First patient treated with remdesivir discharged with tears, applause

By , Daily Memphian Updated: June 09, 2020 6:45 AM CT | Published: June 05, 2020 4:00 AM CT

Victories celebrated early in a pandemic represent what science knows at the time. Thursday, Patricia Myles, 49, one of the first people treated in the region with the experimental drug, remdesivir, was discharged from Baptist Memorial Hospital-Memphis, 21 days after the intravenous therapy started.

She floated through the lobby on the throng of good wishes from the staff, greeted a grandchild born during the pandemic for the first time and said her only memory of her weeks in the hospital is what happened in the last week.


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Myles was treated by Dr. Stephen Threlkeld, infectious disease expert at Baptist-Memphis. On Thursday, 31 COVID patients were hospitalized there.

“This is just a great person,” Threlkeld told reporters earlier in the day, “and a great family and very popular folks here. We’re very, very happy for these people.”

Remdesivir, which works by blocking coronavirus’ ability to reproduce itself, received widespread publicity in April when clinical trials showed it shortened recovery time an average of four days.

In six months, science likely will be celebrating completely different milestones in the battle against COVID-19 because little is known about how effective remdesivir actually is. Based on promising clinical trial results, the U.S. government released it for experimental use on May 1.

Methodist Le Bonheur Healthcare has also released a remdesivir patient from its Olive Branch hospital. Systemwide, it is administering the drug to eight others. Another died while receiving the therapy.

“The numbers are still too small to know if this is the best treatment option,” said Dr. Shailesh Patel, chief medical officer at Methodist-Olive Branch.

“It is too early to tell you if the medication is going to work wonders.”

All the data, including reactions Myles had, is being combined from patients on remdesivir around the globe and added to the clinical trials.

In a pandemic that has no vaccine or proven treatment, remdesivir, which is manufactured by U.S. pharmaceutical company Gilead Sciences, feels like a balm.

“Families are excited we have a treatment possibility,” Patel said. “They know we are doing everything we can; we are giving them every treatment option available. … It’s hope we are able to offer.”

Each state received doses that are being administered to patients who meet specific conditions. Tennessee has received 4,880 vials of remdesivir, enough to treat approximately 600 patients. As of Wednesday morning, 122 people had been treated, according to the Tennessee Hospital Association.

The criteria here were set up by a panel of physicians at Vanderbilt University Medical Center. Originally, patients had have had symptoms for 10 days, show serious blood oxygenation issues and be free of kidney or liver disease and other conditions that could cause death in six months.


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The Vanderbilt committee has since broadened it to 14 days of symptoms and lowered the oxygen rates, making more people eligible.

Baptist has treated 11 patients with remdesivir thus far and two more were to start treatments Thursday night.

“Most people really don’t start to become very ill until between Day 8 to 11 or 12,” said Dr. Amber Thacker at Regional One Health, which has been using the drug for about 10 days.

“It’s not a cure, the mortality is still there,” she said. “But, it’s the first time we have something with some tangible data. It’s not strong data, but it’s not terrible. It’s much better than what we’ve had to this point.”

Myles was admitted to Baptist-Memphis in mid-May and had already been treated with Tocilizumab at another hospital to “calm down the immune system,” Threlkeld said.

“When people are going along with this infection for a week or 10 days or so, sometimes they just go over the falls. The reason they do is that their immune system just goes crazy and gets ramped up and damages the person. … You set off a grenade in your own foxhole and you have a problem. That’s kind of what we’re talking about.”

She also received convalescent plasma – blood from a donor who had developed antibodies to COVID – and spent several days on an extracorporeal membrane oxygenation machine, which pumps blood out of the body and oxygenates it before pumping it back in.

Threlkeld spoke of her progress over the last two weeks in his briefings with reporters, reporting improvements that may turn out to be anecdotal, he said, but noting several weeks ago that even if the nationwide evidence on remdesivir is anecdotal, “there is a lot of it.”

Physicians seek approval to use remdesivir on a patient-by-patient basis. If approved, the medication arrives by courier from Nashville.

“The first day, it was a paper form,” Thacker said. “That took about a day to get approved. They’ve now made it an online process. It took less than 10 minutes to fill out the form. I had approval in 15 minutes.”

Myles received a 10-day dose along with antibiotics for other conditions.

Research published June 1 from a second trial showed a five-day dose had better results in people who were not as sick.

“What we took away from that was that the first one was in people who were severely ill and it seemed to have some impact in reducing recovery about five days,” said Dr. Jon McCullers, associate dean in the College of Medicine at University of Tennessee Health Science Center and chief pediatrician at Le Bonheur Children’s Hospital. “The problem, even with that, is we may do that exact same thing again and maybe it doesn’t have the same effect.

“It has to be repeated a number of times in different populations for us to really be able to say, ‘You’ll get five days early recovery on average.’ ”


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Speeding treatments to the public before they have been fully vetted is loaded with ramifications, he says, including the degree that patients or their families are able to weigh all the factors – and make informed decisions – in the face of death.

“We are offering it to very sick people and if I tell you, ‘We don’t have anything else, what are you going to do?’

<strong>Jon McCullers</strong>

Jon McCullers

“It’s ethically a difficult thing, which is why we call it compassionate use,” McCullers said. “You are relying on the doctor to give you the drug and then inform you, and we say, ‘We really don’t know.’ You are making the decision, but you are making it on a doctor advising it.”

Even though the restrictions on who may get remdesivir have loosened in recent days, people who are getting it still have little hope of getting better on their own.

“In many cases, there are questions of competence. Does your spouse or parent make the decision for you if you’re not competent because you are on a ventilator and so on? It’s very difficult,” he said.

The possible good thing about rushing through scientific trials and giving physicians access before the drugs are vetted is it gets drugs to the public faster, he said.

“But it also means we have a lot less certainty, and we may get some things out there earlier than they should be or when we don’t know enough information or even things that don’t work. Hydroxychloroquine is a great example.”

Thacker used hydroxychloroquine with the antibiotic azithromycin on a few patients in early April.

“And with most our patients, I had to stop it,” she said, noting heart rhythm irregularities the combination therapy caused.

“It didn’t look to us like it was making any kind of difference, and the combination of azithromycin wasn’t very tolerable to our patients.”

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Topics

Patricia Myles Baptist Memorial Health Care Dr. Stephen Threlkeld Dr. Amber Thacker Dr. Shailesh Patel remdesivir Gilead Sciences
Jane Roberts

Jane Roberts

Longtime journalist Jane Roberts is a Minnesotan by birth and a Memphian by choice. She's lived and reported in the city more than two decades. She covers healthcare and higher education for The Daily Memphian.


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