Some days ago, when I saw the headlines stating that the World Health Organisation (WHO) had dropped the antiviral drug remdesivir from its official list of approved medicines to treat COVID-19, I thought my eyes were playing tricks on me, possibly one of the after-effects of the novel coronavirus. The organization went so far as to say it should not be used to treat hospitalized COVID-19 patients no matter how severely ill they are since it doesn’t reduce mortality or the chances of patients being put on a ventilator and is therefore not worth the high cost or the side effects.
Normally, I would have read this news without reacting, but my shock is a result of my traumatic experience last month. Six people in my household including myself contracted COVID-19. We were knocked out by the virus, and my mother was in the hospital on oxygen support for 12 days. Thanks to brilliant doctors, God’s grace and the timely administering of Remdesivir to my mother, who is 72, severely diabetic and had recently undergone chemotherapy, we have all come out of this relatively unscathed.
The WHO based this decision to disqualify the antiviral on data gathered from its Solidarity trial—across 12,000 patients in 500 hospitals in 30 countries. Dr Subhash Hira who is on several global scientist panels of WHO on COVID prevention voiced his concerns, “I have raised issues about the design of the Solidarity trial done to evaluate the effectiveness of a medicine. They have only looked at two broad criteria: The number of days in hospital or whether a patient died or came out alive. That is a macro level of doing a data collection. In a clinical trial, several variables must be looked at. This trial does not have the strength to determine whether it is a useful drug for the treatment of symptoms of COVID or not.”
By dropping remdesivir from its pre-qualification list, the WHO has added to the confusion around the novel coronavirus, especially for developing nations who use the list as a benchmark for procurement. However, Indian doctors are more likely to make decisions based on their own experiences.
Doctors attend a patient suffering from COVID-19
A leading doctor at the forefront of the COVID war in India, Dr Hemant Thacker explains, “Out of the 300-plus people that I may have used this drug on—I have put 20 of them on the ventilator. So 85 per cent did not go on the ventilator. Whether you want to say remdesivir did that or other things contributed to it, it is an important building block in the armamentarium against COVID. Along with steroids and antibiotics for secondary infection and blood thinners”.
Remdesivir may not be an elixir that magically cures COVID but, clearly, from my family’s experience and that of several friends and acquaintances, there is evidence that it helps in keeping many people off the ventilator and therefore does help prevent mortality, contrary to what the WHO says.
Dr Thacker explains, “When the fever is relentless, accompanied by bad lab parameters and a CT scan showing more than 30 per cent lung involvement, I would not wait. I will start remdesivir. If you start early you prevent the patient from going into complications, which is seen on the seventh or eighth day.”
Unfortunately, a small per cent of COVID cases have to be put on a ventilator because of the cytokine storm, where the immune system goes into overdrive and attacks its own tissues leading to multi-organ failure. Dr Thacker explains, “The tragedy of the coronavirus is that in 1-2 per cent of patients it is a relentless progression. Nothing can punctuate it. For those 1 to 2 per cent, I am not going to hang up a drug where I have seen 85 per cent of those patients that I have put on remdesivir, not worsening. Just now I probably have 30 patients admitted under me. Out of those about 12 are on the drug. They will soon go home. My judicious use of remdesivir has helped me and I am going to continue using it irrespective of WHO’.
Having gone through Covid with my family, I feel the WHO is misleading the public. When my mother and I and other family members tested positive for COVID-19, some of us had a high fever and extreme fatigue. My mother’s fever remained low grade and we were relieved that she’s getting away lightly despite her co-morbidities and age. Though she was on steroids, the antiviral drug Favipiravir, and antibiotics, on day 10 her fever climbed to 102 and her oxygen saturation dipped to 94/93. A short walk from the bedroom to the living room made her saturation drop further to 91. Our GP, Dr Vishakha Shivdasani, took a swift and timely decision to have her admitted to Bhatia hospital immediately where she was put on oxygen support. The very next day she started a six-day course of remdesivir as her CT scan showed advanced COVID pneumonia. There were times her oxygen saturation fell to 83/84 when she walked a bit. However, by the sixth day of remdesivir and other medications, she was stronger and started weaning off oxygen and was home after 12 days and off oxygen completely.
