NAGPUR: In view of alarming Covid-19 situation in the city and severe shortage of oxygen for patients, the Nagpur bench of Bombay high court on Monday requested chief minister Uddhav Thackeray to set up an oxygen production plant here urgently.
“In our view, it wouldn’t be difficult for Maharashtra Government to take immediate action in this regard. We also request guardian minister Nitin Raut to look into this matter and coordinate with the CM. We hope and trust that some urgent decision will be taken in the matter and conveyed to this court,” a division bench comprising justices Zaka Haq and Amit Borkar said, before adjourning the hearing till Tuesday 2.30 pm.
Earlier, amicus curiae Shreerang Bhandarkar assisted by Nidhi Dayani quoted media reports on mayor Dayashankar Tiwari’s statement regarding 500-bed facility to be made available at Mankapur Indoor Stadium.
Coronavirus: Live updates
“We direct the mayor to file an affidavit pointing out background of making such statement. We direct the Nagpur Municipal Corporation (NMC) commissioner to file separate affidavit pointing out whether what the mayor said can be implemented,” the bench said.
The amicus and other lawyers told the HC that all major injections needed had suddenly vanished from the market. They informed that that Tocilizumab injections were being sold by the private pharmacists at exorbitant prices and there was reason to believe that some persons had hoarded these life saving drugs.
“We direct the Food and Drugs Administration (FDA) commissioner to inquire into the matter immediately and submit a report by Tuesday. We want that the flow of Tocilizumab from the production centres/factories to wholesalers and to retailers and the dispensing of these injunctions from the counters of the private pharmacists should be tracked. If there is any hoarding, appropriate action as per the law should be taken against the erring persons,” the judges said.
The directives came while hearing a bunch of PILs, including suo motu based on TOI report, one filed by District Bar Association (DBA) president Kamal Satuja and other by Subhash Zanwar against the central government.
Earlier, intervenor’s counsel M Anilkumar, while quoting an oxygen producer, informed that Rs 10 crore would be required for setting up of a plant having capacity to produce 900 cylinders/day.
Senior counsel MG Bhangde and additional government pleader Deepak Thakre informed HC on behalf of FDA joint commissioner Vijay Kose that Remdesivir injunctions were being supplied to the hospitals as per procedure laid down by FDA commissioner on April 5. They clarified that the injection wasn’t sold from private pharmacists counters.
‘Ensure 24x7 patrolling at hospitals to prevent attacks’
Concerned over growing number of attacks on the hospitals treating Covid-19 patients by their relatives, the HC directed police commissioner Amitesh Kumar to ensure round-the-clock patrolling by the police near their premises.
“The CP should deploy sufficient police force at the government hospitals to ensure unnecessary vandalism and rowdiness is not created by the relatives. The doctors and health workers should work in a protected atmosphere, without there being any fear of vandalism,” the court said.
The judges asked police to take stern action against persons creating ruckus at hospitals. “The authorities should immediately act on the hospitals’ complaint. They shouldn’t permit any person to take photographs or make videos by forcible entry in the hospital. Such entry should be prohibited even to media persons. We request the media that the unfortunate incidents should not be highlighted too much because those create unnecessary panic in the citizens,” they said.
Ban on Remdesivir sale adds to woes of bedless patients
The district administration’s latest move to ban sale of anti-viral injection Remdesivir from any type of outlets has added to the woes of patients who are failing to get a Covid bed.
Though having breathlessness and different symptoms, many patients are forced to rely on day care or casualty-based treatment in private hospitals. However, the onus of arranging the injection was left to the patients or their kin while doctors or medical staff was administering the drug by showing them as day care patient or on OPD basis.
One of the previous orders of the collector had allowed sale of Remdesivir stock left after supplying to authorized Covid hospitals. In the last three days, the collector has issued three orders which have confused the stockists, doctors and patients alike.
On April 6, the collector’s order mandated delivery of Remdesivir directly to Covid hospitals by the carrying and forwarding agent.
On April 9, another order asked the agent to hand over the doses to stockists and distributors who will give it to Covid hospitals while the leftover could be sold through retailers.
On April 12, yet another order came which states the collector office will receive the entire supply and hand it over to stockists with the names of hospitals to which the drug is to be supplied. This means, no supply will be left for public.
VHA president Dr Ashok Arbat said basically the administration must make Remdesivir freely available in the market and let the doctors decide when it has to be given. “Such orders will create more trouble for the patients. A patient is getting admitted for injection treatment like Remdesivir, O2 and other supportive management. Remdesivir is very important drug. But such decisions will create more confusion in Covid management,” he said.
Asked about category of patients needing the anti-viral injection, Dr Arbat said it is solely the discretion of a clinician as to whether a mild or moderate patient needs it or nor. “The government capped bed charges, then it took control of oxygen and now Remdesivir. Does it want to control the treatment too,” he asked.
