Skip to main content

Remdesivir

Last Updated: July 24, 2020

Remdesivir is an intravenous (IV) investigational nucleotide prodrug of an adenosine analog. Remdesivir binds to the viral RNA-dependent RNA polymerase, inhibiting viral replication through premature termination of RNA transcription. It has demonstrated in vitro activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).1 In a rhesus macaque model of SARS-CoV-2 infection, remdesivir treatment was initiated soon after inoculation; remdesivir-treated animals had lower virus levels in the lungs and less lung damage than the control animals.2

Remdesivir has been studied in several clinical trials for the treatment of COVID-19. The recommendations from the COVID-19 Treatment Guidelines Panel (the Panel) are based on the results of these studies.

Recommendation for Prioritizing Limited Supplies of Remdesivir

  • Because remdesivir supplies are limited, the Panel recommends that remdesivir be prioritized for use in hospitalized patients with COVID-19 who require supplemental oxygen but who are not on high-flow oxygen, noninvasive ventilation, mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) (BI).

In this section, “high-flow oxygen” refers to the receipt of supplemental oxygen through a high-flow device.

Recommendation for Patients with Mild or Moderate COVID-19

  • There are insufficient data for the Panel to recommend either for or against the use of remdesivir in patients with mild or moderate COVID-19.

Recommendation for Patients with COVID-19 Who Are on Supplemental Oxygen but Who Do Not Require High-Flow Oxygen, Noninvasive or Invasive Mechanical Ventilation, or ECMO

  • The Panel recommends using remdesivir for 5 days or until hospital discharge, whichever comes first (AI).
  • If a patient who is on supplemental oxygen while receiving remdesivir progresses to requiring high-flow oxygen, noninvasive or invasive mechanical ventilation, or ECMO, the course of remdesivir should be completed.

Recommendation for Patients with COVID-19 Who Require High-Flow Oxygen, Noninvasive Ventilation, Mechanical Ventilation, or ECMO

  • Because there is uncertainty regarding whether starting remdesivir confers clinical benefit in these groups of patients, the Panel cannot make a recommendation either for or against starting remdesivir.

In a randomized clinical trial, there was no observed difference between the remdesivir and placebo groups in time to recovery or mortality rate in these subgroups. However, because the trial was not powered to detect differences in outcomes in these subgroups, there is uncertainty as to the effect of remdesivir on the course of COVID-19 in these patients.

Duration of Therapy for Patients Who Have Not Shown Clinical Improvement After 5 Days of Therapy

  • There are insufficient data on the optimal duration of remdesivir therapy for patients with COVID-19 who have not shown clinical improvement after 5 days of therapy. In this group, some experts extend the total remdesivir treatment duration to up to 10 days (CIII).

Rationale

The recommendations for remdesivir are largely based on data from a multinational, randomized, placebo-controlled trial (the Adaptive COVID-19 Treatment Trial [ACTT]). This trial included 1,063 hospitalized patients with COVID-19 and evidence of lower respiratory tract infection who received IV remdesivir or placebo for 10 days (or until hospital discharge, whichever came first).

Participants who received remdesivir had a shorter time to clinical recovery than those who received placebo (median recovery time of 11 days vs. 15 days, respectively).3 In the preliminary subgroup analyses of ACTT, there was no observed benefit for remdesivir in people with COVID-19 who did not require oxygen supplementation; however, the number of people in this category was relatively small. Remdesivir is being evaluated in another clinical trial for the treatment of patients with moderate COVID-19; complete data from this trial are expected soon.

The preliminary analysis also reported that the patients with the clearest evidence of clinical benefit from starting remdesivir were those who required supplemental oxygen but who did not require high-flow oxygen, noninvasive or mechanical ventilation, or ECMO at baseline (n = 421). In this subgroup, those who received remdesivir had a shorter time to recovery than those who received placebo (recovery rate ratio 1.47; 95% confidence interval [CI], 1.17–1.84); in a post-hoc analysis of deaths by Day 14, remdesivir appeared to confer a survival benefit (hazard ratio [HR] for death 0.22; 95% CI, 0.08–0.58).

