It’s April 19. India’s COVID-19 tally is at an alarming 2 lakh plus. Hospitals are at full capacity. The situation has reached a breaking point. Drugs are in shortage and the sought-after Remdesivir shows no signs of being available. Arth Jain needs it. He, like 2 lakh others, has a patient suffering from COVID-19 in the hospital and the injection is what can determine how quickly recovery can be made.
“There is an endless list of distributor helplines doing the rounds. I called in on some of these,” says Arth.
Distributor 1: “We only supply the drug to hospitals. Sorry, but we cannot help you.” Distributor 2: “The drug is not available today. Call in and come tomorrow. It might be there.”
Distributor 3 replies with a graphic step of how the drug can be procured.
What is to be done?
If you have recently had a harrowing experience in the task of securing even a vial of the ‘life-saving’ drug, or if you are currently at your wit's end, this may be what you need to know - the hospital has the drug.
What was the new law introduced by the Government regarding Remdesivir?
In a bid to prevent the hoarding and black market sale of the drug Remdesivir that is claimed to be effective in treating COVID-19, Maharashtra Finance Minister Ajit Pawar said that the vials of the drug would be supplied by the distributors to the hospitals directly.
This eliminates the need for a middle man in the form of retail shops. In a meeting that was held to take stock of the grave situation, Pawar said “Once provided directly to hospitals, only needy patients will have access to it. District Collectors will control the distribution.”
“We have been directed to prepare guidelines for the use of this injection. District Collectors have the right to control its distribution,” he said.
We spoke with a source who runs a COVID-19 care centre in Pune and he stated that in Maharashtra, the link for Remdesivir is only between the distributors and the hospitals. “There is a rare chance of the hospital claiming they do not have it. The stocks of the drug are counted when they leave the distributor and are then allocated to the hospitals. Supply is based on demand.”
He also makes a contrast with how things were chaotic before April 17 when the laws were changed. “Before the new law, only people with connections would get the Remdesivir. People were running around with prescriptions. I, myself got those who weren’t admitted in my centre, coming and asking for the drug. There was a doctor among them who asked for the drug, producing fake documents. I asked for the authentic documents and was persistent about it. He never showed up again. Fortunately, after the new law, things have stabilised.”
He also adds that in Pune, the hospitals and COVID-19 designated centres are issued a list at around 5 pm with the allocated vendor name and allocated injections per day. “We have to submit a demand list on an online document before 3:30 pm. All hospitals get stock close to their demand.”
What if the hospital claims to have run out of the Remdesivir vials?
Arth’s patient was told by the consulting doctor that they would need the drug and would have to arrange it as the hospital was unable to supply it. Now that retail shops were not stocking the drug, Arth got in touch with the distributors to try to procure the injections.
“We were frantic and tried calling multiple people. Everyone seemed to be out of stock. Through a distant connection, we met a lady who had 3 injections left after their mother had been treated. This however did not come easy. An injection that is at an MRP at Rs 1500 was given to us for Rs 15000/ injection. It’s worth sharing that the next day a compounder from another hospital offered to sell us at a similar price.”
What is happening at the ground level is shocking
Through the lady, we were able to arrange for 3 injections. The requirement is 4 injections for 3 days, 6 injections for 5 days. We were still in need of one more injection. “Now we were relieved that we had gotten hold of those 3 injections, and decided to go the official route for the remaining injection.”
On reaching out to the HOD of the hospital, here is what they came to know and it threw them off gear at what desperation can make the system do. “On that very same day, according to hospital records, 2 injections were taken out of the hospital remdesivir bank under the name of our patient. We had no clue about this. Now to find out, where were the 2 injections that had never reached us?”
They later traced the 2 injections back to the hospital itself saying that “it might have been a miscommunication”. So, who is responsible at the ground level?
“If we had never ventured to check and reach out to the high authorities of the hospital, they would be under the impression that we were benefitting rightly from the drug.”
Are the helplines an actual help?
As confusion is rampant about the status of availability of Remdesivir, people are clueless about where to get the drug from, if all sources pin the responsibility on the other. There is news about the shortage, which fuels rumours, black market sale of the drug. It is a crisis of economics. The demand is soaring high. But the supply cannot meet these expectations.
Arth also encourages people to not bank entirely upon the companies who put out their helplines with promises of the drug being made available to you. “It’s a scam. Every helpline number has a recorded voice that states a shortage. They aren’t even taking down a name or number so as to call once they get hold of the drug. People should avoid these.”
If you are helpless here is what you can do
After speaking to someone who runs a hospital and COVID-19 care centre, Arth was told that “the hospital has to arrange it. It is their responsibility, as they go to the distributors authorised by the Government. The stock of Remdesivir is then replenished. The link is now only between the hospitals and the distributors.”
“As in our case, where the hospital initially claimed to not have the injection, if you are facing a similar dead-end, the solution is to persevere and make your way to the highest hospital authority to question this claim.”
Try social media as a last resort
Arth recommends trying the social media approach, wherein you put your plea and tag the relevant ministers.
The format of the post being:
Relationship with the patient:
Hospital name and address:
‘Brief description about the situation’
Another important point to make note of is that even though distributors claim to have their hands tied and only supply to hospitals, if you are in dire need of the injection try approaching the distributor with a strong case and appeal on grounds of humanity. “If they are still persistent that they do not have the drug, take it on record and put it up on social media tagging the relevant authorities,” says Arth.
The learning that Arth shares from this ordeal is that “the hospital has the drug. Be persistent. Hold them accountable. If you do hit a dead-end, do not panic. Remdesivir may be a saviour drug but it is not the end-all. Have faith. Your patient will get better. Maybe instead of 3 days, if they had Remdesivir, it may take 6 days to recover. But they will be fine.”
The COVID-19 care centre official emphasises that since Remdesivir has to be administered by a nurse, the chances of people who are home quarantined are fewer. “Blackmarkteing might be the intention. Administration of the drug can only be done under medical supervision. It is not a magic medicine. And only if you need it, you will be prescribed it.”
The real worry is this
The official says that what is actually concerning is Tocilizumab which is used for slightly more critical patients. “This drug hasn’t been available all year and there is nothing that has been done about it. Along with this, the oxygen shortage is worrying. Efforts need to be taken in that direction.”