
Is remdesivir the drug that can kill the coronavirus? - aluket
https://www.economist.com/science-and-technology/2020/04/17/is-remdesivir-the-drug-that-can-kill-the-coronavirus
======
elric
Previous discussion regarding how difficult it is to produce remdesivir:

[https://news.ycombinator.com/item?id=22783363](https://news.ycombinator.com/item?id=22783363)

------
m0zg
It's remarkable how a non-randomized study of Hydroxychloroquine is anathema,
yet a non-randomized study of Remdesivir that's paid for by its manufacturer
and written up by that manufacturer's employee is not. Hmm, I wonder why that
is. To top it off, it might actually have the same QT prolongation issues,
because some other antivirals have them.

That said, politics aside, I hope it works far beyond our wildest expectations
so fewer people die.

~~~
throwaway_pdp09
I'd like to know if there was any evidence or indication of the value of HQNN
before a certain president started spouting it. AFAIK the only reason we're
talking about it is because he did. If that's so then there's no reason to
pick HQNN as being special over any other drug. I suppose there's that very
dodgy french study, perhaps that's what started it all off.

~~~
gridlockd
Virologists generally agree that it is a plausible drug to treat COVID-19, but
will quickly point out that efficacy is unproven and we need to wait for
better studies.

Also, a couple of doctors who are regarded as "cranks" started applying it
early in the disease and presumably had success with. Trump picked up on that,
so now a lot of people have reason to hate on it. Trump poisoned the well.

No "proper" doctor is going to administer a dangerous drug to a non-critical
patient to prevent what might turn out to be a harmless course of the
diseases. However, that also means if these drugs work, but only in the
_early_ stages, then we won't find out any time soon.

~~~
Fjolsvith
> No "proper" doctor is going to administer a dangerous drug to a non-critical
> patient to prevent what might turn out to be a harmless course of the
> diseases.

This "dangerous" drug has been used in medicine for 60 years for probably more
than a billion or two people. I'm sure that a "proper" doctor faced with a
dying patient that is unresponsive to everything else is going to offer this
drug. Its a good thing that congress approved the Right To Try law.

~~~
panpanna
> This "dangerous" drug has been used in medicine for 60 years

Note that the doses required here are MUCH higher (one European hospital tried
1000mg doses) which is toxic. It can result in blindness, heart failure and
other issues.

~~~
Fjolsvith
If I was dying and nothing else was working, I'd accept the risk.

~~~
panpanna
But what if people died _because_ of the drugs??

[https://www.nicematin.com/sante/coronavirus-nous-avons-
deja-...](https://www.nicematin.com/sante/coronavirus-nous-avons-deja-du-
interrompre-le-traitement-de-hydroxychloroquine-azithromycine-au-chu-de-
nice-489118)

~~~
Fjolsvith
Its all French to me.

------
cheriot
> enough to supply more than 140,000 patients

> the firm has set an “ambitious goal” of producing more than 500,000
> treatment courses by October, and 1m by the end of the year

So no. Even if this is a cure, the pandemic gets worse before it gets better.

~~~
gridlockd
Global infection rate has stabilized, it's not getting "worse" in that sense.
At that rate, there won't be much more than another doubling.

If 80% of those infected do not need treatment at all, that amount of courses
may well be sufficient, or close to it.

~~~
jhayward
I think this makes the mistake of thinking there is such a thing as a global
infection rate. There are instead a couple of hundred separate epidemics, each
with its own R0 and trajectory.

It’s also dangerously wrong, but human nature, to look at the current state of
epidemics and project their future state. Epidemics that have been suppressed
rather than extinguished resemble unstable explosives. Just because they’re
sitting there nicely today doesn’t mean they won’t explode 3 seconds from now.

~~~
gridlockd
There is a global average infection rate. Of course it's just an average, but
is representative of the growth of global cases. Of course you can arbitrarily
divide this down from hundreds of epidemics to thousands of outbreaks, but
we're talking about the _global_ supply of the drug.

