The Arizona Senate has passed legislation which would prohibit a hospital or health care provider from imposing any treatment for COVID-19 or a variant but the bill has stalled in the House where Speaker Rusty Bowers has not scheduled it for its First Reading.
According to sponsor Sen. Nancy Barto, the legislative intent of Senate Bill 1393 is to confirm that public policy makes it “a fundamental right” to refuse any COVID-19 treatment or vaccination. Yet despite clearing the Senate on March 15, House Speaker Rusty Bowers has yet to allow the bill to have its First Reading in that chamber.
SB1393 would allow health care providers to ask a patient to specify in writing the circumstances under which the patient would accept a COVID-19 treatment if the patient cannot later express his or her consent. For purposes of the proposed legislation, a health care provider is defined as a licensed physician, a licensed nurse practitioner, or a licensed physician assistant.
The bill also requires a hospital or health care provider to ensure a patient who refuses a COVID-19 treatment is counseled and given information on other treatment options. No treatment could be mandated without a patient’s informed consent.
In addition, a patient orimmediate family of the patient would have to be advised of the patient’s right to leave a hospital; immediate family is described as a patient’s spouse, parent, child, sibling grandparent, or legal guardian.
Barto’s co-sponsors on SB1393 were Senators Sine Kerr, David Livingston, and Warren Petersen. The bill was supposed to be heard by the House Judiciary Committee on Wednesday morning, but without a First Reading that could not occur.
The Arizona Medical Association and most of the state’s hospitals oppose the bill.
Remdesivir: the only FDA-approved treatment for COVID-19. It’s an antiviral drug that the federal government touts as an effective and safe treatment for COVID-19 hospitalizations. However, the opposite may be proving true.
Despite governmental reassurances of remdesivir’s safety and efficacy, there continue to be reports and studies that indicate otherwise.
The FDA granted full approval to remdesivir – or, Veklury – on October 22, 2020. It wasn’t a new drug developed for this virus. Remdesivir was developed years earlier in 2009 by Gilead Sciences to fight hepatitis C and respiratory syncytial virus. At that point, remdesivir was known as Adenine C-Nucleoside, or GS-5734.
In 2014, remdesivir was given another opportunity to be deployed with the 2013 to 2016 West African Ebola virus. They received backing from the U.S. government for this effort. Before remdesivir could be implemented widely, the Ebola outbreak had subsided. Then the drug received another opportunity to treat Ebola in a 2018 outbreak. However, remdesivir failed to improve survival rates. Instead, a different treatment with a familiar name increased survival rates – monoclonal antibody therapies.
Over the past four years, the National Institutes of Health (NIH) has awarded Gilead Sciences just under $6 million in research grants for remdesivir. These grants were for researching its efficacy against MERS-CoV and any emerging coronaviruses.
It was after remdesivir’s failure to make a significant impact in the last Ebola outbreak in 2018 that Gilead Sciences looked to repurpose the drug. When the COVID-19 outbreak occurred, that became another opportunity for the experimental antiviral drug.
Since remdesivir had around a decade of research and trials behind it, Gilead Sciences was able to quickly submit its preclinical data and initiate further clinical trials to obtain an emergency use authorization (EUA) in May of 2020.
With nearly a year of full FDA approval, there exists more data and research on remdesivir.
More FAERS deaths than hydroxychloroquine and ivermectin:
The FDA Adverse Events Reporting System (FAERS) reports that remdesivir has caused nearly 1,500 deaths from 2020 to present. A total of nearly 6,000 cases, over 4,500 of them considered “serious.”
By comparison, hydroxychloroquine has just over 1,100 deaths, with over 14,150 cases from 2020 to present; just over 13,500 cases were considered serious.
Ivermectin had the lowest FAERS reports: under 30 deaths last year and this year, with nearly 430 cases and under 200 of those considered serious.
FAERS only has data for remdesivir from 2020 to 2021, when it was first used as a therapeutic treatment for COVID-19. In contrast, FAERS has tracked hydroxychloroquine for 35 years, and ivermectin 25 years – neither are FDA-approved as a treatment for COVID-19.