In patients who required high-flow oxygen or noninvasive ventilation at baseline (n = 197), there was no observed difference in time to recovery between the remdesivir and placebo groups (recovery rate ratio 1.20; 95% CI, 0.79–1.81). In the post-hoc analysis of deaths by Day 14, there was no evidence that remdesivir had an impact on the mortality rate in this subgroup (HR 1.12; 95% CI, 0.53–2.38).

In participants who were on mechanical ventilation or ECMO at baseline (n = 272), there was no observed difference in time to recovery between the remdesivir and placebo groups (recovery rate ratio 0.95; 95% CI, 0.64–1.42). In the post-hoc analysis of deaths by Day 14, there was no evidence that remdesivir had an impact on the mortality rate in this subgroup (HR 1.06; 95% CI, 0.59–1.92).

A review of the final data set, which included 28-day mortality, showed that this data set was consistent with the published preliminary data (unpublished data, based on communication from the ACTT study team to the Panel).

For patients with COVID-19 who required high-flow oxygen, noninvasive ventilation, mechanical ventilation, or ECMO, there was no observed difference between the remdesivir and placebo groups in time to recovery or mortality rate. However, because the trial was not powered to detect differences in outcomes within these subgroups, there is uncertainty as to whether starting remdesivir confers clinical benefit in these patients. For this reason, the Panel cannot make a recommendation either for or against starting remdesivir in these patients. Because the supply of remdesivir is limited, the Panel recommends that the drug be prioritized for use in those in whom efficacy has been demonstrated (i.e., in hospitalized patients who require supplemental oxygen but who are not on high-flow oxygen, noninvasive ventilation, mechanical ventilation, or ECMO).

Data from a multinational, open-label trial of hospitalized patients with severe COVID-19 showed that remdesivir treatment for 5 or 10 days had similar clinical benefit.4 The optimal duration of therapy for patients who do not improve after 5 days of receiving remdesivir is unclear. In the absence of data, some experts consider extending the total treatment duration of remdesivir to up to 10 days in patients who do not improve after 5 days of remdesivir.5

Clinical Data to Date

Multinational Randomized Controlled Trial of Remdesivir Versus Placebo in Hospitalized Patients

ACTT is a National Institutes of Health-sponsored, multinational, randomized, double-blind, placebo-controlled trial in hospitalized adults with COVID-19.3 Participants were randomized 1:1 to receive IV remdesivir or placebo for 10 days. The primary study endpoint was time to clinical recovery, which was defined as either discharge from the hospital or hospitalization for infection control purposes only. Severity of illness at baseline and at Day 15 was assessed using an eight-point ordinal scale:

  1. Not hospitalized, no limitations
  2. Not hospitalized, with limitations
  3. Hospitalized, no active medical problems
  4. Hospitalized, not on oxygen
  5. Hospitalized, on oxygen
  6. Hospitalized, on high-flow oxygen or noninvasive mechanical ventilation
  7. Hospitalized, on mechanical ventilation or ECMO
  8. Death

Study Population

The study population consisted of hospitalized patients aged ≥18 years with laboratory-confirmed SARS-CoV-2 infection. Patients were enrolled if they met at least one of the following conditions:

  • The patient had pulmonary infiltrates, as determined by radiographic imaging;
  • SpO2 was ≤94% on room air;
  • The patient required supplemental oxygen;
  • The patient was on mechanical ventilation; or
  • The patient was on ECMO. .

The study excluded individuals who had alanine aminotransaminase (ALT) or aspartate aminotransaminase (AST) levels >5 times the upper limit of normal (ULN), those who had an estimated glomerular filtration rate (eGFR) of <30 mL/min, and those who were pregnant or breastfeeding.

Participant Characteristics
  • Of 1,063 enrolled participants, 1,059 had preliminary results available for analysis (n = 538 for the remdesivir group; n = 521 for the placebo group).
  • The mean age was 58.9 years; 64.3% of participants were male, 53.2% were white, and 79.8% were enrolled in North America.
  • 52.1% of participants had two or more comorbidities; 37% were obese (the mean body mass index was 30.6 kg/m2).
  • The median time from symptom onset to randomization was 9 days (interquartile range [IQR] 6–12 days).
Follow-Up

  • At the time of the preliminary analysis, 391 remdesivir recipients and 340 placebo recipients had completed the study through Day 29, recovered, or died.
  • Eight remdesivir recipients and nine placebo recipients terminated the study prior to Day 29.
  • At the time of this preliminary analysis, 132 remdesivir recipients and 169 placebo recipients had not recovered and had not completed the Day 29 follow-up visit.

