With oxygen beds running out, many opted to keep patients at home on oxygen support, leading to a cylinder shortage. (Express Photo by Tashi Tobgyal) Rs 50,000 for a vial of remdesivir, Rs 40,000 for a large oxygen cylinder: This is what some people paid in Delhi over the last three weeks trying to save lives of loved ones as the Covid surge left the healthcare infrastructure overwhelmed, and created fertile grounds for black marketers.
Members of the healthcare industry, hospital owners and government officials The Indian Express spoke to flagged key factors that led to this — from a lull in cases after the first wave which led to scaling back of production to not enough being done to bolster healthcare infrastructure.
Take the example of remdesivir, typically administered to patients in ICU. A Delhi government official said the problem of black marketing began as hospitals started prescribing it for patients who may not have needed it. Its supply is centralised, and the government allocates it to the states, which then provide it to hospitals based on requirement. It is not available with chemists.
As hospitals started asking family members of patients to procure the drug, many had no option but to look to the black market. In one case, in the last week of April, a lawyer with a Delhi-based law firm set out to procure it for two of his friends, admitted in a private hospital. The doctor had told him remdesivir was not available at the hospital.
After a few desperate calls, the lawyer was informed a person based in Uttar Pradesh can procure 12 vials for Rs 6 lakh — Rs 50,000 per dose. On April 17, the Centre announced that prices of remdesivir had been brought down by manufacturers — between Rs 899 to Rs 3,490. After money was paid in cash, a person left with the vials from Gujarat and delivered them to attendants at the hospital the next day.
Desperate family members of patients had also started thronging to distribution centres, prompting Delhi’s drug controller to ask police to provide security to 30 sites engaged in distribution of remdesivir in the city. A letter in this regard was sent on April 22.
A Delhi government official said “pilferage happened from hospitals” as there was no way to guarantee that injections meant for a patient was given to her, especially if she had died. Those vials, the official said, reached the black market.
Till May 4, Delhi Police had arrested five nursing staff from private hospitals for allegedly stealing vials and selling them illegally. “We have registered 303 FIRs till May 7 of which 225 cases are related with fraud in the name of providing Covid medicines or oxygen, etc, while 78 are related with black-marketing, hoarding or overcharging. We have arrested 153,” said Delhi Police spokesperson Chinmoy Biswal.
The official stressed that hospitals should not only ensure judicious use — noting down and sharing details of each batch administered to patients — but also not prescribe the drug unless absolutely required. “Unnecessarily prescribing six injections, creating panic, led to an increase in demand,” the official said.
“The hospital has to reach out to the Delhi government” to get the injections, the official said, as “there is no other way”. He asserted that Delhi has “enough supply if medical practitioners judicially use it”. On May 8, around 55,000 injections of the drug were available in Delhi, when active cases were nearly 88,000, the official said.
The Centre was aware that by the first week of April that as cases shot up, such a situation could arise. The Central Drugs Standard Control Organisation wrote to the drugs controllers of all states on April 7 that some states were “reporting shortage of remdesivir” and that “this may lead to its hoarding and black marketing”.
The seven manufacturers of the drug had cut down its production, an industry insider said, as the number of active cases had dropped near the end of last year. After a peak of 10 lakh active cases in September, it had come down to just over 1.3 lakh in February.
But as cases again started growing in March-April, the surge caught drug manufacturers off guard. They ramped up production, but the industry insider said that there is more demand than they can meet even today.
The government told the Supreme Court on May 9 that the “production levels prior to the recent surge” were around 60,000 per day, but it was enhanced to around 2 lakh per day within three weeks. It centralised the distribution of the drug on April 21, till when the manufacturers were supplying to hospitals directly.
Dr Alex Thomas, president of the Association of Healthcare Providers (India), said doctors “should not be allowed to prescribe what is not available in the pharmacy”. “If it is not available in the hospital, you can’t expect it to be available in other places, and this encourages black marketing.”
The oxygen crisis
Thomas also spoke about the other key crisis — of oxygen cylinders. The paucity of oxygen has, over the past month, played out across the capital as well as its courts, with the state and centre blaming each other even as patients’ kin pay as much as tenfold for a cylinder.
“In Delhi, we had a very good system going, each hospital was connected to a supplier and they had promised enough oxygen for three to four weeks. Then the government stepped in and changed everything and appointed officers and said Hospital A has to get from this vendor and Hospital B from that vendor, and everything went haywire. In many cases, hospitals were not able to get oxygen, while private parties were. Some of them opened up centres,” said Thomas.
With oxygen beds running out, many opted to keep patients at home on oxygen support, leading to a cylinder shortage.
The Empowered Group 2, created by the Centre during the first wave last year, to look after logistics, including oxygen, came up with a supply plan for medical oxygen to states if cases surged again. On April 15, Union Health Secretary Rajesh Bhushan shared this plan with the states. Thomas said that in Delhi, this adversely impacted the system in place.
On May 3, AHPI, along with Consortium of Accredited Healthcare Organisations, IMA Hospital Board, and Delhi Nursing Home Forum, formed a Covid Coordination Committee “to mitigate the traumatic situation due to the second wave” and urged the government “to put old roster system in place for oxygen supply directly from vendors to hospitals and desist individuals hoarding cylinders at home, which are lifeline for hospitals”.
They stated that the “erstwhile system of vendors supplying oxygen was disrupted by reallocation of vendors for different hospitals”, which created “big confusion”.
“Vendors are no longer supplying to small hospitals and asking them to collect oxygen cylinders from their sites. Hospitals as such are putting their bulk of time in procuring oxygen rather than care of patients. A new trend also has emerged; individuals are rushing to vendors and buying oxygen cylinders to be hoarded at home,” they wrote.
Among those directly touched by the crisis was 42-year-old Jasbir Singh, who lives in Ghaziabad. He recalled that as his mother’s oxygen level started dipping, he tried finding her a hospital bed in Delhi and Noida, “but all of them said no”.
“We eventually got an 11 kg oxygen cylinder for Rs 6,000 but that finished within an hour as there was less gas. We then bought a 30 kg cylinder for
Rs 40,000 and when her condition deteriorated, we admitted her to a hospital in Meerut where we are providing oxygen cylinders from Delhi,” he said.
Dr C M Bhagat, who has a hospital in Delhi and is the convenor of the oxygen committee for AHPI, said that in this wave, patients needing oxygen for domiciliary care has also gone up. “Cylinders that would cost Rs 10,000 earlier went up to Rs 50,000 to even Rs 1 lakh,” he said.
Delhi government’s allocation is based on 10 litres of oxygen per minute for non-ICU oxygen beds and 24 litres per minute for ICU beds. However, Bhagat said, even non-ICU patients can require as much as 15 litres per minute.
He mentioned that as well-intentioned NGOs also started taking oxygen, though from nearby states, it created a dearth of items such as flowmeters and oxygen concentrators, leading to their prices shooting up.
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