On 26 February, what seems like ages ago in the ongoing pandemic, the University of California Davis Medical Center in Sacramento finally got RNA test results confirming that a critically ill patient it had been treating for a week had coronavirus disease 2019 (COVID-19). (It took 4 days before the U.S. Centers for Disease Control and Prevention agreed to evaluate the patient samples because the person did not meet the strict criteria the agency then had in place, and 3 more days for the result to come back.) The patient, who for privacy reasons UC Davis physicans refer to only as they but who has been described as a woman by California's governor and state health officials, was the first likely case of U.S. community spread detected, meaning that the source of her infection was not known: She had had not traveled outside the United States to an infected area or been in known contact with a confirmed case.
The difficulty the medical center faced acquiring a test for its patient received widespread media scrutiny, but her fate largely escaped notice: After her condition declined, the UC Davis doctors secured what’s known as compassionate use permission from the Food and Drug Administration to test an experimental drug on their patient outside of a clinical trial. The drug, remdesivir made by Gilead Sciences, is given by an intravenous drip. Several randomized, placebo controlled trials of remdesivir for COV-19 are now underway in China and the United States and everyone is looking for quick hints on whether the drug works—a new preprint out today on the drug’s use in three COVID-19 patients is raising questions about its ultimate value.
Remdesivir cripples an enzyme called RNA polymerase that is used by many viruses to copy themselves; it does not specifically target SARS-CoV-2, the virus that causes COVID-19. But it worked well in test tube and animal studies of human coronaviruses, cousins of SARS-CoV-2 called severe acute respiratory syndrome and Middle East respiratory syndrome, that cause similar respiratory conditions. (Ebola also is an RNA virus, but a test of remdesivir in the Democratic Republic of the Congo last year showed that it didn’t work for that disease.)