The current narrative around ivermectin paints the antiviral as ineffective at best and deadly at worst (in the case of overdosing or taking the version designed as a horse dewormer). Thursday, Banner Hospital told news outlets that they were experiencing heightened cases of ivermectin poisoning. They reiterated that ivermectin wasn’t FDA-approved and shouldn’t be used to treat COVID-19.
“Ivermectin is not an FDA-approved treatment for COVID. Clinical trials are ongoing to assess ivermectin for COVID, but no clear findings have been released that confirm this drug as a safe or effective form of treatment for COVID. For this reason, it is not currently a drug that Banner hospitals or providers will prescribe,” stated Banner Hospital.
Yet, doctors are still prescribing ivermectin – along with other non-FDA-approved treatments like hydroxychloroquine, azithromycin, and monoclonal antibodies.
A higher cost and financial incentive:
Whereas both hydroxychloroquine and ivermectin are available in generic brands over the counter for low prices (as low as under $20 for the former and under $30 for the latter, according to the latest deals we could find around press time), remdesivir doesn’t have a generic alternative and is only available to hospitalized patients.
Remdesivir costs $520 a vial, or $3,120 for a patient with private health insurance undergoing the typical six-vial treatment course. For 2020, Gilead Science reported around $24.35 billion in sales.
By comparison, the EUA-only monoclonal antibodies from Regeneron (REGEN-COV, a combination of casirivimab and imdevimab) cost less: around $2,100 per dose. The federal government covers that cost. Any costs to the patient would have to do with administration of the treatment; those costs can vary per health insurance.
Hospitals have a financial incentive if they administer remdesivir. The Centers for Medicare and Medicaid Services (CMS) gives hospitals a New COVID-19 Treatments Add-On Payment (NCTAP), a 20 percent bonus for any remdesivir treatments.
Mixed results on efficacy and safety:
Research on remdesivir’s efficacy and safety have arrived at mixed conclusions.
Some studies cast doubt on its safety, citing findings of adverse effects including respiratory and organ failure, low potassium, low red blood and platelet cell counts, gastrointestinal distress, low blood pressure, nausea, and vomiting. A pervasive concern has focused on remdesivir’s connection to kidney failure in COVID-19 patients.
Johns Hopkins Medicine speculated last May that COVID-19 itself might be the culprit for kidney damage or failure. That was published several weeks after remdesivir received its emergency use authorization (EUA) from the FDA.
In July, a study found that veterans who received remdesivir experienced longer hospital stays than those who didn’t. They also found no difference in mortality rates between those who received remdesivir and those who didn’t.
Some research abroad has concurred with these findings. A German study released last month stated that they weren’t confident in remdesivir’s ability to reduce or prevent intubation or mortalities.
In February and April studies, French researchers reported a correlation between remdesivir and kidney failure. A January review of remdesivir published by the American Society of Nephrology suggested that remdesivir not be administered to COVID-19 patients due to the kidney failure that occurred in animal testing.
And then there are the anecdotal reports of remdesivir’s impact. State Senator Kelly Townsend (R-Mesa), reported that two law enforcement officers were denied their choice of treatment – either ivermectin or hydroxychloroquine – and were instead given remdesivir. Shortly after, Townsend said that the two officers died due to kidney failure.
“I have asked @dougducey’s office for consideration re people’s right to try Ivermectin or HCQ [hydroxychloroquine] but are being denied while in hospital. A healthy border patrol agent just died who was denied access to potentially life-saving treatment & now a retired female Tucson police officer. She is on a ventilator,” wrote Townsend. “Both given Remdisivir, both have/had kidney failure. This denial of meds is criminal.”
Other studies say that the remdesivir may be more helpful than harmful, or that its benefits outweigh the risks.
Last October, the European Medicines Agency (EMA) launched an investigation into the potential link between remdesivir and acute kidney failure. After several months of research, they concluded that remdesivir wasn’t connected to kidney failure in COVID-19 patients.
The Journal of American Medical Association (JAMA) Network sought to reconcile the conflicting reports of remdesivir being both useful and ineffective, in a report issued in July. They determined that those receiving remdesivir in real-world hospital settings were more likely to be more severely ill than those who received it in a randomized, controlled hospital study.
Remdesivir’s drug information sheet doesn’t mention kidney damage or failure as one of the adverse reactions discovered in their trials.