Abstract
Since the first detection of a cluster of COVID-19 patients in China in late 2019, it becomes a global concern due to its transmissibility and ability to progress patients in severe respiratory failure and acute respiratory distress syndrome, which need intensive care unit support for a long time. We observed the repurposing use of remdesivir and favipiravir whether considered as a therapeutic option or not through survival rate and changes in biomarker during 10-day treatment stay in ICU.
 The retrospective observational study in a tertiary care hospital dedicated to COVID-19 at Dhaka, Bangladesh was done at the peak of COVID-19 pandemic in Bangladesh. The mortality rate, length of ICU stays and eight prognostic biomarkers of patients treated with remdesivir and favipiravir was observed as one of the first ever reported experience in Bangladesh.
 Among the critically ill patients in ICU, 26 (44.8%) died and 32 (55.2%) were cured during the study period and highest mean duration of stay in ICU was observed (14.33 days and 18.13 days) in FPV-treated patients. Mean of means for all biomarkers CRP (26.0) and d-Dimer (2.64) was recorded higher in favipiravir treated patients in death cases, but NLR, d-NLR, platelet, PLR was much higher in remdesivir treated patient of both death and improved cases. Though overall outcome variables between death and improved cases were not statistically significant (p<0.39)
 The severity of disease progression in critically ill COVID-19 patients in ICU depends on comorbidities and hyper-responsive inflammatory or immunological biomarkers to predict. Though the emergency use authorization and repurposing use of different antivirals are still on trial, but remdesivir and favipiravir revealed not much hope in improving prognostic biomarkers, survival rate and disease progression at the peak of pandemic in Bangladesh.
Highlights
Since the cluster of novel respiratory viral infections first recognized in China in late December 2019, it was observed with growing apprehension as infections with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) virus― named Coronavirus Disease of 2019 (COVID-19) have spread to hospitals in Bangladesh
The relationship between gender and age group, change and relationship of biomarkers with different groups of patients treated with remdesivir and favipiravir, along with convalescent plasma were observed in the study
58 patients with confirmed COVID-19 were treated in intensive care unit (ICU), of whom 45 (77.5%) were male and 13 (22.5%) were female
Summary
Since the cluster of novel respiratory viral infections first recognized in China in late December 2019, it was observed with growing apprehension as infections with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) virus― named Coronavirus Disease of 2019 (COVID-19) have spread to hospitals in Bangladesh. Its transmissibility caused the spread of the disease throughout a population quite rapidly and case counts might increase by hundreds or even thousands per day in densely populated metropolitan areas as no herd immunity exists to COVID-19. COVID-19 is manifested by a severe hypoxic respiratory failure requiring a long time intensive care with specialized support. COVID-19 patients may present with solely neurological manifestations like loss of smell, loss of taste, stroke, vertigo, or respiratory failure even without having any respiratory symptoms. One study found that 97.5% of COVID-19 affected persons will develop the symptoms within 11.5 days [2]. A study comprises more than 44 thousand COVID19 patients divided the symptoms into mild to moderate (81%), severe (14%), and critical (5%). Critical cases presented with multi-organ dysfunction, shock, or respiratory failure with an overall mortality rate of 49%. [3]
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