Preliminary Analyses

  • Remdesivir significantly reduced time to recovery compared to placebo (the median time to recovery was 11 days vs. 15 days, respectively; recovery rate ratio 1.32; 95% CI, 1.12–1.55; P < 0.001).
  • Clinical improvement based on the ordinal scale outlined above was significantly higher at Day 15 in patients who received remdesivir than in those who received placebo (odds ratio 1.50; 95% CI, 1.18–1.91; P < 0.001).
  • The benefit of remdesivir for reducing time to recovery was clearest in the subgroup of hospitalized patients who required supplemental oxygenation at study enrollment (ordinal scale 5, n = 421; recovery rate ratio 1.47; 95% CI, 1.17–1.84). In a post-hoc analysis of deaths by Day 14, remdesivir appeared to confer a survival benefit in this subgroup (HR for death 0.22; 95% CI 0.08–0.58).
  • In patients who required high-flow oxygen or noninvasive ventilation at study enrollment (ordinal scale 6, n = 197), there was no observed difference between the remdesivir and placebo groups in time to recovery (recovery rate ratio 1.20; 95% CI, 0.79–1.81). In a post-hoc analysis of deaths by Day 14, there was no evidence that remdesivir had an impact on the mortality rate in this subgroup (HR 1.12; 95% CI, 0.53–2.38).
  • Among patients who were on mechanical ventilation or ECMO at study enrollment (ordinal scale 7, n = 272), there was no observed difference in time to recovery between the remdesivir and placebo groups (recovery rate ratio 0.95; 95% CI, 0.64–1.42). In a post-hoc analysis of deaths by Day 14, there was no evidence that remdesivir had an impact on the mortality rate in this subgroup (HR 1.06; 95% CI, 0.59–1.92).
  • Among patients who were classified as having mild to moderate disease at enrollment, there was no difference in the median time to recovery between the remdesivir and placebo groups (n = 127; recovery rate ratio 1.38; 95% CI, 0.94–2.03). Mild to moderate disease was defined as SpO2 >94% on room air and a respiratory rate of <24 breaths/min without supplemental oxygen.
  • The mortality estimate by Day 14 was lower in the remdesivir arm than in the placebo arm (7.1% vs. 11.9%, respectively), but the difference was not statistically significant (HR 0.70; 95% CI, 0.47–1.04).
  • The use of remdesivir was associated with a shorter time to recovery, regardless of the duration of symptoms prior to randomization (≤10 days vs. >10 days).
  • The percentages of participants who experienced serious adverse events (AEs) were similar in the remdesivir and placebo groups (21.1% vs. 27.0%, respectively).
  • Transaminase elevations occurred in 4.1% of remdesivir recipients and 5.9% of placebo recipients.

Limitations

  • At the time of publication, the full data set was not available for analysis.

Interpretation

In patients with severe COVID-19, remdesivir reduced the time to clinical recovery. The benefit of remdesivir was most apparent in hospitalized patients who only required supplemental oxygen. There was no observed benefit of remdesivir in those who were on high-flow oxygen, noninvasive ventilation, mechanical ventilation, or ECMO, but the study was not powered to detect differences within subgroups. There was no observed benefit of remdesivir in patients with mild or moderate COVID-19, but the number of participants in these categories was relatively small.

