it stated.

"IMA invokes the public to adhere to the appropriate use of masks as it is equal to receiving a vaccine. IMA also requests people to venture out only when it is absolutely necessary and adopt physical distance and handwashing at all situations," it said.

With cases rising, the Union government on Tuesday also said that doctors should ensure "rational and judicious" use of Remdesivir, underlining it is to be given only to COVID-19 patients admitted in hospitals and is not to be used in home settings.

At a weekly press conference, NITI Aayog member (Health) Dr V K Paul said, "Remdesivir is to be used only in those who require hospitalisation and are on oxygen support. That is the precondition. "There is no question of its use in the home setting and for mild cases, and it is not to be procured from chemist shops."

Remdesivir is an intravenous drug that is administered as an injection. It is being developed by US-based biotechnology Gilead Sciences. It was first developed for the treatment of Ebola. It was subsequently used for the treatment of other coronavirus infections, the Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS), although it did not have any substantial effects. The benefits of using Remdesivir to treat COVID-19 is still being investigated. Amid conflicting reports from the World Health Organisation (WHO), India approved the emergency use of Remdesivir and listed it under investigational therapy (treatment not proven to be beneficial as it is still being researched).

Several pharmaceutical companies had obtained a voluntary licence from Gilead Science to produce a generic version of Remdesivir in India. Anticipating a huge demand, they had produced the drug in large quantities, However, the demand dwindled by September when the cases started dipping. It left the manufacturers with huge stocks of the drug, which they later reportedly destroyed. With the demand rising again, the Indian government stopped its export and capped the price.

(With inputs from PTI)

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