The Delhi High Court on Monday said the gap between demand and supply of Amphotericin B, used for treating black fungus affecting primarily those who have recovered from COVID-19, is too wide to bridge and drastic steps are required to be taken.
A bench of Justices Vipin Sanghi and Jasmeet Singh, which heard for six hours the matter relating to various issues arising out of the COVID-19 pandemic, said the gap between the demand and supply is more than one-third and it cannot work at this pace.
It appears the present production and supply and their projections may fall well short of the requirement of the medicine to treat black fungus patients not only in Delhi but across India, the bench said.
The court also said this situation is very different from oxygen crisis and if there is very limited supply, everyone will have to take a cut. How do we pass any order that you give it.
The Centre indicated to the court about the expected supply of the medicine stock in May and June, early delivery of its import and ramping up of production.
Regarding augmentation of the medicine, central government standing counsel Kirtiman Singh and Amit Mahajan said expected supply in May was 1.36 lakh vials, in June it would be 2.55 lakh vials.
Besides, the import order of the drug is 7.05 lakh vials and the government is trying to find out other avenues, he said, adding that it has also set up a portal for real time data where the states have to update the number of black fungus patients, admissions to and discharges from the hospital and the deaths.
The court directed the Centre to file a further status report with all the relevant details and listed the matter for hearing on May 27.
The bench was informed by the Delhi government's counsel that while on May 21, there were around 200 cases of Mucormycosis (black fungus) in the national capital, the number has increased to 475 as on Monday.
After perusing the figures given by the Central government, the bench said, The gap is too wide to bridge. Something drastic needs to be done. It cannot work at this pace. The gap is more than one-third. There is a huge shortfall even with these steps.
The bench asked the Centre to find out if there can be more licensees, apart from existing five firms, to manufacture the medicine.
On being asked about the situation worldwide and whether the medicine was in shortfall across the globe, the Centre's counsel said black fungus cases are majorly in South Asia and very few in other countries, so the drug is not in much demand there.
He said the Centre was trying to do whatever it can and there are several constraints like capacity and quality management of the drug.
The counsel said black fungus was not a contagious disease and it is not going to grow at the pace at which COVID-19 grew and added that those who have developed Mucormycosis, best of luck to them and God be with them.
He said the Centre will place in the status report about the efforts and progress made by them for alternative medications.
The court was informed by various advocates that besides black fungus, now white and yellow fungus have also been reported and the latter is more lethal and few cases have been reported in Ghaziabad.
To this, the high court asked if all these are related to oxygen and steroid administered on COVID-19 patients.
Additional Solicitor General Chetan Sharma said that according to Dr Randeep Guleria, AIIMS Director, it is caused due to steroid overdose and also seen in diabetic patients.
The Centre's counsel submitted that they have issued a notification to identify black fungus under the Epidemic Disease Act which will ensure that all suspected and confirmed cases of Mucormycosis shall be reported through the Health Department and have also issued SoP for reporting the disease.
He said it is a drug not a jackfruit and the government can't force people to produce sub standard drugs.
Senior advocate Rahul Mehra, representing the Delhi government, said there is an outcry in the society as to how the patients can't have medicine and the number of cases in Delhi have now increased to 475.
When the Centre's counsel said the Delhi government had demanded one lakh vials of the medicine which was too much, Mehra said it was in the context of 1,000 cases expected by this month.
The court said, Point is Delhi government may have asked for one lakh... The question is how you are planning to meet the demand of Delhi and of all over India. Even your projections are not sufficient to meet the demand.
Amicus Curiae and senior advocate Raj Shekhar Rao said there is a genuine problem on the ground and he might sound alarmist but the expected number of black fungus is to go up to 40,000-50,000 in next months.
Meanwhile, a woman advocate apprised the court about her 80-year-old grandfather, who is admitted at Ganga Ram Hospital and fighting black fungus, saying they have not received a single vial of the medicine for last five days due to which he has undergone two surgeries and possibly the third one might take place on Tuesday.
The court issued notices to the two governments and the hospital and asked the authorities to try if the patient could be shifted to AIIMS where the vials are reported available or arrange for medicines.
The issue of shortage of the medicine for treating black fungus was raised by advocate Rakesh Malhotra who said these cases are rising.