Maharashtra / Pune hospitals running out of remdesivir for COVID-19 patients

Pune: Several hospitals in Pune are now facing an irregular supply of remdesivir, an antiviral drug proven to have had some impact in fighting Covid-19. Late on Wednesday, at KEM hospital, for instance, the administration was struggling to procure remdesivir for a critical patient, while Noble hospital authorities said they paid for the stock of vials but had yet to receive it on Thursday.

At Bharati hospital, too, doctors admitted to a shortage, while at Rao Nursing Home, doctors said they got a limited supply as against the required stock. While Ruby Hall said it had an adequate stock, several doctors said there was an increasing demand for this antiviral drug.

Administered intravenously with a double dose on the first day, followed by one dose in the next four days, remdesivir is said to help improve recovery time of oxygen-assisted moderately ill Covid-19 patients. Pharmaceutical firms Hetero, Cipla, Zydus and Mylan are among major companies distributing the drug to hospital pharmacies.

According to several distributors, the production capacity of Hetero is being enhanced as a third plant is being planned at Hyderabad. At least 2.5 lakh units are being manufactured every month and, according to a top official, there has been a huge demand from Maharashtra, especially Pune and surrounding areas.

Officials said Pune, on an average, required at least a minimum supply of 25,000 vials of remdesivir per month and the situation would be normalised in the next five days or so.

It has also been reliably learnt that there was a requirement of the antiviral drug in Nepal and South Africa, where a sizable number of vials were being sent. “All this has led to a temporary reworking of the supply mechanics and also enhancing production due to the increased demand,” a top official said.

Civic authorities said the standing committee recently approved a proposal to procure 1,000 vials of remdesivir and the stock would be available for civic-run healthcare facilities in the next two to three days.

Over the past two days, however, at some hospitals, authorities have informed relatives of critical patients to also help in procuring remdesivir as stocks are drying up.

Dr Madhur Rao, senior deputy medical administrator at KEM hospital, said they had made an effort to procure remdesivir till late on Wednesday and, on Thursday, got a stock report of some vials.

Doctors at some hospitals said they had to inform relatives of patients who require the drug to also help in procuring remdesivir. At Noble hospital, executive director Dr H K Sale said they had already paid for the drug but had yet to receive their supply and there were at least 31 critical patients at the hospital.

While Symbiosis hospital CEO Dr Vijay Natarajan said they had some stock of the vials, he pointed out that the Covid-19 task force guidelines needed to be properly followed before administering remdesivir.

“There has been a rampant misuse of this antiviral drug. This is indicated basically for a patient who progresses towards a requirement of more than four litres of oxygen. There are cases that have come to the fore when patients start demanding as referring doctors have prescribed the injection,” Dr Natarajan said.

He said even as remdesivir had proven useful for patients, international guidelines and Covid task force advisories needed to be followed.

Food and Drug Administration (FDA) Joint Commissioner (Drugs) Pune Division S B Patil said there was an increasing demand for this “drug of choice”. We are receiving calls from Nanded and other places whether the drug was available in Pune and there were some issues in the supply chain.

“There are 400 vials of remdesivir at present and in the next two days the stock is expected to increase to 2,800 vials,” Patil said.

The drugs are supplied through distributors to hospital pharmacies and each hospital has to send daily reports of the opening and closing balance of drugs apart from a five-page form providing patient details who have been administered the drug. Most hospitals said it was a cumbersome process as doctors had to fill up the forms.

According to experts, however, the demand for remdesivir was driven by the fact that it had managed to cut the duration of Covid-19 symptoms from 15 days to 11 in clinical trials around the world, and a recent advisory by Central Drugs Standard Control Organisation has urged drug controllers of all states to also take immediate measures to prevent the injections from being sold on the black market.