> It’s also dangerously wrong, but human nature, to look at the current state
> of epidemics and project their future state.

I'm sorry, but in the real world you _have_ to make predictions in order to
make decisions. If you never make predictions you can always be right, but
then you'll always be useless.

> Epidemics that have been suppressed rather than extinguished resemble
> unstable explosives. Just because they’re sitting there nicely today doesn’t
> mean they won’t explode 3 seconds from now.

An "explosion" in that sense will still take weeks to become critical, giving
you time to react, assuming you have testing and tracing capacity.

~~~
jhayward
> _I 'm sorry, but in the real world you have to make predictions in order to
> make decisions._

I'll overlook the implication that I don't live in the 'real world'. What the
statement means is that just because you're fine today you can ease up,
because you really don't like the shutdown. You're still standing in an
explosives factory, and now propose to shoot off bottle rockets just because
nothing bad has happened today.

In the real world, you look at conditions as they are. In this case, those
conditions are that the virus is still epidemic and there are none of the
preconditions necessary to contain it present in the US, at least, and also in
most of Europe.

> _assuming you have testing and tracing capacity_

Where is it that you are describing, since you are 'in the real world'?

Here in the US there is no where that I am aware of that has sufficient
testing and tracing capacity to deal with a 3-week old exponential outbreak.

------
prox
Like the article says, there have been some hopeful anecdotes, but that is a
long way from an effective cure and rigorous testing phase. Aka to early to
tell.

------
Protostome
what is dead may never die

------
tinus_hn
Probably not because it was suggested months ago already, so if it was a
magical solution we’d know by now.

~~~
kmlevitt
Actually no we wouldn’t, because real clinical trials with thousands of
subjects take a long time to wrap up, even when researchers are working at
breakneck speed.

FWIW The anecdotal evidence from doctors and patients who have managed to get
a hold of some of it has been very good so far.

~~~
confiscate
yes but, if in a trial, if one arm performs substantially different than the
control arm (e.g. 50% or even 100% lower death rate), the large difference
between arms can lead to investigators ending the trial early

ironically, this happened in a previous 2019 trial of Remdemsivir, for a
different virus, Ebola

in that trial, 4 drugs for Ebola were tested, including Remdemsivir. 2 non-
Remdemsivir drugs succeeded substantially--the large difference between those
drugs and Remdemsivir, was enough to cause the investigator to end the trial
early and drop Remdemsivir

ironically, the investigator for that trial was none-other-than Dr. Fauci.
Maybe that's why he hasn't mentioned Remdemsivir much on TV these days, based
on his past professional disappointing experience with Remdemsivir

also, double ironically, Remdemsivir was initially designed to treat Ebola
virus, not for flu or coronavirus type viruses. The fact that after the Ebola
trial, Remdemsivir was declared not that effective for Ebola (the very virus
Remdemsivir was created for), means there is even less of a chance Remdemsivir
will prove to be effective for Covid-19 in the current trials

[https://www.sciencemag.org/news/2019/08/finally-some-good-
ne...](https://www.sciencemag.org/news/2019/08/finally-some-good-news-about-
ebola-two-new-treatments-dramatically-lower-death-rate#)

~~~
confiscate
as an extreme example

if Remdemsivir cures 100% of all Covid-19 cases, halfway through the trial,
they would have enough data to show a net positive benefit. They don't need to
finish the whole trial to declare Remdemsivir useful

the fact that they are running the whole trial to finish, most likely means
the effect of Remdemsivir is not too noticeable. They need more data to get to
statistical significance. Hence, they want the trial to run to original
planned finish date.

my guess is

Remdemsivir probably has some positive effect. Say, 10% lower death rate if
used during 1st few days of infection. Still great, much much better than our
current situation of nothing. It would not cure Covid completely, but it would
help substantially, especially in large populations of infected

~~~
kmlevitt
Looks like you may have been right. Oh well, I hope it at least helps people
at the early stages of the disease.

