In an effort to address the Covid-19 crisis in Maharashtra, the state government floated an open-ended Expression of Interest (EoI) for procurement of essential medical supplies including oxygen concentrators, medical oxygen, Remdesivir to meet demands of districts.

Disaster Management, Relief & Rehabilitation Principal Secretary Aseem Gupta floated a global tender for supply of 25,000 MT of liquid medical oxygen and 10 lakh 100 ml Remdesivir vials.

“Companies with experience of oxygen production and supply are invited to submit their expression of interest for the said supply,” he said.

Issued on April 27, 2021 the deadline for such submissions is 5 PM on May 10. Meanwhile, the Maharashtra government stated it will start scrutinising received bids and placing orders from April 30 onwards. Interested bidders must: upload brochures containing technical specifications of products along with specifications; quote prices for the same; Submit online the Chartered Accountant certified Statement of Accounts of their respective firms for the last three years.

Among other supplies, the state government is also seeking to purchase 40,701 oxygen concentrators (OC) with 35,585 units enjoying a capacity of 10 ml/minute. These items will be distributed to rural hospitals, PHCs and Covid-dedicated hospitals.

The government asked for 132 PSA plants ranging from 600-3500 litre per minute capacities. The plants will be installed near district, sub-district, general and municipal hospitals. Additionally, 27 ISO tanks of 21 tons capacity will be distributed in various districts. Barring Nashik, Pune and Nagpur that will receive four tanks each, all districts such as Thane, Kolhapur, Aurangabad, Latur and Akola will receive three tanks each.

A copy of the EoI can be viewed below:

According to MyMahanagar, Maharashtra has a quota of 4 lakh 37 thousand injections of Remdesivir that offers some relief to the health system. The state demanded 60,000 Remdesivir injections daily but received only 40,000 injections from the central government.

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After Bombay High Court’s intervention, Maharashtra’s Remdesivir allocation for the period between April 21 and April 30 has been increased from 2,69,000 vials to 4,35,000 vials, by the Central Committee. This decision was taken after the Drug Controller General of India spoke to the Nagpur Bench.

However, the State’s counsel informed the Division Bench of Justices Sunil Shukre and Avinash Gharote, that they hadn’t received even one third of the allotted vials from pharmaceutical companies. The Bench orally noted that this was missing from their affidavit and then directed them to file a detailed response on the efforts taken by them to procure the drugs from manufacturers, following the Centre’s revised order, reported LiveLaw.

Further, the court said, “The Central Government’s order is specific and it ought to be followed in its letter and spirit by all the States, in particular the State of Maharashtra. It is in this regard that we would like to have specific information from the State of Maharashtra, which for the present, is not forthcoming.”

The Bench then directed the State, through the Nodal officer, to issue a revised circular, on the allotment of Remdesivir to different districts within Maharashtra, if not already done. “Unless and until such a revised district-wise allocation order is issued by the State Government, it would not be possible for any of the districts to ascertain as to whether or not it is being supplied Remdesivir vials in numbers matching with the drug quota allocated to that district,” said the Bench.

The issue of shortage of Remdesivir was raised by the Bench and it also interacted with the Drug Controller (Ministry of Health and Family Welfare) on April 23. The Controller VG Somani had informed the Court that the allocation of Remdesivir was done by a Central Committee, adding, the allocation can be increased if a specific request with proper justification is received from Maharashtra, reported LiveLaw.

The High Court also took stock of persistent issues regarding the drugs. It said, “There are also complaints about irregularities taking place at the Covid Care Centers. It is alleged that these centres/hospitals despite having stock of Remdesivir vials, are not making available Remdesivir vials for their administration to some of the needy patients and this is resulting in some kind of pilferage at the level of individual Covid Care Hospitals.”

It directed the District Collector, Nagpur and also the Commissioner, N.M.C. to carry out individual checks at different hospitals and ensure that the vials of Remdesivir drugs are actually put to use for treating Covid patients to their fullest extent, “without tampering with those vials.”

On the issue of oxygen supply in Nagpur district, the Bench noted, “As regards the supply of oxygen from Bhilai Plant, it appears that there is a problem being faced by the District administration of Akola. It is stated in the affidavit by the Divisional Commissioner, Amravati that for the present, there is disruption in regular supply of the allocated quota of oxygen to Akola district from Bhilai Plant. This quota is 10 metric tons every alternate day.”

But the court said that the supply from Bhilai Plant is going to be increased from April 28 as per the information received by the District Collector, Nagpur, and the situation regarding supply of allocated quota of oxygen to Akola district can be reviewed on the next date. In the meantime, the court has directed the Divisional Commissioner, Amravati to also look for alternate sources of supply of oxygen within the district of Akola or from nearby districts and place his suggestion in this regard before this Court so that specific directions can be issued.

The matter will be heard on April 29.