Remdesivir needed only for patients with low oxygen: Experts
Concurring with the guidelines of the state Covid task force members and views of doctors from other parts of the state, experts here said Remdesivir needs to be used judiciously and after considering due clinical indicators.
They said the first important factor to use the anti-viral drug is assessing if patient’s blood oxygen level is down.
Since not all patients feel breathlessness, this line of treatment can well solve the ongoing crisis for the injections and oxygen, they said.
Senior paediatrician Dr Satish Deopujari, who recently developed seven models to facilitate teaching in explaining cardio-respiratory and arterial blood gas (ABG) functions, says Covid patients having a drop in oxygen saturation level are the only candidate for Remdesivir therapy, which also includes the 6-minute walk test.
“Administering this drug at home without proper monitoring is not recommended,” he said.
According to him, severe disease (breathlessness, hypoxia, or >50% lung involvement on imaging within 24 to 48 hours) was reported in 14% of patients. “Remdesivir is needed in the first 12 days of illness only if SPO2 level goes down. After 12 days, it doesn’t have the desired effect,” he said.
On shortage of Remdesivir, he said using an important drug like it in situations where it is not recommended could be an important factor.
He said people have developed an extreme fear of Covid-19. Citing his own example on how he managed the disease, the 66-year-old doctor said, “I kept on monitoring SPO2 and took paracetamol as when necessary and that was enough.” He added that high-risk patients need close observation.
Dr Imran Noor Mohammad, a member on HC appointed Covid-19 committee, said that Remdesvir is not an elixir. “Patient won’t die if it is not given. I have recommended that its use must be judicious and clinically prescribed. People are going for CT scan right on day one of testing positive. We found hospitals administering Remdesivir on OPD basis,” he said.
Dr Mohammad, who is also ex-secretary of Critical Care Society of Nagpur, said Remdesivir must be given when a patient has CT scan score of 12 or13, fever and SPO2 level 89 or less. “But there is mass hysteria. People are thinking they will die if they don’t get it,” he said.
Pulmonologist Dr Ravindra Sarnaik, who too is member of Covid-19 committee, said that Remdesivir is known to benefit only in reducing hospital stay. “In case of patients with moderate disease needing oxygen, 30% patients have reportedly improved when steroid, oxygen and Remdesvir are given,” he said.
Dr Sarnaik stresses it is important to overcome fear in this situation. “We see people without need for oxygen getting hospitalized and those who need it are waiting for beds,” he said.
Respite for admitted Covid patients as hospitals get 100% Remdesivir stock
The kin of patients will not have to go searching for Remdesivir injections at distributors, stockists or pharmacies now. The collector office has for the first time ensured Covid hospitals get all the available stock on Monday. The entire stock was taken over by the collector from the suppliers, and distributed to hospitals as per NMC’s approved bed capacity of each hospital.
After taking over the entire stock of Remdesivir allotted for the district, collector office has also issued an order on Monday that Covid hospitals and such facilities will get their share of the injections from designated distributors or stockists only. The distributors and stockists were provided a list of Covid hospitals and facilities, along with number of beds allotted to each, by the collector office. Retail sales of the drug remain prohibited in the district.
In a twist, some hospitals that had increased the number of beds beyond the number sanctioned by NMC are likely to face shortages even now. It is not known how patients admitted in these additional beds would be administered the drug. “We had sought list of hospitals and number of beds allotted to them from NMC. Accordingly, we distributed Remdesivir for 100% of their capacity. If someone has increased the beds then NMC must look into the violations,” said the collector. He added that hospitals are not supposed to ask kin of patients to procure Remdesivir from outside.
Dr Anup Marar, convener of Vidarbha Hospital Association (VHA), said they have already appealed that Remdesivir must be administered as per the mandated guidelines of Covid treatment protocols and Indian Council of Medical Research (ICMR). “Only E and F category patients are to be treated with Remdesivir while the rest with Favipiravir. So, we can say that the shortage is unlikely to happen,” he said.
The latest order of allotting Covid hospitals Remdesivir stock may have given some respite to indoor patients, but serious patients who are yet to find a bed seem to have been left in the lurch.
A day ago, the collector office could manage to distribute some stock to hospitals after a consignment of 1,500 Remdesivir vials had reached the city’s carrying and forwarding agents (CFA) at Wadi late in the evening. On Monday, stocks from at least three more brands reached the city, allowing the collector office to send supplies to all hospitals.
According to a distributor and stockists, the Remdesivir injections are distributed from Nagpur to districts as far as Jalgaon and even in other states like Chhattisgarh and Madhya Pradesh. “The shortage in Nagpur depot will have repercussions in neighbouring states too,” he said.
As hospitals had started handing over Remdesivir prescriptions to patients’ kin to arrange for the drug, long queues were seen outside the pharmacies even beyond midnight, which had warranted the latest strategy by the collector office.