Chou Pai-chien, the director of Thoracic Medicine at Taipei Medical University Hospital, explains that Remdesivir acts by disrupting the virus’ RNA polymerase (an enzyme used by many viruses to copy themselves) to prevent the virus from proliferating, but it has to get into cells to be effective.
There are two major challenges to overcome if remdesivir is to go mainstream – the timing of when to administer the drug and testing in clinical trials.
Challenge No. 1: When to Take the Drug
It usually takes most anti-viral medications at least seven days to clearly be effective in bringing down a fever. “To say it can break a fever in one day is overestimating its capability,” Chou said, suggesting that the results described in the New England Journal of Medicine study may have been because the drug was administered at just the right time.
As with many experts, Chou believes about 80 percent of novel coronavirus cases are relatively mild and would not require the use of remdesivir, and the drug may lead to side effects that are not yet known.
The problem is, however, that patients with severe bouts of COVID-19 can quickly develop pneumonia, have trouble clearing phlegm, and can have large amounts of mucus enter their bronchial tubes, and if remdesivir is administered too late, its effectiveness will be diminished.
So when should the drug be given to patients? Should it be used as soon as COVID-19 diagnosed or when pneumonia appears? The answers to these questions will influence dosages, but they can only be obtained from clinical trials, which will determine whether or not the drug can, in fact, suppress the virus.
Challenge No. 2: Insufficient Trials
Another issue is whether remdesivir can actually reach the 1,000 tests in clinical trials. The patients in the trials not only have to meet strict screening conditions, such as not using other medications, their lung ailments also must be caused exclusively by the novel coronavirus. If participants are not recruited quickly enough, it would delay when participants are “unblinded,” or told what treatments they received during the trial, and push back the timing of the results.