INDIA. Mumbai: The Union Government banned the export of “Remdesivir” injection (an anti-viral drug) and “Remdesivir” Active Pharmaceutical Ingredients (API) even as a load of active cases across India surged up to 11.08 lakh on Sunday.
Seven Indian companies are manufacturing “Remdesivir” injection under a voluntary licensing agreement with M/s. Gilead Sciences, USA. These companies have an installed capacity of about 38.80 lakh units per month.
The Government prohibited the export of “Remdesivir” till the situation improves. It has taken the steps to ensure easy access of “Remdesivir” to hospitals and patients. All domestic manufactures of “Remdesivir” have been advised to display on their website, details of their stockists/distributors to facilitate access to the drug. Drug inspectors and other officers have been directed to verify stocks and check their malpractices and also take effective measures to curb hoarding and black marketing. The state health secretaries will review the situation with Drug Inspectors of their state/Union Territory. The Union Department of Pharmaceuticals is already in touch with the domestic manufacturers to ramp up the production of “Remdesivir”, an official release stated.
The government has also advised the states that the existing “National Clinical Management Protocol for COVID-19″, has been developed after many interactions by the committee of experts, and is the guiding document for treatment of COVID-19 patients. In that protocol, “Remdesivir” is listed as an investigational therapy, i.e. where informed and shared decision making is essential, besides taking note of contra indications mentioned in the guidelines. The government has also advised the states and union territories to communicate these steps to all hospitals, both in the public and private sector, and monitor the compliance.
Maharashtra SOP
Maharashtra Chief Minister Uddhav Thackeray held a meeting of the COVID-19 task force on Sunday night in which various issues, including formulation of Standard Operating Procedure (SOP) to deal with the issues such as night curfew, mini lockdown and total lockdown were discussed. Thackeray is expected to announce the decision about the proposed lockdown after Ambedkar Jayanti on Wednesday.
The above the meeting was attended by Health Minister Rajesh Tope, Medical Education and Drugs Department (MEDD) Minister Amit Deshmukh, Chief Secretary Sitaram Kunte, Addl CS Ashishkumar Singh, CM’s Principal Secretary Vikas Kharge, Principal Health Secretary Dr. Pradeep Vyas, Dr. Sanjay Oak (Head, Task Force) and others.
Suggestions by Task Force
The members of the Task Force pointed out that 95 percent of the patients can be treated and cured at home if isolation wards equipped with Oxygen concentrators and beds are set up in housing societies. For this help of local bodies can be sought. Then only serious patients can be hospitalized. Besides, the new patients can be asked to undergo 6 minutes “walk test” and they can be admitted to the hospital if their condition is serious. Since, of late some of the young patients also require ventilators, the use of ventilators have to be planned, the members pointed out. Besides, a heavy fine should be imposed upon those who roam in public without wearing a mask. Also, the services of third-year MBBS students can be utilized for patient care in public hospitals.
Union Minister Prakash Javdekar on Sunday told media in Pune that Maharashtra will receive 1121 ventillaors within next 3 to 4 days.
The surging number of patients
Dr. Vyas stated that there were 1.50 lakh patients between March 14 to March 20, 2021. Whereas 04 lakh new patients were registered in a short span from April 04 to April 10, 2021. Totally 1982 patients died in this period, the death rate was 0.5 percent and it is going up. The positivity rate is 26 percent and it is also increasing with more tests. On April 10 alone, 2.60 lakh tests were carried out. They included 01 lakh antigen tests. As of now out of 20,250 ICU beds, 75 percent are occupied, while out of 67,000 oxygen beds, 40 percent have been occupied. No beds are available in 11 to 12 districts.
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The oxygen shortage
Chief Secretary Sitaram Kunte pointed out that out of 1200 MT, 980 MT is being used for medicinal purposes. However soon the existing stock will be depleted. As such the oxygen can be brought from Gujarat, Karnataka, and Madhya Pradesh, where it is manufactured in bulk.
Remdesivir
Health Minister Rajesh Tope suggested that the “Remdesivir” be supplied directly to the hospitals by wholesalers instead of it being sold by retail chemists at an exorbitant cost. Besides, the doctors be asked to fill in forms whenever “Remdesivir” is given to the patient so that the centralized record of the drug can be maintained. Also, its excessive use should be regulated.
Gaps in containment strategy alleged
The people waiting at the NESCO centre set up by the BMC at Goregaon East in North Mumbai for COVID-19 vaccination. The centre is absolutely spick and span, equipped with all facilities.(Photo credit: Raju Vernekar)
While Maharashtra achieved the distinction of vaccinating 1 crore, 38 thousand 421 people on Sunday, the Union Health Secretary Rajesh Bhushan, pointed out gaps in containment strategy adopted by Maharashtra, Punjab, and Chhatisgarh. The reluctance towards following COVID-19 preventative behavior, overburdened test centers, and lack of containment strategy is leading to a rise in cases and deaths in these three states, he pointed. Bhushan leveled these allegations based on feedback given by the 50 high-level public health teams, deployed in these states to take stock of the COVID-19 situation.
The public health teams, which visited different hospitals and vaccination centres reportedly highlighted issues related to testing, hospital infrastructure, containment operations, and vaccination progress, Bhushan stated in his letter.
The charges against Maharashtra
The 30 teams deployed in Maharashtra reported that there was reluctance towards following COVID-19 appropriate behavior. The teams reported that testing capacities in at least eight districts- Palghar, Satara, Amrawati, Bhandara, Jalna, Nanded, Buldhana, and Latur were overwhelmed and were delaying reporting of test results. There was resistance to testing in the Bhandara district reporting a large number of cases from outside containment zones.
Containment operations in Satara, Sangli, and Aurangabad districts were not up to the standard while contact tracing operations in Buldhana, Satara, Aurangabad, and Nanded were ‘suboptimal.’ While Ahmednagar, Aurangabad, Nagpur and Nandurbar districts reported a high occupancy of hospital beds, Aurangabad is depending on neighboring districts for treatment of its critical patients.
Pune, Palghar, Osmanabad, and Bhandara were facing medical oxygen shortages and ventilators in Satara and Latur were malfunctioning. There was an acute shortage of health workers in Palghar, Aurangabad, Jalna, Nandurabar, Jalgaon Yawatmal, and Satara. The Centre’s teams advised the authorities to hire contractual workers to address these issues.
Punjab
The teams deployed in Punjab stated that the rate of vaccination was slow in Patiala and Ludhiana. Both districts were lagging in terms of contact tracing. The Rupnagar district has no dedicated COVID-19 hospital and RT-PCR testing laboratory. The teams also asked the district administration to prioritize addressing hospital infrastructure in SAS Nagar, Jalandhar, and Ludhiana as hospital bed occupancy rates continued to rise due to rising COVID-19 cases.
Chhattisgarh
In Chhattisgarh, Korba, Durg, and Balod districts were facing a shortage of RT-PCR testing facilities. These districts had high bed occupancy rates and all ICU beds were occupied. Besides, the Korba was facing a shortage of Remdesivir. Also, Durg, Jashpur, and Rajnandangaon districts were facing a shortage of healthcare workers.
Tika Utsav
In the meanwhile on the first day of four days long “Tika Utsav”, nearly 27.69 lakh vaccine doses were given at 63,800 centers across the country, thus taking the cumulative coverage of COVID-19 vaccination up to 10.43 crore, on Sunday under the drive which will be operational till April 14.
