Gujarat govt's mucormycosis mess creates chaos for patients, hospitals

AHMEDABAD: Gujarat has India's highest 40% load of the lethal mucormycosis infection in Covid-19 patients. The state, as per details shared by Union health minister Dr Harsh Vardhan, has 2,165 out of the country's total 5,424 cases of the infectious black fungus.

However, the game plan to deal with the fungal infection which has caught global attention amidst the pandemic seems to have created more hurdles for the patients and hospitals alike which suddenly find themselves at the mercy of the state for emergency medicine - liposomal Amphotericin B injections. In fact, there have been as many as three different updates in five days for Ahmedabad-based private hospitals to get Amphotericin B injections. Initial notification by the state government dated May 19 mentioned disbursal from SVP Hospital and GMERS Sola Civil from May 20.
Another notification later swapped SVP for LG Hospital. On Monday, the distribution channel was again as LG was dropped and hospitals were asked to mail their requests to Civil Hospital, Asarwa instead where doctors would verify the patient details and MM diagnosis and accept or reject the requisitioned drug stock.
After chasing these centers in vain for four days only to be told through pasted notices that drug stock was not yet available, the Civil Hospital authorities had recieved requests for injections from seven hospitals while Sola Civil Hospital had got requests from two district-based hospitals. "All the requests are being processed," said authorities.
"Several patients have lost the battle against mucormycosis due to timely want of injections. The delay is costing lives of the patients," said a senior administrator of a private hospital who conceded patients' kin are turning the heat of their loss on them, picking up fights with staff.
"We have put eye surgeries of a dozen patients on hold as two weeks of injection therapy is needed to get clear margins between necrosis and healthy areas. We advised discharge to patients but some fear they won't get a bed. Such insecurity over injections and beds is disturbing," said a senior doctor at a leading private hospital.
Meanwhile, the private hospital authorities were disappointed to know that they were being sanctioned lyophilized (freeze-dried) amphotericin B instead of drug of choice- lyposomal Amphotericin B.
‘Control is injustice to private patients’
Infectious diseases specialist Dr Atul Patel who is one of the 30-authors of the global recommendations for mucormycosis treatment said liposomal Amphotericin B is recommended therapy which is simply not available to private hospitals. “Amphotericin B (lyophilised) injections are highly toxic and not recommended globally. But in absence of drug of choice, these injections should be used to save lives," said Dr Patel.
He added that emergency medicines must be available freely. “Control of the entire stock of life-saving drugs for mucormycosis by the government is injustice to patients at private hospitals,” said Dr Patel.
Dr Navin Patel, a city-based ENT surgeon, said surgeries for mucormycosis are on hold for the past few days due to lack of medicines. “It can have grave consequences for patients,” he said. At Civil Hospital,which has availability of injections, there is a flood of patients with 500-plus patients being treated through medical therapy and surgery. "We have nine wards for Mucormycosis patients who are being operated and treated. Government taking charge of the drugs has worked in favour of patients as it guarantees quality drugs at standard price. Otherwise, patients were forced to cough up Rs 20,000 for Rs 5,000 vial of injection,” said Dr Devang Gupta of ENT department in Civil Hospital. Dr Bharat Gadhvi, president of Ahmedabad Hospitals and Nursing Homes Association (AHNA), said that several city-based hospitals, including his own hospital, have put in request for the injections, but are yet to receive it.
“When everyone knows how grave the scenario for the infection is, it’s excruciating to know that the hospitals would have to wait for some more time to get the shots. We appeal to the state government not to delay the procurement for the hundreds of patients,” said Dr Gadhvi.