STOCK LIMITED, UP GOVT TREADS WITH CAUTION ON BLACK FUNGUS INJECTION
: With Uttar Pradesh having received “very limited” stock of the injection amphotericin B that is used to treat black fungus (mucormycosis) patients, the state government has chosen to tread with caution on its use.
Uttar Pradesh has reported 170 black fungus cases and 17 related deaths so far, according to official data.
There were 23 new black fungus cases and six deaths on Thursday. Black fungus is a rare and potentially fatal health condition that is surfacing among the recovered Covid patients.
A government order issued on May 19 by additional chief secretary (medical health) Amit Mohan Prasad said, “Very limited doses of amphotericin B injections have been received, hence its usage will be done cautiously and strictly as per standard treatment protocol. Treatment of black fungus will be done at state-run medical colleges, hence these colleges will get the drug via director general medical education and director general medical health.”
Those being treated at private hospitals need to obtain the medicine after permission from the divisional commissioner or additional director (medical
typically exist in abundance in the environment. “If a person’s immunity is suppressed, it will infect them. If the spores have access to high sugar, it will grow. We have seen this happen with Covid-19 patients with diabetes and uncontrolled sugar, or who are immuno-compromised or have been given immune-suppressants,” he added.
Several states are scrambling to place orders for the life-saving drugs required for it, and a Union minister announced manufacturing was being stepped up. According to the Union government’s lawyers at the Delhi high court, which asked the Centre to submit a report on steps taken to import drugs for it, the supplies of Amphotericin B, the only last line drug that can treat it, are being distributed on the basis of caseloads. The court was hearing a clutch of petitions for better Covid-19 management, and one of the petitioners mentioned the shortage of, and clamour for, Amphotericin B.
The Centre’s counsels Kirtiman Singh and Amit Mahajan told the court that as per the case load, 3,150 vials have been released to the Capital in three tranches between May 11 and May 20. To this, the Delhi government’s lawyer, senior advocate Rahul Mehra, said that the projected weekly demand was 15,000 vials.
“We are not questioning your allocation…you are doing good work… You need to import this to bridge the gap between your plan to enhance the capacity and completing manufacture before we lose more precious lives. So act fast on this…Float a global tender and ask internationally …. Make a global enquiry ,” a bench of justices Vipin Sanghi and Jasmeet Singh told the Centre’s lawyers. Meanwhile, on Thursday, Mansukh Mandaviya, who is the Union minister of state for chemicals and fertilisers, said in a tweet: “Black Fungus (Mucormycosis) curing drug #AmphotericinB’s shortage will be resolved soon! Within three days, 5 more Pharma companies have got New Drug Approval for producing it in India, in addition to the existing 6 pharma companies”. The shortage has been triggered by an unprecedented surge in cases, which often requires one patient to be treated with multiple vials of the antifungal drug. Experts at Delhi’s All India Institute of Medical Sciences (AIIMS) said on Wednesday they would normally see 10-15 cases a year, but have now received over 100 cases this month itself.
“Cannot talk about disease incidence as such but in our clinical life we would see maximum five to seven such patients in the intensive care units. It was rare,” said Dr Anjan Trikha, professor, department of anesthesia, critical care and pain medicine, AIIMS, Delhi on Thursday.
Delhi chief minister Arvind Kejriwal on Thursday said he has directed three governmentrun hospitals in Delhi to set up dedicated centres for mucormycosis cases, while promising to ensure adequate supply of medicines needed to treat the disease.
The facilities will be at Lok Nayak Hospital, Guru Teg Bahadur Hospital, and Rajiv Gandhi Super Speciality Hospital. Delhi has in place a fourmember technical committee to “streamline and systemise” the distribution of Amphotericin-B. Hospitals need to raise requests for supply with this committee. After an approval, the Directorate General of Health Services issues the drug to the representative of the facility.
Even though it has not been yet established whether the virus that causes Covid-19 is directly responsible for growing cases, clinicians say several factors found in Covid-19 patients could lead to the secondary infection.