1/n Listen up: I am no huge fan of Remdesivir (full disclosure, I own GILD stock) but if its going to work, it has to be given early
2/n But that means LOTS MORE TESTING AND EARLY INTERVENTION particularly in high risk people (that we know). So, the FDA approval can only work if a LOT more testing was available.
3/n That, in turn, means the number needed to treat to save a life will go up...and that's a decision that we need to take as a society. Right now, it's the ONLY drug that's been shown to work (leave aside the late stages of severe disease).
4/n Which means that the medical community needs to come up with reasonable guidelines, while we MASSIVELY increase testing during this opening of the country
5/n Which in turn means 1. publish the damn paper. 2. do a post approval (Phase 4) study in early patients stratified by risk )3. Continue masking, social distancing and hygeine 4. Get an evidence based solution from docs about how to use Rem in patients
6/n And that in turn, means that combination studies, cocktails etc are esp important during this time. I don't know how to incentivize docs to study this, but its critical
7/n So, now is the time to be even more VIGILANT. As I said, maybe Remdesivir in a cocktail will turn the course of the pandemic. AZT in a cocktail did. But this is the time to get to work, people. Post approval studies are crucial.
8/n I'll continue this thread. But last week, there was a critically ill patient -- vent, pressors etc -- and the hospital administrators were like: Remdesivir. Thankfully, we enrolled in a trial of T-reg cells. But lets get guidelines.
9/n For late stage patients, adding a (mild) anti-viral sounds ridiculous. But maybe a cocktail with Remdesivir for early stage patients ? Let's be rational, and we can #BUYUSTIME for the arrival of a vaccine.
