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Comment by vanilla-almond | Hacker News Reader

Gilead signed a billion dollar deal with the EU Commission for Remdesivir on the 8 October.

However, Gilead apparently received the WHO study on 28 September and so were aware of the conclusions of the study before they signed a deal with the EU Commission.

This naturally leads to further questions, as discussed in this tweet thread:

https://twitter.com/kakape/status/1317042940825436162

Edit: Martin Landray, professor of medicine and epidemiology at the University of Oxford and leader of the UK-based Recovery trial also has a good summary of the WHO trial:

https://twitter.com/MartinLandray/status/1316989951297396736

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I'm not sure that anyone ever _really_ thought it improved survival. Just cutting time in hospital would be useful enough.

You generally spend time in the hospital when your condition is critical. So, if it cut hospital time, it would improve survival.

Or kill you faster.

Dead people don't spend time in the hospital. Therefore, being dead improves survival.

I assume they track hospital time by the discharge date, the deceased would be classified separately.

I'm not making any assumptions.

I don't understand what you're doing. For more clarity, I'll change my statement to

>So, unless you die, if it cut hospital time, it would improve survival.

That doesn't makes sense to me, it can make recoveries faster, while still making dying faster or slower, and still have the same mortality. They are all independent consequences

Every day that you are in critical condition carries a relatively high risk of death. Beyond that, hospitals are full of other diseases, and staying in one when your immune system is already taking a beating is dangerous.

The drug may have some negative effect on the chance that you'll die each day, but it is unlikely that the effect would be strong enough to prefer spending more time in critical condition. And getting cured faster will allow your immune system to be more able to fight off other risks.

>So, unless you die, if it cut hospital time, it would improve survival.

Maybe that's what usually happens. It's not hard for me to imagine that it could improve survival for some, but has fatal side effects for some percentage. The numbers could be arranged so that survival doesn't change but average hospital stay is lower. Is this the case? Probably not, but I have no idea.

This too is my recollection of the initial clinical trial results — shortened course of disease but no indication of improved survival. The new WHO study reinforces the initial evidence but is not new news.

Edit: The closest Gilead has come to suggesting a survival advantage from Remdesivir was a comparative analysis presented in July [1]. The analysis was highlighted as inconclusive because it wasn’t a double-blinded placebo-controlled study, which is the gold standard for clinical trials.

[1]: https://www.bloomberg.com/news/articles/2020-07-10/gilead-s-...

The biggest limitation to this drug is that it probably works very well IF given in the first 12 hours of infection when viral replication is highest.

The problem is that since it's intravenous, it's hard to justify giving it to people BEFORE they seem sick.

Naturally patients and doctors are pressured to treat the sickest patients first, and so they get the Remdesivir, despite it likely not doing much so late in sickness.

Ideally, if we could identify people highest at risk, and early in their disease - THEY should be given the drug very rapidly. ...but again, without that identification step, it's very hard to justify giving someone an experimental treatment.

Martin Landry: "People will argue about the need for earlier use (possibly) or that with even more data there may be a benefit (possibly - but where are those trials going to come from).

But the effect is modest at best - and so far there is no strong evidence it is there at all."

But it doesn't follow at all that because there is no effect when administered late, the effect, if administered early, is modest as best. In fact, there are many medication that are very effective if administered before the first symptoms appear and are completely useless after. If you get exposed to rabies, you can get a rabies vaccine and have close to no chance of contracting it, whereas if you get a vaccine after you develop symptoms, you're almost certain to die.

Similarly, the flu antivirals are somewhat helpful if taken early but have no effect if taken too late.

It's as if they're doing this on purpose. It is quite obviously pointless to administer antiviral drugs _after_ the cytokine storm sets in and the person is already dying.

Landray says in the same twitter thread:

"...Remdesevir is given by intravenous infusion for 5-10 days. It is not cheap. And supplies are limited (not surprising given scale of epidemic)."

This means anyone showing early symptoms is likely to require a stay in hospital for early administration of the intravenous infusion. There are questions about how scalable this is. Landray again:

"COVID affects millions of people & their families around the world. It is not a rare disease and we need scalable, affordable, and equitable treatment solutions."

Gilead was said to be working on an inhaled version (it can't be administered orally, because it is completely destroyed in the liver).

Medicine is definitely politics when its uncertain how much certain drugs really help.

One the one hand you could say: WHO has an unreviewed study that says "china early vaccine tests good, usa drug bad" and Gilead has a bunch of studies that say usa drug good.

On the other hand you could say: the studies wording is so fine tune that its hard to say if any are true.

Results:

- some side with their political/religious beliefs (and will downvote this probably)

- some are confused about what is true and admit they just don't know (I'm definitely there)

- some are a bit of both

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