We’re in a global pandemic unlike any we’ve seen in many decades—since the HIV epidemic, really. And because we’re watching the global numbers of people who’ve contracted COVID-19 rise exponentially, and death rates follow along that upward path, there’s a lot of fear and desperation.
Simultaneously, here in the United States, the public is getting conflicting messages from the White House, federal public health officials, state and local officials, and medical research leadership. Do we shelter in place or go back to work? Masks or no masks? What treatments show promise of helping people who are sick with COVID-19? The answers are all over the place.
Now, with several clinical trials underway, we are beginning to report findings on possible COVID-19 therapies, and things are becoming even more confusing. Particularly for the public, which is getting very mixed messages about what they should be doing to protect themselves, how and when to get tested, and what treatments are showing benefit or not.
Because of this confusion, it is more critical than ever that news organizations really use sound judgement regarding what “news” they report on these scientific research updates, and how they report it. While it may benefit our bottom lines to be first to publish (these days, we all are chasing Google’s algorithms for our content to land on the coveted first page of search items), the public is getting conflicting information in the midst of a pandemic—and that is a reason to report with strong caution.
The latest case in point involves the drug remdesivir. The drug, developed by Gilead Sciences, is one of the most anticipated therapeutics now being studied in the treatment of COVID-19, for which no other drugs so far have shown to be effective in randomized clinical trials. (Such trials, which compare a drug to a placebo group, are the gold standard method to really determine if a drug is in fact effective.)
On the same day, April 29, we got two very different pieces of news on this drug.
New Remdesivir Research: One Study Taketh Away
On the morning of April 29, The Lancet lifted an embargo several hours early on a randomized, double-blind, placebo-controlled trial that showed remdesivir was not associated with statistically significant clinical benefits in people with severe COVID-19.
The study was conducted across 10 hospitals in Hubei, China. It enrolled 237 patients from Feb. 6 through March 12, and randomly assigned two out of every three (158 participants) to receive 200 mg injections of remdesivir on the first day, followed by 100 mg per day for the next nine days. The remaining 79 participants received placebo injections at the same intervals.
In this study, according to the authors, remdesivir “was not associated with statistically significant clinical benefits,” although they did find some signs that people on remdesivir who recovered from COVID-19 did so a little bit faster than people on placebo.
They also noted their study was not the final word on remdesivir’s efficacy, for two main reasons:
- The study had a participant size too small to be conclusive.
- Researchers stopped the study early; they were not able to find eligible patients after March 12 because Wuhan, China, rapidly got a handle on its COVID-19 outbreak.
“Public health measures used in Wuhan led to marked reductions in new patient presentations in mid-March, and restrictions on hospital bed availability resulted in most patients being enrolled later in the course of disease,” the authors reported. “Consequently, we could not adequately assess whether earlier remdesivir treatment might have provided clinical benefit.”
The findings of this study were not a surprise: It was reported that the study results had actually been posted to the World Health Organization’s website on April 23, before they had gone through peer-review, a move that WHO described as “inadvertent.”
New Remdesivir Research: Another Study Giveth
Almost simultaneously as the Lancet study was made public showing no clear clinical benefit to remdesivir, early results from a National Institutes of Health (NIH)–sponsored randomized controlled trial were also made public. The NIH put out a press release, before peer review was completed and the full study data were released, showing more promising results from a larger study than the one published in The Lancet.
According to the press release, the NIH study involved a total of 1,063 participants with advanced COVID-19 and lung involvement, with a currently unknown number getting remdesivir and the others a placebo.
The study found that “patients who received remdesivir had a 31% faster time to recovery than those who received placebo”—11 days versus 15 days—and those who received remdesivir also had slightly better chance of survival, with an 8% mortality rate compared to 12% of those who received placebo.
Shortly after the NIH announcement, it was reported that the U.S. Food and Drug Administration would soon announce that remdesivir will be made available to COVID-19 patients for emergency use in hospitals, based on this early data.
This Is a Time for Reasoned, Not Rushed, Remdesivir Reporting
We’re in a very dire situation, where many people are dying rapidly. Meanwhile, many people who aren’t directly hit by COVID-19 are beginning to feel the angst of sheltering in place for nearly two months in some states. And though some states have yet to even reach their peak number of infections, hospitalizations, or deaths, many are already talking about “getting back to business,” even while widespread testing (for either the new coronavirus or antibodies) remains elusive for all but those who are actively presenting with illness.
During all of this, President Trump has toyed with the idea of injecting people with household cleaner or blasting people with some kind of ultraviolet light to kill the virus.
So, in our collective grief, rage, and desperation, I understand the need and desire for some semblance of hope.
But I’m concerned about the long-lasting impact of research being conducted and data released without peer review under the guise of expedience; of making treatments available before full data sets are released and reviewed; and of media reporting on these stories that may offer false doom or false hope too soon.
And I’m not the only one.
“At most a ‘solid hit’ but certainly not a ‘home run,’ tweeted Carlos del Rio, M.D., a prominent infectious disease doctor and researcher at Emory University. “Not a ‘game changer’ I am afraid but reminds me of the first AZT vs placebo study published in 1987. That was the beginning of the long road to develop a treatment for HIV. The ‘home run’ did not happen until 1996 with PIs [protease inhibitors].”
Until now, we haven’t lived under a global pandemic with both a 24/7 news cycle and social media, where people can (and do) offer their opinions, no matter how off-base or dangerous, to thousands or millions of followers. The science and public health communities, along with health care providers and media outlets, can use this opportunity to do a lot of good.
We can get information out to a public really desperate for it. But we also have to be willing to temper expectations until there’s some kind of consensus about the future direction of therapies that may save millions of lives and get people out of their homes again.
I fear that, when we rush to publish data too quickly, or to report results as simply “good” or “bad,” we discredit the field. While it may give people the sugar-rush of optimism or the clarity of a hard “no,” it may damage our credibility and send people further into the dark web or conspiracy theories if we don’t tell people the truth—even if that pill may be somewhat bitter.
We are going to be getting a lot more results from COVID-19 studies over the next few weeks and months. Let’s hope that they ultimately give us some conclusive evidence on what treatments will work, and how we should best use them.
Until then, continue to social distance; wash your hands; fight for the rights of people most impacted by COVID-19; and look towards social, political, and economic changes that may need to be made for the long term if we want to prevent naturally occurring diseases from becoming unnatural—and often human-made—pandemics.