Maharashtra: Urgent need to streamline Remdesivir supply, say doctors

Under the existing protocol, a particular hospital or nursing home is eligible to receive Remdesivir for 10% of the active Covid patients under treatment, on a day-to-day basis.

Proprietors of small to mid-sized hospitals and nursing homes said they are struggling to obtain adequate quantities of antiviral drug Remdesivir under the new allocation system introduced in the state 10 days ago. Where hospitals were earlier able to procure vials directly from manufacturers (through medical representatives of pharma companies), they now have to obtain them from district collectors, based on requests sanctioned by the Food and Drug Administration (FDA).

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“This has made the supply extremely erratic. Our need is about 40 vials per day. Before FDA stepped in, we could buy between 200 to 300 vials at a time and that would keep us steady for a short period. Now we are on our toes every day wondering how many vials will come. We get about 20 vials every two days. In the past five days, we have received stock only on three days,” said Dr Prince Surana, proprietor of Surana Hospital in Chembur which has 70 Covid beds.

Under the existing protocol, a particular hospital or nursing home is eligible to receive Remdesivir for 10% of the active Covid patients under treatment, on a day-to-day basis. Each hospital raises their daily requirement with the area’s concerned health officer, who then forwards the same to FDA, which makes the doses available at the collector’s office.

“But this quota is not enough. In every hospital, more than 5% of admitted patients will need Remdesivir. After all, they are admitted because their oxygen saturation is low. Every patient whose oxygen level is less than 95 should get the injection. So yes, one consequence of this system is that the drug is not reaching the facilities as per their need,” said Dr Deepak Baid, former president of Medical Consultants Association.

Another consequence, doctors said, is that relatives of patients are unnecessarily sent on treasure hunts to find the drug elsewhere (usually in the black market), which is exhausting and also puts them at risk of fraud. “If we don’t have enough doses, we have to give patients’ relatives prescriptions and ask them to find vials elsewhere. But we know this is futile given the demand,” said Surana.

Nevertheless, doctors largely agreed that FDA’s active oversight in the matter is required so that smaller districts do not run out of supplies, as witnessed recently in Latur, Bhandara and Aurangabad. They also said the procurement system has improved over the past 10 days, but not enough to assuage their concerns.

“Initially through FDA, we were only getting about 10% of the daily need. Now we are getting about 40% of the requirement, which is also not enough. The biggest worry is whether tomorrow’s stock will come or not,” said Dr Amit Thadani, director, Niramaya Hospital in Kharghar which has 60 Covid beds. “Some days you get five doses, some day six doses, and someday 20 doses. But our requirement is about 30 to 40. We are at the mercy of the collector’s office,” he added.

“The Centre has kept the control of Remdesivir supply with itself. We have streamlined its distribution through district collector to curb black marketing. The supply of Remdesivir from the Centre is still less. Compared to the schedule given to Maharashtra till April 30, we have got 170,000 fewer injections. We need 65,000-70,000 injections on a daily basis,” said FDA minister Rajendra Shingne.

Even though Remdesivir has been proven to have “little or no impact” on Covid mortality, it remains in high demand, with Maharashtra’s daily requirement of around 70,000 vials. The consensus among doctors is that while it may not be a “silver bullet”, it does cut down the patient’s hospital stay and reduce their viral load. “So not having adequate doses is, in fact, a strain on the system even though the drug has little impact on mortality. In my experience, it can play an important role in recovery, especially when used in the right combination with other drugs,” said Sandeep Kothari, a chemist at CritiCare Hospital.