The order may be read here: 

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The Bombay High Court (Nagpur Bench) has directed the Maharashtra Government to provide 10,000 vials of Remdesivir, an antiviral drug used to treat Covid patients to hospitals in Nagpur, by 8 P.M, on April 19, reported LiveLaw.

The Division Bench of Justices SM Modak and SB Shukre were hearing a suo motu PIL initiated last year to take stock of the coronavirus situation in Maharashtra. It noted that, “There has been a disparity in the distribution of Remdesivir amongst various districts in and around Nagpur, and the drugs aren’t released in proportion to the requirement, but perhaps by considering factors which may not be relevant to the whole issue.”

The Bench has directed the Commissioner of Police, Nagpur, to identify areas where law and order problems could arise due to non-availability of drugs like, outside hospitals or supply centres for oxygen, and provide protection accordingly.

As per a LiveLaw report, the Bench ordered the State and the Nagpur Municipal Commissioner (NMC) to immediately grant necessary permissions to private hospitals, which are interested in setting up oxygen generation units. On April 13, while hearing the matter, the High Court had recorded in its order that the “State Government has, in principle, accepted the proposal regarding setting up of an oxygen plant / factory at Nagpur. It is stated that the Government is considering setting up of such plants also at some other places in the State of Maharashtra, and for that purpose, the Chief Secretary, Government of Maharashtra has convened an official meeting on 15/04/2021.”

Advocate Tushar Mandelker (appearing for the intervenor Dr. Shishir Kolhe) alleged the ‘discriminatory practice’ by pointing out that on April 16, the Thane Collector provided 5,328 vials of Remdesivir, against 2,664 Covid beds in the district, while merely 3,326 vials were provided by Nagpur’s Collector on the same day despite 8,250 Covid designated beds.

The Bench then noted in its order, “The State Committee must ensure a fair and proportionate distribution of Remdesivir vials by following the principle that where the requirement is higher, the supply shall also be higher…Covid scenario has turned to its worst ever and the situation is of gravest order, so much so that there are no beds available, there are no lifesaving drugs available in sufficient quantity, that there isn’t sufficient supply of oxygen and there is also dearth of medical and paramedical staff”, reported LiveLaw.  

The court also reportedly observed that the statistic shows “some arbitrariness in the district-wise distribution of Remdesivir vials by the State and this is required to be stopped forthwith.”

The court observed that on April 17, only 500 vials of Remdesivir were allocated and on two other dates, nothing was given. It was informed that denial of vials to so many patients in 117 hospitals across Nagpur has severely affected the management of covid patients and in some cases, the possibility of death due to non-availability of drugs could not be ruled out.

The High Court Bench referred to Pt. Parmanand Katara vs Union of India & Ors (1989), to state that every doctor at the government hospital positioned is duty-bound to give medical assistance and no law can allow to avoid and delay the discharge of such duty cast upon the professional and that under Article 21, the state is obligated to preserve life.

Another intervenor in the PIL, Dr. Mukesh Chandak had informed the court on April 15 that patients were also facing difficulty in getting RTCPR tests. According to the applicant/intervener, the delay in getting the reports by the patients is because “the laboratories are not giving the reports unless the reports are uploaded on the Indian Council of Medical Research (ICMR) portal and sometimes the server is slow, which results in delay in uploading of the reports.”

The Bench of Justices Z.A Haq and Amit Borkar held that test results should be made available to patients immediately on WhatsApp and a positive report must be uploaded on the ICMR website within 24 hours.

It said, “We direct that after making the reports available to the patients on WhatsApp as also hard copy of it, the reports of the patients, who test positive shall be uploaded on the ICMR portal within 24 hours and the reports of the patients who test negative should be uploaded on the ICMR portal within 7 days and if these directions are not complied with by the laboratories, the authorities will be free to take appropriate action against the concerned laboratories, as deemed fit by the concerned authority.”

It was also brought to the court’s attention that several Covid-19 patients have been standing outside hospitals waiting to be admitted, causing their health to deteriorate. As per a LiveLaw report, the court has directed the Nagpur Collector and Nagpur Municipal Commissioner to set up temporary healthcare facilities. It said, “We had referred to setting up a day-care Centre in February. NMC commissioner suggested directions for setting up Covid Care Centres with ICMR guidelines.” In the meantime, the court suggested that pandals should be constructed to provide them drinking water facilities as a temporary relief measure.

The matter will be heard on April 21.

The order dated April 15 may be read here: 

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Immediate actions must be taken against Bharatiya Janata Party (BJP) leader Devendra Fadnavis and other office bearers for hoarding Remdesivir, said the Aam Aadmi Party (AAP) in a press release on April 18, 2021.

At a time when people in Maharashtra are dying due to the Covid-19 pandemic and there is a Remdesivir shortage, former Chief Minister Fadnavis arrived at Mumbai’s Vile Parle police station on April 17 to declare that the party ordered the 4.75 seized medicinal vials from Bruck Pharma company in Daman distribute the stock among people.

