Against the backdrop of shortage of Remdesivir injections and resultant panic among citizens, the district administration and office-bearers of prominent organisations of healthcare experts have come up with a joint appeal to private hospitals not to use the said injection rampantly. Ravindra Thakare, District Collector; Dr Archana Kothari, President of Indian Medical Association (IMA); Dr Anup Marar of Vidarbha Hospitals Association (VHA); Dr Rajesh Sawarbandhe, representative of IMA; Dr Nandu Kolwadkar of VHA, Dr Sameer Chaudhary of AOI Vidarbha, issued a signed appeal regarding Remdesivir use to all private healthcare professionals in Nagpur on Sunday. Thakare appealed to the private doctors to use Remdesivir injections only in case of COVID-19 patients in ‘E’ and ‘F’ categories, as per the Maharashtra COVID-19 Task Force’s recommendations for management of hospitalised patients.

 

The doctors should ensure that Remdesivir injection is administered as per these guidelines only. If the injection is administered in other-than-specified conditions, the District Collector warned, serious cognisance will be taken of such act. “Remdesivir injection is a weapon to combat COVID-19 infection, but it has to be used properly. Doctors need to be alert about its use,” Thakare said. As per the official press release issued by Directorate of Information and Public Relations, Dr Archana Kothari said that the patients should have faith in doctors and Remdesivir injection should be used only when needed, depending upon the patient’s condition. Dr Anup Marar was quoted as saying that Remdesivir injection might be harmful for body if administered without need.

 

Hence, he added, it is to be administered only in case of patients who need it. In another development Dr Pradeep Vyas, Principal Secretary of Public Health Department, Government of Maharashtra, issued a letter to all Collectors, Municipal Commissioners, and Divisional Commissioners as well as Secretary of Medical Education Department regarding Remdesivir use. The letter issued on Saturday reiterates the clinical protocols and indications for rational and optimal use of Remdesivir injection, which has been given emergency use authorisation in treatment of COVID-19. “Last few days it has been seen that, there are huge crowds outside retailers asking for Remdesivir injection. It is unnecessarily leading to lot of panic as every drug has its own usage and limitations. Remdesivir has been shown to reduce the duration of stay in the hospital but has no effect whatsoever on the mortality due to COVID-19 infection, and this needs to be highlighted. Further, it is of use only if prescribed in the initial few days based on indications,” Dr Vyas stated in the letter. Furher, the letter asks the authorities to direct retailers to dispense the medicine only if it is accompanied by information in prescribed format.

 

This format has been devised ‘to curtail unethical practices and misuse’, stated Dr Vyas. The format has columns for name of hospital, patient details with identification, clinical information (fever in degree Fahrenheit, breathlessness, respiratory rate, SpO2 in room air, whether patient is on oxygen in lit/min quantity, whether patient is on invasive ventilation). The clinical information is sought in terms of number of days for the said parameters, and parameters at the time of admission as well as present-day. The format seeks the latest laboratory report, mention of HRCT findings and co-morbid conditions, and indications for starting Remdesivir dose. The hospital in-charge has to certify the details. 

 

When is Remdesivir injection administered? Maharashtra COVID-19 Task Force’s recommendations for management of hospitalised patients categorise COVID-19 patients on the basis of symptoms. Patients in ‘E’ category face difficulty in respiratory system, respiration rate of 24/minute, SpO2 level is below 94 per cent, and PaO2 below 60 mmHg. Patients with pneumonia (LRTI) with respiratory failure with sepsis/septic shock/multi-organ dysfunction syndrome are categorised in Group ‘F’. For a patient with moderate infection in both these categories, Remdesivir injection is recommended to be administered 200 mg intravenous (IV) once in a day on Day One, followed by 100 mg IV once in a day for four days. If a patient in these two categories is on mechanical ventilation, then the injection is to be administered for nine days.