First Case of Covid-19 in the United States

Holshue et al. (March 5 issue) 1 describe the management of the first case of Covid-19 in the United States.We disagree that remdesivir should be used on the 11th day after the onset of symptoms.Few data on the viral load kinetics in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the cause of Covid-19, are available. 2However, a study of changes in viral load over time in patients with severe Middle East respiratory syndrome coronavirus 3 showed that copies of RNA peaked before the 11th day of illness.We doubt that the dramatic improvement in the clinical condition of the patient described by Holshue et al. was associated with remdesivir.Readers may have a very misleading impression that remdesivir should be administered as a salvage therapy for Covid-19.We do agree that randomized, controlled trials are needed to evaluate the efficacy and safety of remdesivir.However, in a clinical trial of therapies for Ebola virus disease that was terminated early, the mortality in the remdesivir group was significantly higher than that in the other groups. 4 More safety information should be disclosed by the pharmaceutical industry before a new trial of remdesivir is launched, 5 since most cases of Covid-19 are mild or moderate.