In Goa, around the same time, my friend Oscar De Lima, in his 40s, tested positive for COVID-19 along with six of his friends. When his fever of 103 did not break for a week, and his CT scan showed that the infection had travelled to the lungs, he knew hospitalization and probably remdesivir was imminent. After researching online and seeing the WHO’s updates, he was extremely apprehensive about the drug. However, when he reached the hospital, seeing his debilitation Dr Vikram Dalvi, at the Manipal Hospital, Goa, informed him that they would start remdesivir the next day and he would get respite after 48 hours.
“I was going half-heartedly to the hospital. I had read many negative things about remdesivir. On day 3 of the medicine, I started getting small spates of relief. After that, it was a very quick recovery all the way. There was no turning back. I recovered well with no after-effects. No breathlessness. No cough. I don’t know what I would have taken if it wasn’t for remdesivir,” says Oscar. He drove himself home after eight days in the hospital. Five of the seven friends who tested positive were hospitalized and administered remdesivir—all of them are back at work now.
Doctors warn that while it is not an antidote designed for the coronavirus, it should not be dismissed as ineffective. Besides, there’s no alternative antiviral for moderate to severe cases right now.
It’s no secret that the WHO has an axe to grind with the US and President Donald Trump after he criticized their handling of the pandemic and subsequently withdrew US funding to them. WHO decided to take the antiviral off their approved list barely a month after remdesivir was the first medicine to be approved by the USFDA to treat the novel coronavirus—and a month after Trump was given the drug.
According to an infectious disease specialist who worked with the WHO on their HIV/AIDS prevention and treatment project, the implementation of a clinical trial and declaring a drug unsatisfactory is way out of the WHO’s mandate. It is a public health, regulatory and program development organization. They don’t have FDA-level scientists.
Fortunately, both the US FDA and the Indian Council of Medical Research (ICMR) have approved of remdesivir for the treatment of COVID-19, and these individual sovereign agencies have the final word. However, patients tend to consult Google as much as they consult doctors, and reading strong statements from the WHO will naturally create conflict in their minds. Dr Hemant Thacker says, “Today when you give it [remdesivir] to a patient they raise queries. We tell the patient—please sign a declaration saying that you don’t want to take remdesivir.” He adds, “If one of the WHO senior staff got COVID-19, I would like them to refuse remdesivir. Then I know there is conviction.”
One of the issues raised was the high cost of the drug. However, on humanitarian grounds, Gilead had licensed several pharma companies in developing nations to manufacture generic versions royalty-free. This has reduced the price considerably in India, with it being as low as Rs 2,200 for a 100 mg injection. On being asked whether the WHO’s decision will deter people from using remdesivir in India, Y.K. Hamied, the Chairman of Cipla—which manufactures the drug under the name Cipremi—said, “No, it won’t affect the use in India, until some other medication comes up which is better. Today there is limited choice. Remdesivir has helped many Covid patients in India. It has to be used early and not when the condition is severe.”
Medical experts believe the WHO should focus on giving guidelines to control transmission and not go beyond its scope. Let scientists have the final word, not politicians and administrators. Even though the vaccine is within sight, the virus is still raging and claiming thousands of victims each day. “Amongst all the drugs that have been tried if there is one drug that comes back to the prescribing pen, amongst the antivirals, it is remdesivir’, says Dr Thacker.
Let’s not sacrifice health and precious lives at the altar of politics and revenge.
Anushka Jagtiani is a former TV journalist with NDTV, where she covered heath and pharma, and presently works as a freelance writer. She holds an MSc in Comparative Politics from the London School of Economics.
The opinions expressed in this article are those of the author’s and do not purport to reflect the opinions or views of THE WEEK.
