Six months into the Covid-19 pandemic, and scientists and drug-makers around the world are frantically testing existing antiviral drugs to curb the spread of the respiratory virus until a vaccine is found. Two of the most talked-about drugs are the Russian-approved Avifavir, and the American drug Remdesivir. Local production of both antiviral medications began in Egypt a few days ago, and they are soon expected to be available on the market. Avifavir, aka Avigan, is based on the Japanese influenza drug Favipiravir which was approved for manufacture and sale in Japan in 2014 and became a generic drug in 2019. In response to COVID-19, the Russian Direct Investment Fund (RDIF) has pushed development deals capitalising on Avigan's generic status, and partnered with Russian pharmaceutical research and development group ChemRar to develop the Russian generic version currently known as Avifavir. The Russian modified antiviral drug Avifavir received a registration certificate from Russia's Ministry of Health on 29 May, becoming the first Russian drug approved for the treatment of Covid-19 patients. On 11 June the first batch of Avifavir drug was delivered by RDIF and ChemRar Group to Russian hospitals. “The day after it was delivered to hospitals in Russia Avifavir was incorporated in coronavirus treatment protocols and has had very impressive results,” Ahmed Saad, a doctor in Moscow, told MBC Masr Channel in a telephone interview on Sunday. Saad revealed that the Russian medicine reduces the treatment period from 21 days to five days. On Monday, two Egyptian drug=makers announced that they had started production of Avifavir and expected it to be available in the local market within a few weeks. “Starting today [Monday], we began manufacturing the Japanese-originated medicine Avifavir, and it will be available in Egypt within a few days or weeks,” Amgad Talaat, Eva Pharma's general manager, told MBC Masr channel on Monday. Talaat added that the oral medicine Avifavir will be sold in Egypt under the trade name Avipiravir and will be priced around LE4,500 a package. It is currently being tested for the treatment of Covid-19 patients in Japan, Italy and the UK, and is already included in treatment protocols in Saudi Arabia, said Talaat. The 10 Ramadan for Pharmaceutical Industries and Diagnostic Reagents (Rameda), another leading Egyptian pharmaceutical company, also announced that it had commenced production of the Japanese-originated/Russian-modified drug under the brand name Anviziram. “We started production of Anviziram after obtaining approval from the Egyptian Drug Authority. It will take us about three weeks to make the drug available in the local market,” Amr Morsy, CEO of Rameda, said on Monday. The company aims to export Anviziram to neighbouring countries upon receipt of approval from the Ministry of Health and the Egyptian Drug Authority. Egypt obtained batches of Avigan samples from its Japanese manufacturer Fujifilm in March, and has conducted clinical and research trials via the Egyptian National Research Centre (NRC), according to Minister of Higher Education and Scientific Research Khaled Abdel-Ghaffar. In addition to Anviziram, Rameda said it has also been granted Egyptian Drug Authority approval to manufacture Remedisvir, a broad-spectrum intravenous antiviral medication which has been used in treatment of Covid-19 patients, and aims to commence production as soon as possible. Eva Pharma announced on Monday that it has already started production of Remdesivir, and expects to offer it on the market within days. “We have already started producing Remdesivir in our factories in 6th of October City, and the price per vial will be less than LE2,000,” said Eva Pharma's general manager. Ten days ago, Eva Pharma said it had reached a “landmark” deal with the US-based Gilead Sciences Inc to become the only licensed manufacturer of Remdesivir in Africa and Middle East. According to California-based Gilead, a total of nine companies have been granted a non-exclusive voluntary licence to distribute the drug in 127 countries worldwide: six in India, two in Pakistan and one in Egypt. “Remdesivir is mainly used for medium to severe coronavirus cases. It will not be available in pharmacies, and will not be prescribed for home-isolated cases. It will only be available in isolation hospitals, and used under the supervision of a physician,” Talaat said. A US National Institutes of Health trial found the antiviral drug helped hospitalised coronavirus patients recover more quickly. It was the first drug to demonstrate a benefit in treating Covid-19. Due to its positive trial results, the US Food and Drug Administration issued emergency authorisation for Remdesivir's use on 1 May. While it falls short of an approval, the authorisation allows more hospitalised patients to receive the drug. Health Minister Hala Zayed said earlier this month that Egypt's coronavirus treatment protocols “are constantly updated”. In an attempt to free up beds for critical cases in overwhelmed state-run isolation hospitals, under Egypt's latest treatment protocol mild and moderate Covid-19 patients are treated at home or in university hostels. The Health Ministry now uses clinical examinations, chest x-rays, and laboratory analyses to identify suspected cases of coronavirus, with treatment starting immediately, and continuing until the result of PCR testing comes through. Late last month the ministry compiled coronavirus drug kits, which include medications and preventive supplies, for coronavirus patients being treated at home, and the people with whom they had come into contact. The treatment kit is available through 5,013 health units and medical centres, and 1,000 medical convoys, across all governorates. On 19 June Egypt recorded 1,774 new infections, the highest single-day rise since the announcement of the first infected case in Egypt on 14 February. The surge in coronavirus infections and, sadly, deaths, is expected to increase in the coming days. Egypt has yet to reach its peak infection rate, says Hossam Hosni, head of the Ministry of Health Scientific Committee to Combat Covid-19. Hosni expects the number of coronavirus cases to increase to between 2,000-2,500 a day by the first week of July, after which “the number of cases will stabilise and start decreasing”. Despite the surge in coronavirus infections, on Tuesday the cabinet issued a series of measures to reopen businesses. The cabinet announced that the night-time curfew, in place since March, will be cancelled on 27 June. Prime Minister Mustafa Madbouli said restaurants and cafes will be allowed to reopen until 10pm starting Saturday, at a reduced capacity of 25 per cent. They will not be allowed to serve shisha, or water pipe. Shops will be allowed to open till 9pm, though public parks and beaches will remain closed. Sporting clubs, cinemas and theatres, which closed in March, will be permitted to open from 27 June at 25 per cent of their capacity. Places of worship will be allowed to hold daily prayers, but will not be holding weekly sermons on Fridays or Sundays. Public transport will be allowed to operate from 4am to 12am. Egypt will gradually resume regular international flights from 1 July. Foreign tourists will initially be restricted to visiting the South Sinai, the Red Sea and Marsa Matrouh governorates. Visa fees will be waived for tourists arriving on direct flights to resort cities until the end of October. *A version of this article appears in print in the 25 June, 2020 edition of Al-Ahram Weekly
