Long-awaited COVID-19 antiviral drug remdesivir arrives in Minnesota

Minnesota state health officials received a long-awaited shipment of an experimental antiviral drug used to treat COVID-19 patients Tuesday that could benefit 180 to 325 patients.

The drug, remdesivir, which is donated by the manufacturer and distributed by federal and state governments, is still in short supply even though it was approved for emergency use May 1.

For the past three weeks, Minnesota has been allocated only enough vials to treat 80 to 140 patients, depending on dosages needed. In two of those weeks, no states received any shipments, and the federal government has said there will be none next week.

"We are not giving remdesivir to everybody that we want to give it to, and that creates a difficult and painful situation," said Dr. Frank Rhame, a virologist at Allina Health. "It is in excruciating high demand."

The drugmaker Gilead Sciences Inc. said it's working to meet the global demand for the drug, which can cut recovery times by 30%; it expects to produce enough to treat 1 million people this year.

The Minnesota Department of Health said it distributed most of what it received this week to hospitals.

Since the shipments began in early May, Minnesota has received 7,800 vials or about 1% of the doses distributed nationwide. The allocation is based on patient hospitalizations, and states that have seen a rise in patients, such as Arizona, got a larger allotment this week.

Although most people who are infected with the new coronavirus recover without needing medical attention, people with underlying health conditions are most likely to need to be hospitalized.

Of about 2,400 Minnesota patients, 79% had at least one existing medical problem, such as hypertension, cardiovascular diseases, diabetes and obesity, according to the Health Department.

The number of people needing hospital care in Minnesota has been steadily decreasing throughout June, with 181 people in intensive care beds and 170 in general hospital beds as of Wednesday.

"The trends reversed last week," said Soumya Sen, an associate professor at the University of Minnesota's Carlson School of Management who tracks hospitalization trends.

"The more people in intensive care the more the need for the drug," he said.

The drug has been shown to cut recovery times from 15 to 11 days. While most clinicians acknowledge that the improvement is not a huge benefit, it would be important if there were a hospital surge because it could free up beds faster.

"We would be able to treat more patients and save more lives," Sen said.

Since the drug was first distributed, about 690 people have needed intensive care, he noted. The supplies Minnesota has received were enough to treat 700 to 1,300 patients, although patients who are not in intensive care do receive the drug in some cases.

Since delivery of the medication has been spotty, hospitals have been forced to ration the drug to those who could benefit the most using an ethical framework developed by the Health Department.

"You pick the people who are earlier in the disease," Rhame said. "Some of them are not in the ICU."

To avoid any favoritism toward certain patients, each hospital is asked to set up a triage team that will make decisions about who gets the drug separate from the treating physician.

"We go through our patient lists every day that we've got the drug in supply," Rhame said. "And then the next couple days you don't have any left and you can't give it to anybody."

Dr. Sarah Lim at the Health Department said she is concerned about what will happen when the drug distribution program ends in two weeks.

"I would say we are more concerned about whether the supply from [the federal government] will stop after this last expected shipment and whether there will be a gap in availability," she said. "I have reached out to Gilead but they were unable to provide any answers."

The drug is expected to be available commercially if it receives approval from the Food and Drug Administration and would no longer be considered experimental.

With 31,296 confirmed COVID-19 cases and 1,325 deaths in Minnesota, state health officials Wednesday reported 419 new cases and 12 deaths, including 10 in long-term care facilities.

But the new case counts were inflated because of a lag in reporting test results to the state by a private laboratory. Officially, the number of tests processed Tuesday was more than 19,500, a one-day increase of more than 13,000 tests.

However, state health officials clarified that the tests could have been run anytime from Saturday to Monday.

About 27,400 who were known to have been infected have since recovered and no longer need to be isolated.