There's not enough remdesivir for all Covid-19 patients, so California has suggested hospitals hold a lottery… Asked about the allocation of remdesivir, CDPH pointed CNN to guidance the department issued on Monday on how to allocate scarce medications for Covid-19.

That guidance suggests establishing a 'prioritization' committee of doctors, nurses and others to help allocate the drug to patients.

It also suggests that 'random allocation among patients be considered,' such as 'using a lottery system to select a certain proportion of patients who become eligible for the drug.'

California isn't the only state with tough decisions to make. Texas has some 1,600 patients in the hospital with the novel coronavirus but received only enough remdesivir for 100 to 200 patients…

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…Given the shortage of remdesivir, the idea of having a lottery is 'the most fair and the least fair' method of rationing the drug, said Charo, the bioethicist.

On the one hand, it leaves the decision entirely to chance, and so no one can accuse the hospital of being biased for or against any particular patients.

On the other hand, it leaves no opportunity for doctors to make judgements about which patients would benefit the most by remdesivir.

There's no perfect system – just different concepts of fairness,' said Charo, a professor at the University of Wisconsin School of Law.

Massachusetts General Hospital, one of the earliest to receive shipments of remdesivir, has formed a committee to decide who will get the drugs. The committee includes pharmacists and physicians and ethicists who review patients' medical records and then make allocation recommendations.

Intentionally, the committee does not include the doctors who are personally treating Covid-19 patients, according to Dr. Rochelle Walensky, chief of infectious diseases at Mass General.

Charo supported that decision.

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