Shortage of remdesivir in Bengaluru government hospitals

BENGALURU: The survival of severely ill Covid-19 patients has become a lottery of sorts, thanks to a severe shortage of remdesivir in some government-run hospitals in Bengaluru.
The Ebola drug, used to treat Covid-19 patients, is unavailable in ESI Hospital, Rajajinagar (which has a 20-bed ICU), while Bowring and Lady Curzon Hospital (30-bed ICU) was supplied only 22 vials in the last 10 days, forcing doctors to decide who gets it and who doesn’t.
Doctors say the drug is prescribed for about 30% patients and a five-day course involves administering 200mg intravenously on Day One, followed by doses of 100mg a day for the next four days. The drug comes in 100mg vials.
“Stock of remdesivir is nil,” doctors at ESI hospital confirmed. “As government doctors, we cannot tell patients to buy any drug from outside. The state had supplied 27 vials of the drug, but that was over long ago. We are helpless and can only watch as the condition of patients deteriorate.”
Sources at the hospital say they require a minimum Rs 2.5 lakh to procure a consignment of the drug, but the financial wing of the hospital cluster has raised objections to the proposal. And doctors admit that sometimes they have broken the rules by asking family members of patients to procure the drug.
“At least 40 of about 120 of our patients need the drug,” doctors said. “Sometimes, when the situation is dire, we stick our necks out and ask patients’ families to try and procure the drug from outside. But most patients’ relatives think since it’s a government hospital we must provide it on our own and our intentions are mistaken. It’s a tough scenario.”
Doctors say the hospital has treated more than 600 Covid-19 cases and seen close to 50 fatalities. “We are making efforts to buy enough quantities of the drug. We have also written to the state government,” said Dr Imtihan Hussain, medical superintendent, ESI Hospital Rajajinagar.
The situation is only slightly better at Bowring and doctors, on condition of anonymity, said: “Those seeking admission in hospitals are ones with severe symptoms. We don’t have any patients who have mild symptoms or are moderately asymptomatic. Generally, about 30% of our patients are administered remdesivir, but given the short supply, we end up selecting patients to give the drug to. It’s a tough choice and one we shouldn’t have to make. We decide depending on severity and breathing issues of patients.”
Dr Manoj Kumar HV, dean, Bowring and Lady Curzon hospital, which has dedicated 160 beds to Covid-19 patients, said, “I won’t deny there is a shortage of remdesivir, but we are managing the situation. We have got 22 vials in the last 10 days. We place a request for drug once in 2-3 days with Karnataka State Drugs Logistics and Warehousing Society (KSDLWS) via central procurement. We can’t buy on our own as per the rulebook.”
Doctors at Bangalore Medical College and Research Institute’s Trauma Care Centre and Rajiv Gandhi Institute of Chest Diseases said they have faced no shortage of the drug. N Manjushree, additional director, KSDLWS, told TOI that they have 22,600 vials of remdesivir in stock, of which 17,000 vials were received a day ago.
Not all is well in private hospitals too. While many private hospitals say there is no shortage of remdesivir, some are facing a problem. These hospitals procure directly from manufacturers, besides receiving a supply from the government as well. “We received 24 vials of the drug from the government besides buying vials on our own. There is no shortage of remdesivir,” said Dr Deepak Balani, chief medical officer, Sakra World Hospitals.
But Dr Balani said there is a shortage of Tociluzumab, another drug, which is prescribed for Covid-19 patients with severe pneumonia. “A week ago, we got some, but the stock had an expiry date of August 31. We didn’t have a choice so we used it all. Supply has been restricted. The drug has helped many patients recover worldwide,” he said.
Dr R Ravindra, who heads Suguna Hospital, said: “We have 21 patients on remdesivir in my hospital. We need a minimum 21 vials a day, but they are not easily available. I have got 60 vials paying Rs 5,800 each. There is a severe shortage.”
Chemists in the state said there is an increased demand for the drug, but admit they have no stock due to the government’s restriction on sales. The price of remdesivir in Bengaluru varies from Rs 2,800 to Rs 5,400. But there is a thriving black market where the drug is allegedly being sold at very high prices.
AK Jeevan, general secretary, Karnataka Chemists and Druggists Association, said remdesivir is not available in the open market. “The government has restricted supply,” Jeevan said. “It is not available with wholesale dealers. Covid hospitals get a supply of the drug directly from manufacturers. This is done to ensure the government has a database of remdesivir recipients. Fewer people are now calling up and asking for the drug than in previous months since they now know that only hospitals treating Covid patients can use the drug and that it not available over the counter.”