Multinational Randomized Trial of Different Durations of Remdesivir Treatment in Hospitalized Patients

This was a manufacturer-sponsored, multinational, randomized, open-label trial in hospitalized adolescents and adults with COVID-19. Participants were randomized 1:1 to receive either 5 days or 10 days of IV remdesivir. The primary study endpoint was clinical status at Day 14, which was assessed using a seven-point ordinal scale:4

  1. Death
  2. Hospitalized, on invasive mechanical ventilation or ECMO
  3. Hospitalized, on noninvasive ventilation or high-flow oxygen devices
  4. Hospitalized, requiring low-flow supplemental oxygen
  5. Hospitalized, not requiring supplemental oxygen, but requiring ongoing medical care for COVID-19 or for other reasons
  6. Hospitalized, not requiring supplemental oxygen or ongoing medical care (other than the care that was specified in the protocol for remdesivir administration)
  7. Not hospitalized

Study Population

The study enrolled hospitalized patients aged ≥12 years with reverse transcription polymerase chain reaction (RT-PCR)-confirmed SARS-CoV-2 infection and radiographic evidence of pulmonary infiltrates. Patients in this study had either SpO2 ≤94% on room air or were receiving supplemental oxygen. The study excluded patients who were receiving mechanical ventilation or ECMO or who had multiorgan failure, ALT or AST levels >5 times ULN, or an estimated creatinine clearance of <50 mL/min. Patients were also excluded if they had received an agent with putative anti-SARS-CoV-2 activity within 24 hours of starting treatment in the trial.

Participant characteristics
  • Of 402 randomized participants, 397 began 5 days (n = 200) or 10 days (n = 197) of remdesivir treatment.
  • The median age, demographic characteristics, and frequency of coexisting conditions were similar between the two groups.
  • The median time from symptom onset to the first dose of remdesivir was 8 days in the 5-day group and 9 days in the 10-day group. The median duration of hospitalization before the first remdesivir dose was 2 days in both groups.
  • At baseline, patients in the 10-day group had worse clinical status (based on the ordinal scale distribution outlined above) than those in the 5-day group (P = 0.02).
  • Few patients were on mechanical ventilation: Four (2%) were assigned to the 5-day group, and nine (5%) were assigned to the 10-day group. Although mechanical ventilation was an exclusion criterion for enrollment, some patients were intubated between screening and treatment initiation; others were protocol deviations.
  • 172 participants (86%) in the 5-day group completed a median of 5 days of treatment, and 86 participants (44%) in the 10-day group completed a median of 9 days of treatment.

Study Endpoint Analyses

  • 65% of patients in the 5-day group and 54% of those in the 10-day group had a two-point improvement in clinical status on the ordinal scale.
  • After adjusting for imbalances in the baseline clinical status, the Day 14 distribution in clinical status on the ordinal scale was similar in the 5-day and 10-day groups (P = 0.14).
  • The time to clinical improvement of at least two levels on the ordinal scale (median day of 50% cumulative incidence) was similar in the 5-day and 10-day groups (10 days vs. 11 days, respectively).
  • The median duration of hospitalization among patients who were discharged on or before Day 14 was similar in the 5-day group (7 days; IQR 6–10 days) and the 10-day group (8 days; IQR 5–10 days).
  • By Day 14, 120 patients (60%) in the 5-day group had been discharged and 16 (8%) had died; in the 10-day group, 103 patients (52%) had been discharged and 21 (11%) had died.
  • Serious AEs were more common in the 10-day group (35%) than in the 5-day group (21%). Four percent of patients in the 5-day group and 10% of patients in the 10-day group stopped treatment because of AEs.

Limitations

  • This was an open-label trial without a placebo control group, so the clinical benefit of remdesivir could not be assessed.
  • There were baseline imbalances in the clinical status of participants in the 5-day and 10-day groups. At the start of the study, more patients in the 10-day group than in the 5-day group were receiving noninvasive ventilation or high-flow oxygen (30% vs. 24%, respectively), and fewer patients in the 10-day group than in the 5-day group were not receiving supplemental oxygen (11% vs. 17%, respectively).

Interpretation

In hospitalized patients with COVID-19 who were not on mechanical ventilation or ECMO, remdesivir treatment for 5 or 10 days had similar clinical benefit. Because this trial only evaluated a few patients who were on mechanical ventilation, the appropriate duration of remdesivir treatment for critically ill patients is still unclear.

Randomized Controlled Trial of Remdesivir Versus Placebo for Severe COVID-19 in China

This was a multicenter, double-blind, randomized, placebo-controlled trial that evaluated patients with severe COVID-19 in China.6 Patients were randomized 2:1 to receive IV remdesivir or normal saline placebo for 10 days. Concomitant use of lopinavir/ritonavir, corticosteroids, and interferons was allowed. The primary study endpoint was time to clinical improvement, defined as improvement on an ordinal scale or discharged alive from the hospital, whichever came first. The planned sample size was 453 patients.

