Among ambulatory patients with mild-to-moderate COVID-19 at high risk for progression to severe disease, the Infectious Diseases Society of America (IDSA) suggests remdesivir initiated within 7 days of symptom onset rather than no remdesivir.
In hospitalized patients with severe COVID-19 (patients with SpO2 ≤94% on room air), the IDSA panel suggests remdesivir over no antiviral treatment.
In patients with COVID-19 on invasive ventilation and/or ECMO, the IDSA panel suggests against the routine initiation of remdesivir.
In patients on supplemental oxygen but not on mechanical ventilation or ECMO, the IDSA panel suggests treatment with five days of remdesivir rather than 10 days of remdesivir.
In patients with COVID-19 admitted to the hospital without the need for supplemental oxygen and oxygen saturation >94% on room air, the IDSA panel suggests against the routine use of remdesivir. [1]

The National Institute of Health COVID-19 treatment guidelines state that intravenous remdesivir is approved by the Food and Drug Administration (FDA) for the treatment of COVID-19 in hospitalized adult and pediatric patients (aged ≥12 years and weighing ≥40 kg). It is also available through an FDA Emergency Use Authorization (EUA) for the treatment of COVID-19 in hospitalized pediatric patients weighing 3.5 kg to <40 kg or aged <12 years and weighing ≥3.5 kg. Remdesivir should be administered in a hospital or a health care setting that can provide a similar level of care to an inpatient hospital. [2]

A review article assessing evidence for outpatient management of COVID-19 stated that ambulatory care for patients should focus on supportive therapy and reducing the risk of transmission. Remdesivir was found to significantly reduce time to recovery and non-significantly reduce mortality in hospitalized patients with COVID-19, though no evidence was stated for the outpatient setting. [3]

Evidence showing a median recovery time of 10 days in hospitalized patients who received remdesivir, as compared with 15 days among those who received placebo (rate ratio for recovery, 1.29; 95% CI, 1.12 to 1.49; P <0.001). P <0.001), and an 11.4% mortality by 29 days with remdesivir compared to 15.2% with placebo (hazard ratio, 0.73; 95% CI, 0.52 to 1.03), led to the FDA approving the use of remdesivir in hospitalized patients. Another study assessing remdesivir in hospitalized patients with moderate COVID-19 showed improved clinical status by day 11 compared to standard of care for a 5-day course of remdesivir, but not for a 10-day course.
The Solidarity Trial, also assessing hospitalized patients, found no effect of remdesivir on 28-day mortality, need for mechanical ventilation nor duration of hospitalization in a study including 5451 patients. While there is varied evidence regarding the use of remdesivir in hospitalized patients, researchers have concluded that remdesivir is likely to be most effective during the early stage of viremia, which is prior to the inflammatory pulmonary phase requiring hospitalization. There is very little evidence on outpatient remdesivir use, and experts state that remdesivir administered intravenously for 5 days is not a practical daily outpatient treatment. [4]

VEKLURY® (remdesivir) is a SARS-CoV-2 nucleotide analog RNA polymerase inhibitor indicated for adults and pediatric patients (12 years of age and older and weighing at least 40 kg) for the treatment COVID-19 in hospitalized patients.

Remdesivir should be administered in a hospital or in a healthcare setting capable of providing acute care comparable to inpatient hospital care. The recommended dose is a single loading dose of 200 mg on day-1 followed by once-daily maintenance doses of 100 mg from day-2 infused over 30 to 120 minutes. For patients not requiring invasive mechanical ventilation, the recommended treatment duration is five days. If improvement is not seen, treatment can be extended to ten days. For patients requiring invasive mechanical ventilation, the recommended treatment duration is ten days.

Remdesivir is not recommended in patients with an eGFR less than 30 mL/min. Warnings and precautions for remdesivir include; hypersensitivity and anaphylactic reactions, increased risk of transaminase elevations (hepatic monitoring recommended), and risk of reduced antiviral activity when co-administered with chloroquine phosphate or hydroxychloroquine sulfate. The most common adverse reactions (incidence greater than or equal to 5%, all grades) include; nausea, increased AL, and increased AST.

Store VEKLURY for injection, 100 mg vials below 30°C (below 86°F) until required for use. Do not reuse or save reconstituted or diluted VEKLURY for future use. After reconstitution, use vials immediately to prepare diluted solution. Dilute the reconstituted solution in 0.9% sodium chloride injection, USP within the same day as administration. The diluted VEKLURY solution in the infusion bags can be stored up to 24 hours at room temperature (20°C to 25°C [68°F to 77°F]) prior to administration or 48 hours at refrigerated temperature (2°C to 8°C [36°F to 46°F]). [1], [2]

A search of the published medical literature revealed 1 study investigating the researchable question:

What does the literature say about the efficacy and safety of a 3-day course of outpatient remdesivir in high-risk, non-hospitalized patients with COVID-19?