Covid-19: Now, SOSs for injection to treat black fungus

NOIDA: The crisis cycle – ticking like a clock, from hospital beds to oxygen to remdesivir to ambulances since the second wave of the pandemic began ravaging Delhi-NCR in April – has now moved to Amphotericin B, the antifungal drug hospitals have been using to treat recovering Covid patients who have developed mucormycosis (black fungus).
Social media feeds and WhatsApp groups have over the past few days begun flooding with SOSs for the injection, sending many scrambling to hospital pharmacies across Delhi-NCR. Earlier this week, the shortage was also flagged by hospitals in Gurgaon, leading to the Haryana government forming a panel to procure the injections.

Patients admitted to Noida hospitals who need treatment for black fungus are in a spot because Amphotericin B is not available in the district. Chief medical officer Dr Deepak Ohri said the health department was waiting for supplies from Lucknow. Chemists are not allowed to procure the drug.

Drug inspector Vaibhav Babbar confirmed Amphotericin B is not available in the market. “Once we get the vials of this medicine, we will distribute it to hospitals as per government directives. It is being sourced centrally by the state and will be provided to districts,” said Babbar.
Pranjul Srivastava, a resident of Sector 34, has looked everywhere for the injection his cousin admitted at Kailash hospital in Noida needs. “I have approached everyone I could in the last three days. The hospital does not have it, and chemist stores don’t keep it. I have forwarded the request to the chief medical officer and am waiting for a response,” said Srivastava.
Ohri said that the state government will evolve a mechanism to provide the injection to all districts through the Uttar Pradesh Medical Supplies Corporation Limited. “Once we get the stock, attendants of the patients will be contacted. We are trying to procure the drug,” said Ohri.
The other drug that’s making families sweat hard is Tocilizumab, which has a complex requisition process and also needs a letter from the Meerut divisional commissioner. An immunosuppressant, the medicine is injected intravenously. It is considered an experimental treatment for fighting severe Covid-19 infections and is hence not freely available.

Those waiting to get vials of Tocilizumab said they have to wait 24 to 48 hours, and sometimes, even three to four days. As private hospitals in Delhi-NCR started prescribing the medicine for patients during the second wave, the demand for the imported drug suddenly soared and consequently its illegal trade also flourished. Since April 29, the Uttar Pradesh government has issued at least three orders and circulars for distribution of the drug to critical patients in L3 hospitals. The latest one was circulated on May 14.

To procure the drug, apart from a prescription, the attendant has to send a requisition form to the Meerut divisional commissioner through the hospital concerned. Forwarded via email, the requisition form has to provide a patient’s C-reactive protein (CRP), interleukin 6 levels (IL-6) and coagulation (D-dimer) test reports. An indemnity letter covering the cost of the medicine, Aadhaar card and recommendation of the government nodal officer deputed at the Covid care facility where the patient is admitted are also needed for the requisition to be taken up by the office of the divisional commissioner.
After approval, a patient has to pay around Rs 40,500 to the hospital. Prashant Pandey, who was involved in the scramble to get Tocilizumab for a 32-year-old patient prescribed the drug at a Greater Noida hospital, said, “After several calls to friends and relatives, we managed to get authorisation. However, it will take another day to get the injection as some formalities are still pending and the chief medical officer’s pharmacy has to hand over the injection to the hospital.”
Divisional commissioner (Meerut zone) Surendra Singh said, “We take a maximum of 48 hours to process a request for Tocilizumab. At times, hospitals do not send the complete requisition form and they have to be reminded to send all documents and reports.”
Gautam Budh Nagar chief medical officer Dr Deepak Ohri said the directions of government authorities were being followed and the injection was being handed over to hospital after verifying all documents.