Participant Population

This study enrolled hospitalized adults with laboratory-confirmed COVID-19 whose time from symptom onset to randomization was <12 days. These patients had SpO2 ≤94% on room air or PaO2/FiO2 <300 mm Hg and radiographically confirmed pneumonia.

Results

  • 237 hospitalized patients were enrolled and randomized to treatment from February 6 to March 12, 2020; 158 patients were randomized to receive remdesivir, and 79 patients were randomized to receive placebo. The study was stopped before the target enrollment was reached due to control of the COVID-19 outbreak in China.
  • The median age of the participants was 65 years; 56% of the participants in the remdesivir arm and 65% of the participants in the placebo arm were male.
  • There were more patients with hypertension, diabetes, or coronary artery disease in the remdesivir arm than in the placebo arm.
  • At Day 1, 83% of the participants required supplemental oxygen by nasal cannula or mask; only one participant required mechanical ventilation or ECMO.
  • The median time from symptom onset to randomization was 9 days for the remdesivir group and 10 days for the placebo group.
  • 65% of the participants in the remdesivir group and 68% of the participants in the placebo group received corticosteroids.
  • 28% of the participants in the remdesivir group and 29% of the participants in the placebo group received lopinavir/ritonavir.
  • 29% of the participants in the remdesivir arm and 38% of the participants in the placebo arm received interferon alfa-2b.

Study Endpoints

  • There was no difference in the time to clinical improvement between the remdesivir and placebo groups (a median of 21 days vs. 23 days, respectively; HR 1.23; 95% CI, 0.87–1.75).
  • For patients who started the study drug within 10 days of symptom onset, a faster time to clinical improvement was seen in the remdesivir arm than in the placebo arm (a median of 18.0 days vs. 23.0 days, respectively; HR 1.52; 95% CI, 0.95–2.43); however, this was not statistically significant.
  • The 28-day mortality was similar for the two study arms (14% and 13% of participants in the remdesivir arm and placebo arm, respectively).
  • There was no difference between the groups in SARS-CoV-2 viral load at baseline, and the rate of decline over time was similar between the two groups.
  • The number of participants who experienced AEs was similar between the two groups (66% and 64% of participants in the remdesivir and placebo groups, respectively).
  • More participants in the remdesivir arm than in the placebo arm discontinued therapy due to AEs (12% vs. 5% of participants in the remdesivir and placebo groups, respectively).

Limitations

  • The study was terminated early; as a result, the sample size did not have sufficient power to detect differences in clinical outcomes.
  • The use of concomitant medications (i.e., corticosteroids, lopinavir/ritonavir, interferons) may have obscured the effects of remdesivir.

Interpretation

There was no difference in time to clinical improvement, 28-day mortality, or rate of viral clearance between the remdesivir-treated patients and the placebo-treated patients.

Uncontrolled Case Series From Remdesivir Compassionate Use Program

In an uncontrolled case series of 53 hospitalized people with COVID-19, most patients needed less oxygen support after receiving compassionate use remdesivir. There was no comparison group, however, so it is not possible to assess whether the improvement was the result of using remdesivir.7

Clinical Trials

Multiple clinical trials are currently underway or in development. Please check ClinicalTrials.gov for the latest information.

Monitoring, Adverse Effects, and Drug-Drug Interactions

Remdesivir can cause gastrointestinal symptoms (e.g., nausea, vomiting), elevated transaminase levels, and an increase in prothrombin time (without a change in the international normalized ratio).

Clinical drug-drug interaction studies of remdesivir have not been conducted. Remdesivir levels are unlikely to be substantially altered by cytochrome P450 (CYP) 2C8, CYP2D6, or CYP3A4 enzymes, or by P-glycoprotein (P-gp) or organic anion-transporting polypeptide (OATP) drug transporters.

Remdesivir may be administered with weak to moderate inducers or with strong inhibitors of CYP450, OATP, or P-gp. Strong induction may modestly reduce remdesivir levels. The clinical relevance of lower remdesivir levels is unknown.8 Based on information provided by Gilead (written communication, July 2020), the use of remdesivir with strong inducers (e.g., rifampin) is not recommended.

