COVID-19 treatments like remdesivir are in high demand but limited supply, so who gets them?

The ABC7 I-Team goes on the front lines with the decision-makers
CHICAGO (WLS) -- COVID-19 cases are still surging across large parts of the country, and as the vaccine remains a distant possibility effective treatments for the novel coronavirus are still desperately needed.

With high demand, limited supplies and many unknowns about current therapies for COVID-19 patients, medical professionals used to making life or death decisions face new and stressful challenges.

Many tough decisions are made and experimental treatments are carried out in the COVID ICU.

"When you look at the criteria, I know I'm a miracle," said Paulette Foster, COVID-19 survivor.

Foster, who lives in Hazel Crest, was one of the first patients at Northwestern Medicine in Chicago to receive the highly sought anti-viral remdesivir.

A minister and counselor, she went to the ER in March with abdominal pain and was eventually diagnosed with COVID-19. She became severely ill, and spent 13 days on a ventilator.

Her husband had to sign off of remdesivir, which is shown to reduce recovery time by about one-third.

"I was in such a bad state at the hospital, so I really should not have been a candidate, but it was miraculous," she said. "I know it was the hand of God, and I do absolutely believe in the gift of modern medicine."

Foster qualified as part of a compassionate use trial for remdesivir. Several hospitals told the I-Team that despite the early chaos of COVID-19, they were able to develop effective protocols and criteria to vet patients for the few, fast-moving clinical trials for several therapies.

Treatment decisions at many hospitals involve a team approach, including pulmonary physicians, infectious disease doctors, nurses and critical care pharmacists.

Critical care pharmacists are vital players in the research and discovery of best medications for COVID-19 patients.

They investigate drug therapies from other countries, looking at new medications and different dosing strategies. As part of their responsibilities these pharmacists may be called on help with emergency responses. At Northwestern they analyze the long-term consequences patients may experience after spending weeks in the COVID ICU.

"There's a lot that goes on behind the scene of a care team that most people are unaware of," said Courtney Makowski, critical care pharmacist at Northwestern Medicine. "We definitely keep track every day to make sure that someone's been assessed for a trial every single day."

"Not every patient is eligible for medication because of things that are unique to themselves," explained Abeer Ammar, critical care pharmacist at Northwestern Medicine. "It gets very stressful and exhausting, kind of, waiting every single day like, is this patient going to get better?"

Limited supplies of remdesivir meant recipients had to be carefully selected. The U.S. government just secured more of the drug for another half million patients through September.

However, now it comes with a price tag: a five-day course of treatment will cost anywhere from $2,300 to $3,100.

How much will be made available for future use in Illinois is unknown, and doctors cautioned that experimental medications are not the right fit for everyone.

"We're not denying therapy," explained Dr. John M. Coleman, critical care pulmonologist. "We make the decision based on what their inflammatory markers look like, what their labs look like. Could the patient tolerate the drug? Where are they in the course of the disease and would this be a benefit. Do the risks outweigh the benefits? A lot of these therapies are new and evolving, and we don't have a lot of data to say they have safety."

But the data is starting to come in as investigational options are expanding. Doctors continue to test treating patients with convalescent plasma containing antibodies to help fight off the disease. Drugs already used to treat autoimmune disorders are showing promise in preventing severe complications. Scientists recently announced the drug dexamethasone, a common and inexpensive steroid, was able to reduce deaths by one-third for patients on ventilators.

"Different inclusion, exclusion criteria enabled us to sort of say that maybe one patient might benefit more from one drug or another," said Dr. Shivanjali Shankaran, infectious disease specialist.

She said selecting patients for these investigational drugs is not a one sided decision and in many cases family members are involved in the process.

Those who have been dealing with the disease the past six months stress this virus demands unconventional approaches.

"A very quick timeline in which we had to start things and make sure that we were doing it in the safest possible way is very different from other experiments or other investigational drugs," Dr. Shakaran said.

As COVID-19 cases nationwide continue to surge, at least doubling in the past two weeks, the demand for testing and treatment is also mushrooming. At the same time, there is a race to develop a vaccine. Worldwide there are more than a dozen different potential vaccines in human testing, with hope that at least one might work.
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