Remdesivir, a therapy for critically ill COVID-19 patients, is in short supply and as the number of patients hospitalized with the virus climbs in Kern County, doctors must make difficult choices about which patients receive it.
"If we have enough medication we’ll give it to everybody but that’s never the case. We always need more," said Dr. Hemmal Kothary, chief medical officer for Dignity Health's Central California division, including its three local hospitals, Bakersfield Memorial, Mercy Downtown and Mercy Southwest.
The Food and Drug Administration gave emergency use authorization on May 1 for the therapeutic. It's given intravenously and works by stopping replication of the virus. It has been shown to speed recovery time by 30 percent, or 11 days compared with 15 days, according to the California Department of Public Health fact sheet.
However, because the drug is in short supply, it's being allocated by the federal government. In California, the allocation is based on the most recent number of hospitalizations in each county, according to the state health department. Kern County so far has received 2,069 doses, according to the Kern County Public Health Services Department. Each patient requires a six- to 11-dose course of treatment.
"There is right now not enough of this product to meet demand," said Jan Emerson-Shea, vice president for external affairs for the California Hospitals Association. "Hospitals can’t go and buy it on their own. They do have to pay for it but the allocation from the state is provided to the counties based on hospital data."
Remdesivir is made by Gilead Sciences and was originally developed as a treatment for Ebola. The drugmaker is now ramping up production, Emerson-Shea said, and by fall supplies are expected to loosen up.
"We currently have doses for inpatients, but we are unsure about future needs and supply as COVID-19 dynamics are ever-changing,” said Dr. Parikshat Sharma, of Bakersfield Heart Hospital.
In the meantime, Kothary, of Dignity Health, said a team of doctors at each of its hospitals is assembled to determine which patients will receive the limited supplies it has. The team consists of ICU doctors, pharmacists, infectious disease doctors and a hospital chaplain.
"If we have three doses of remdesivir and five (patients) that need it, we’ll engage this group and it will help us decide who gets it," Kothary said.
The number of hospitalized COVID-19 patients in Kern's hospitals held steady this week, hovering around 240, but the number being treated in ICUs hit a new high of 68, according to state data.
Among all California counties, Kern ranks sixth for most COVID-19 hospitalizations, behind San Diego County, which has 388, and ahead of Fresno County, which has 242 as of Thursday.
Also in short supply locally is plasma from recovered COVID-19 patients that can be given to hospitalized patients to help fight the virus. Under a clinical trial with the Mayo Clinic that Dignity's hospitals are involved in, every COVID-19 patient in the ICU is eligible to receive plasma, Kothary said.
But like remdesivir, he said: "We have a lot of demand but we don’t always have the supply."
Houchin Community Blood Bank said Friday that so far 70 people recovered from COVID-19 have donated plasma, resulting in 233 units of plasma, but more will be needed.
Kothary said doctors have found patients respond best when given a cocktail of remdesivir, plasma and dexamethasone, a common steroid that a British study recently found helpful in combating COVID-19.
The situation with remdesivir is so critical that the state has issued guidance stating the hospitals are not to save any of the medication for future use if they have more than needed.
Kothary confirmed that local hospitals are working together on this front: Dignity recently had some remdesivir it couldn't use but Kern Medical could, so the medication was sent to Kern Medical.
Gilead Sciences has started testing an inhaled version of remdesivir that would allow it to be tried in less-ill COVID-19 patients to try to keep them from getting sick enough to need hospitalization, The Associated Press has reported.