Minimal to no reduction in remdesivir exposure is expected when remdesivir is coadministered with dexamethasone, according to information provided by Gilead (written communication, July 2020). Chloroquine or hydroxychloroquine may decrease the antiviral activity of remdesivir; coadministration of these drugs is not recommended.9

Because the remdesivir formulation contains renally cleared sulfobutylether-beta-cyclodextrin sodium, patients with an eGFR of <50 mL/min are excluded from some clinical trials (some trials have an eGFR cutoff of <30 mL/min).

Considerations in Pregnancy

  • Use remdesivir in pregnant patients only when the potential benefit justifies the potential risk to the mother and the fetus.5
  • The safety and effectiveness of remdesivir for treatment of COVID-19 have not been evaluated in pregnant patients. Remdesivir should not be withheld from pregnant patients if it is otherwise indicated.
  • Remdesivir is available through the Food and Drug Administration (FDA) Emergency Use Authorization (EUA) for adults and children and through compassionate use programs for pregnant women and children with COVID-19.
  • Ninety-eight female participants received remdesivir as part of a randomized controlled trial for the treatment of Ebola virus infection; six of these participants had a positive pregnancy test. The obstetric and neonatal outcomes were not reported in the study.10

Considerations in Children

  • The safety and effectiveness of remdesivir for treatment of COVID-19 have not been evaluated in pediatric patients.
  • Remdesivir is available through an FDA EUA for adults and children and through compassionate use programs for children with COVID-19. A clinical trial is currently evaluating the pharmacokinetics of remdesivir in children (ClinicalTrials.gov identifier NCT04431453).
  • In the same randomized controlled trial for the treatment of Ebola virus infection discussed above, 41 pediatric patients received remdesivir. These patients included neonates and children aged <18 years.10 The safety and clinical outcomes for children were not reported separately in the published results for the trial.11

References

  1. Wang M, Cao R, Zhang L, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020;30(3):269-271. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32020029.
  2. Williamson BN, Feldmann F, Schwarz B, et al. Clinical benefit of remdesivir in rhesus macaques infected with SARS-CoV-2. Nature. 2020; Published online ahead of print. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32516797.
  3. Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the treatment of COVID-19–preliminary report. N Engl J Med. 2020. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32445440.
  4. Goldman JD, Lye DCB, Hui DS, et al. Remdesivir for 5 or 10 days in patients with severe COVID-19. N Engl J Med. 2020; Published online ahead of print. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32459919.
  5. Food and Drug Administration. Fact sheet for health care providers emergency use authorization (EUA) of remdesivir (GS-5734™). 2020. Available at: https://www.fda.gov/media/137566/download. Accessed July 23, 2020.
  6. Wang Y, Zhang D, Du G, et al. Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet. 2020;395(10236):1569-1578. Available at: https://pubmed.ncbi.nlm.nih.gov/32423584/.
  7. Grein J, Ohmagari N, Shin D, et al. Compassionate use of remdesivir for patients with severe COVID-19. N Engl J Med. 2020;382(24):2327-2336. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32275812.
  8. Gilead Sciences. Remdesivir (GS-5734) investigator’s brochure. Edition 5. February 21, 2020.
  9. Food and Drug Administration. Remdesivir by Gilead Sciences: FDA warns of newly discovered potential drug interaction that may reduce effectiveness of treatment. 2020. Available at: https://www.fda.gov/safety/medical-product-safety-information/remdesivir-gilead-sciences-fda-warns-newly-discovered-potential-drug-interaction-may-reduce. Accessed July 2, 2020.
  10. Mulangu S, Dodd LE, Davey RT, Jr., et al. A randomized, controlled trial of ebola virus disease therapeutics. N Engl J Med. 2019;381(24):2293-2303. Available at: https://www.ncbi.nlm.nih.gov/pubmed/31774950.
  11. Dornemann J, Burzio C, Ronsse A, et al. First newborn baby to receive experimental therapies survives ebola virus disease. J Infect Dis. 2017;215(2):171-174. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28073857.