New indications for remdesivir against Covid-19

THE initial indications for the use of the antiviral medication remdesivir in the treatment of Covid-19 have changed.

Doctors are now advised to administer it to high-risk patients with identifiable risk factors presenting early.

Initially, the medication was administered to patients with severe symptoms and those who were on oxygen support requiring ventilation.

This comes after the World Health Organisation (WHO) conducted further studies on the medicine, which showed it does not prevent disease progression, but rather reduces viral replication.

“By reducing the viral load, the idea is to reduce the chances of severe disease,” Windhoek-based lung specialist Dr Willie Bruwer says.

He says identifiable risk factors include diabetes, being overweight, certain inflammatory markers and others.

“So, we look at pretty much everything, and then we try to decide who are the ones we think are going to experience possible disease progression, and for those patients we give remdesivir,” Bruwer says.

He says early administration of the medication is important, because when given too late it makes no difference.

“The sooner you give it, the better,” he says.

One challenge posed by this indication, he says, is that remdesivir can only be administered intravenously, meaning patients would need to be admitted to a hospital.

However, because they are not severely ill, they are not likely to be admitted.

“Most of those patients don’t end up getting beds in the hospital, because they are not that sick yet,” Bruwer says.

Namibia initially procured the drug in September last year for emergency use.

At the time of its procurement, its use was controversial as it was not recommended by the WHO.

Namibia has reportedly ordered 3 000 ampules of remdesivir at a cost of more than N$3 million.

While the treatment is available at both state and private facilities, it is expensive.

Lady Pohamba Private Hospital pharmacy manager Nardia Coetzee says a full course of remdesivir treatment requires six 100 mg vials of the drug.

“Depending on the brand it can cost between N$1 100 and N$1 800 per vial,” Coetzee says.

It is, however, covered by most medical aid schemes, she says.

Infectious disease specialist Dr Gordon Cupido, who is also the head of internal medicine at the Katutura Intermediate Hospital, says the drug has been controversial, because of a few unsuccessful applications.

It is also not recommended by the WHO, Cupido added.

“Its a drug that’s been around for a while. It has been tried on other viruses, such as Ebola, and has proven to be unsuccessful. However, it has shown to be active against this coronavirus.

“But it does not improve survival, it reduces the length of stay in hospital if it is administered early,” he says.

Cupido says remdesivir is not a vaccine, nor is it an immune therapy.

He says although these treatments are available, precaution should still be taken to avoid contracting the virus altogether.

“So the best thing for people to do is not to get infected.”

Health minister Kalumbi Shangula reconfirmed that Namibia has used remdesivir and will continue to use it.

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