Fig. 1: Clinical and virological assessment of the response to remdesivir.

a Temperature, CRP, total lymphocyte count, and cycle-threshold (CT) value for viral RNA amplification from patient samples, deducted from the CT value at the limit of detection (LoD) of the assay, plotted by day since symptom onset, aligned with clinical interventions. Samples tested in the clinical laboratory at the Royal London Hospital are highlighted (*). Indicated viral isolates a–g were analyzed by Nanopore sequencing (Supplementary Fig. 2 and Table 5). n = 1 biologically independent samples. b Computerized tomography (CT) images at the level of the inferior pulmonary veins (top) and aortic arch (bottom) obtained at indicated time points. Prior to COVID-19 infection, there is moderate bronchiectasis, mucoid impaction and small airway obstruction (black arrows) in the middle lobe and lingula, but the remainder of the lungs are clear (Pre-COVID-19). Shortly before the first course of remdesivir, extensive ground-glass opacification and patchy consolidation with a lower lobe predominance is seen, together with perivascular consolidation in the right upper lobe (Day 32). Nine days after initiation of remdesivir treatment there is improvement in the lower zone ground-glass opacity and consolidation, but persistent consolidation in the right upper lobe and mild progression of the left upper lobe subpleural consolidation (red arrows) (Day 42). 10 days after completion of the first course of remdesivir treatment, following relapse of symptoms and fever, there is further improvement in the lower zone ground-glass opacification, but progressive subpleural consolidation, particularly in the left upper lobe (blue arrows) (Day 53).