Updated: May 22, 2021 1:22:15 am
A day after Gujarat notified mucormycosis, a complication seen in Covid-19 patients, as an epidemic, eight hospitals in the state designated to oversee the equitable distribution of Amphotericin-B injection, used in its treatment, formed committees to “scrutinise” requisitions from private hospitals and patients.
The committees will examine the requisitions on a case-to-case basis, given the shortage of the drug with health officials saying that districts would have to adopt a fragmented policy of distribution.
The eight nodal hospitals are Ahmedabad Municipal Corporation-run LG Hospital and Gujarat Medical Education and Research Society (GMERS) Sola Hospital in Ahmedabad, SSG Hospital in Vadodara, Pandit Deendayal Upadhayay (PDU) Government Hospital in Rajkot, Guru Gobind Singh Government (GG) Hospital in Jamnagar, Surat Municipal Corporation-run SMIMER Hospital in Surat, Sir T Hospital in Bhavnagar and GMERS Gandhinagar.
At the SSG Hospital in Vadodara, which has been performing around 20 daily surgeries for mucormycosis and needs 800 vials per day, the supply has been only 200 vials.
Dr Ranjan Aiyer, Medical Superintendent of SSG Vadodara and HoD of the ENT department, said, “The government has notified SSG as the nodal office but they have not clarified the quantity of the drug that will be made available to the hospital for its own patients… We have a requirement of 800 vials per day for our 165 admissions, but we have been getting only about 200 vials.”
“On Friday, the District Collector and Chief District Health Officer (CDHO) received 200 vials more but they routed it to SSG. We are awaiting further instructions to begin the distribution… government hospitals will first have to be secured with adequate stock before it is distributed,” Aiyer said adding that since Thursday evening, when the notification of the nodal hospitals was made public, the hospital has been receiving continuous queries.
In Ahmedabad, the change of the notified nodal hospital for Amphotericin-B from SVP to LG Hospital on Friday morning resulted in chaos at both hospitals.
Addressing media persons, AMC medical officer of health Bhavin Solanki said, “Around 45 patients are admitted to LG Hospital… AMC shall arrange the stock for them. Per-day requirement for these patients is around 250 injections. Nearly 80 patients with suspected and confirmed mucormycosis are admitted to private hospitals… To cater to the demand from private hospitals, we will need an estimated (additional) 11,000-12,000 injections. The AMC has requested the state government for more stock…”
At GMERS Sola, 11 mucormycosis patients are admitted, medical superintendent Dr Pina Soni said. At GMERS Gandhinagar, 18 patients are admitted and an additional three patients are awaiting admission, said medical superintendent Dr Niyati Lakhani.
“There was a circular from health commissioner (appointing GMERS Gandhinagar as a nodal distribution centre) to provide the drug to private and other hospitals.But even government hospitals are not getting enough stock… An arrangement has been made through the regional deputy director where GMERS Gandhinagar will get Amphotericin B for our own patients…” said Lakhani.
In Rajkot, where 430 patients are undergoing treatment at PDU Hospital, Medical Superintendent Dr RS Trivedi said that the drug availability has improved over the past four days. “On an average, doctors have been performing 15 surgeries for the past 10 days and so far, we have had enough drugs,” said Trivedi said.
Rajkot was the only district that reported distributing 400 vials of liposomal Amphotericin-B to 21 private hospitals, completing the stock that it had received from GMSCL. District collector Remya Mohan confirmed the formation of an expert committee.
In Jamnagar, where 104 mucormycosis patients are undergoing treatment at GG hospital, where about four surgeries are performed daily, procuring the drug has not been an issue so far, Dr Nandini Desai, Medical Superintendent of GG Hospital, told this newspaper.
Jamnagar District Collector Ravi Shankar said that the government has allotted 100 vials of Amphotericin B to private hospitals and a nodal officer would oversee the distribution.
In Vadodara and Gandhinagar, the drug will be distributed under the supervision of the respective District Collectors, after a committee under the Regional Deputy Director (RDD) of Health examines the case. Surat, which received its first stock of 130 injections on Friday, also formed a committee where private hospitals can send their requests before 5 pm every day.
Medical superintendent of SMIMER hospital, Dr Vandana Desai, said, “We have formed a committee of four HoDs of different departments in medicine and one medical expert… The demand is high.” The injectible Amphotericin B is available in three forms — Conventional, Lipid Emulsion, and Liposomal, with the third variety being the most preferred. “The damage that the conventional form and the lipid emulsion can do to renal functions of even a healthy person in a matter of days is a huge factor. The liposomal form is the safest of the three,” Aiyer said.
“Each vial of Liposomal Amphotericin-B costs over Rs 5,000 and the overall cost of treatment of mucormycosis can go up to Rs 26 lakh. Even the alternative drugs are extremely expensive. For example, isavuconazole costs Rs 43,000 per 14 tablets of 100 mg,” Aiyer said, adding, that the civil hospitals will receive the stock from GMSCL and the collection from the “sale” to private hospitals will be deposited into GMSCL accounts by each nodal hospital.
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