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Monday, May 10, 2021

Remdesivir injection: Procurement drops as Gujarat govt continues inconsistency on usage

The procurement has been dropping, from 35,000 injections on an average per day in government stock on April 8 to approximately 25,000 on April 14, 20,000 on April 19, which is now down to 16,500.

Written by Sohini Ghosh | Ahmedabad |
Updated: April 30, 2021 6:52:25 am
RemdesivirThe state government now says remdesivir will not be administered unless a patient is already on supplemental oxygen. (File Photo)

As the shortage, black-marketing and counterfeiting of antiviral injection remdesivir continues in Gujarat, the state government’s stance on the drug used for Covid-19 treatment has been inconsistent from it being the first line of treatment to warning against its indiscriminate prescription and hoarding.

The procurement has been dropping, from 35,000 injections on an average per day in government stock on April 8 to approximately 25,000 on April 14, 20,000 on April 19, which is now down to 16,500.

In September 2020, the Gujarat government increased the procurement of the drug when a shortage was reported. By mid-April when the demand exceeded the available supply and stock, the state government blamed the public for “panic buying and hoarding” and also blamed doctors for “indiscriminate” prescription of the drug.

Earlier this month, the Gujarat High Court said the panic was because of an inconsistent treatment protocol from the WHO, AIIMS New Delhi, ICMR and the state government. The court also directed the government to explain and communicate the usage of remdesivir by experts “through print, digital and electronic media”.

However, inconsistencies persisted. On April 26, the Gujarat government issued nearly half-page newspaper advertisements claiming remdesivir is to be used when oxygen saturation level is less than 90 per cent, CT severity score is more than 20/40or 12/25 and within nine days of onset of symptom. However, the state government guidelines said the drug can be administered to those with oxygen saturation less than 94 per cent, persistent high-grade fever, persistent diarrhoea, persistent viral cough, breathlessness on exertion for routine activities, respiratory rate greater than or equal to 24 breaths per minute, among other factors.

On April 22, the state health department vigorously pushed back on remdesivir usage and aligned its treatment protocol broadly with that of AIIMS New Delhi, while also relying on WHO solidarity trial result. The WHO, in November 2020, held that “evidence suggested no important effect on mortality”.

In the New England Journal of Medicine (NEJM) where the WHO solidarity trial result was published in February 2021, it was concluded, “These remdesivir, hydroxychloroquine, lopinavir, and interferon regimens had little or no effect on hospitalised patients with Covid-19, as indicated by overall mortality, initiation of ventilation, and duration of hospital stay”.

On April 26, Chief Secretary Anil Mukim wrote to Union health seceatry Rajesh Bhushan requesting four lakh vials for the state against the 1.63 lakh injections allocated by the Centre. The letter was part of the state government’s affidavit before the Gujarat HC and also justified its request by saying that “remdesivir is of great significance in reducing the stay in hospitals”.

As per a senior state government bureaucrat, the present allocation of 1,63,500 injections by the Centre from April 21 to 30, (a daily average of 16,350 injections), also includes the stock for open market.

In May 2020, principal health secretary Jayanti Ravi had advocated the use of remdesivir and Tocilizumab saying it had shown results across the world. At least five hospitals in Gujarat had participated in the WHO-sponsored Solidarity Trial, including two hospitals in Ahmedabad.

AIIMS director Dr Randeep Guleria, who was in Gujarat as part of a central team to take stock of the Covid-19 situation in July 2020 said that “oxygen therapy, steroids in mild to moderate patients, anticoagulants and prone positioning would save more lives than Tocilizumab or remdesivir”.

However the Gujarat government continued to endorse the drug and spent Rs 15.52 crore for purchasing “very essential 4,597 Tocilizumab and 18,050 Remdesivir injections for the treatment of Corona positive patients”, as per a statement from Chief Minister Vijay Rupani’s office in July 2020.

On April 8, Deputy Chief Minister Nitin Patel, who also holds the health portfolio, announced that remdesivir would be administered free of cost to moderate patients under observation for five days. He said that “25-30 per cent” of the total hospitalised Covid patients were admitted solely to be administered remdesivir. He also announced that Gujarat would get 35,000 remdesivir injections daily and that a tender for buying three lakh vials was already approved.

The state government now says remdesivir will not be administered unless a patient is already on supplemental oxygen.

The state government task force advised prudent usage of the drug, stressing that it is “not a life-saving, miracle drug”, but the government continued to procure the drug claiming it had got 1.70 lakh injections from April 1 to 9 as against 1.63 lakh it procured in the whole of March.

On April 9, when the Surat collector notified that it had no reserve stock of remdesivir for private hospitals, BJP chief CR Paatil announced free distribution of 5,000 injections from the party office in Surat. Paatil claimed the injections were from Zydus (Cadila) and distributed 3,000 of them.

The FDCA commissioner on April 10 reiterated that “the availability of remdesivir is adequate but it is being used thoughtlessly and has resulted in artificial scarcity”.

The Remdesivir saga

April 8: Deputy Chief Minister Nitin Patel says government would administer remdesivir to patients with mild symptoms at separate facilities over five days to free up hospital beds.

April 9: State Covid task force advises against panic, unnecessary Remdesivir prescription. Gujarat BJP president CR Paatil announces 5,000 remdesivir injections free of cost to needy patients from Surat BJP office.

April 14: Principal health secretary in an affidavit before the Gujarat HC submits that the WHO had said there was no evidence that remdesivir “improves survival in corona patients”.

April 15: Gujarat HC suggests state to come out with a detailed communication explaining all aspects of remdesivir. Also adds that the various treatment protocol guidelines by WHO, AIIMS New Delhi, ICMR, state government, has only added to the public’s confusion.

April 19: Nitin Patel admits in a press conference that the state was procuring only 20,000 vials of Remdesivir a day on an average

April 21: Centre takes over allocation and assigns an interim allocation of 1,63,500 vials from April 21 until April 30 for Gujarat.

April 22: State comes out aggressively against remdesivir. Ahmedabad Medical Association too comes out in support of the state’s stance, adding, “in real, there is no shortage — this shortage is due to misuse, overuse and hoarding”.

April 26: State government issues advertisements on remdesivir usage, laying down patient condition criteria different from its own health department guideline. Chief Secretary Anil Mukim writes to Centre, requesting for a 4 lakh injections for 10 days.

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