However, as the AAP pointed out, political parties are registered with the Election Commission, not the Charity Commissioner. India’s Constitution and Representation of the People Act 1951 explicitly states that political parties cannot do charity.

“It is illegal for a political party to buy drugs, medicines or any other articles for the purpose of donation. The shroud of charity can easily be used to bribe citizens,” said the AAP’s Preeti Sharma Menon. 

Accordingly, the AAP demanded a public investigation into this incident of hoarding large amounts of medical stock for the sake of “cheap politics against opposition states.”

“It is not beyond imagination that the purpose of buying this large quantity of stock was for hoarding and denying it to citizens. This act is tantamount to murder,” said Sharma Menon.

Moreover, Menon condemned all TV channels that broadcasted videos of Fadnavis and other BJP leaders browbeating police officers and thwarting an investigation. Such an act by a common citizen would have resulted in arrest under IPC Section 353.

She asked, “Earlier this year I tried to meet DCP Upadhyay, he made me wait, then his office demanded I leave my cell phone out and when I refused, he did not let me enter his office. I had complained to the Commissioner but no action was taken. But here BJP leaders are seen recording the meeting on their phones! Why does Mumbai Police not treat all citizens equally?” 

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A Gujarat High Court Bench comprising Chief Justice Vikram Nath and Justice Bhargav D Karia, that has been hearing a suo motu Public Interest Litigation (PIL) regarding the Covid-19 situation in the state since April 12, has now observed that more could have been done to control the crisis.

In today’s hearing on April 15, Chief Justice Nath referred to the rise of cases in Gujarat over the past few days, that has gone up to 7,410 cases a day. Bar & Bench quoted him saying, “Not that the State was sleeping, but little more should have been done.”

Bar & Bench reported that in the previous hearing, the court expressed its dissatisfaction with certain policies of the government albeit it observed that the state was doing its best to deal with the situation. The Bench had directed the state to file its response in the matter.

The High Court had observed that several media reports on the pandemic indicated that Gujarat was heading towards a “health emergency of sorts” and initiated a suo motu public interest litigation over the coronavirus situation in the state.

Advocate General Kamal Trivedi (appearing for the State) ensured the Bench that the State is fighting together against the pandemic and that the laboratories are responsible for reducing the staff and the production of Remdesivir, a medicine approved for treating Covid. He reportedly blamed the press for showing the government in bad light and stated that the government’s “intention is not bad”. To this, the court remarked, “Nobody is saying you are to blame for the tsunami of cases. Press is only saying that the state should have been more prepared”, reported B&B.

Dr. Jayanti S. Ravi, Principal Secretary, Department of Health and Family Welfare, as per B&B, informed the court about the following immediate measures undertaken by the state:

• Not more than 50 persons can assemble at wedding functions and funerals and the time duration is restricted to curfew timings from April 14

• Religious celebrations and festivities are prohibited for the months of April and May.

• Public gatherings, processions, social events, for any reason, are strictly prohibited.

• Strength of employees coming in to work reduced to 50% and on alternate days. This is not applicable to essential services.

• Religious places to be closed. Entry to worshipers and pilgrims to be stalled till April 30.

• Negative RT-PCR report mandatory for all passengers coming into Gujarat from April 1, 2021.

• 22 Senior IAS officers assigned special duty of monitoring corporations and districts where the number of cases are increasing.

• 8 senior IAS officers have been given special responsibility of monitoring Covid-19 care centres in corporations.

• Vaccination available to all above 45 years.

• Night curfew imposed in 20 cities along with 4 metro cities from 8 pm till 6 am till April 30.

• Education institutes in the State to remain closed till April 30.

• Public transport closed in Surat and Ahmedabad Corporation.

• Interns, doctors and students of final year of nursing and MBBS dental, physiotherapy is involved in containment activities of Covid-19

• Strict implementation of social distancing and mask-wearing measures.

• Mass gatherings, social and political or other activities prohibited. Festivities restricted to symbolic offerings. Chaitri Navratri, Gui Padavo, Ram Navami, Ramzan Eid celebrations restricted.

• Suggestions received from the Gujarat High Court Advocates’ Association (GHCAA) for physical infrastructure, availability of medication, availability of oxygen, norms of physical movement, restrictions on assembly for social or religious events have been considered duly.

On the healthcare infrastructure

The Government informed the High Court Bench that the State currently has 97 testing labs, of which 43 are government hospitals and 54 are private labs, according to some media reports. As many as 70 RT-PCR machines are available in government labs and 40 are being purchased to enhance testing capacity.

According to the State’s response, Rapid Antigen Testing (RAT) has started in all Primary Health Centres (PHC), Community Health Centres (CHC), Health and Wellness Centres, Urban Health Centres and Outdoor walk-in facility kiosks, and 2177.7 tests per day per million are being conducted as against 66 tests per day per million on June 15, 2020, reported Bar & Bench.

Shortage of Remdesivir injections

The state has been reporting the shortage of this antiviral drug used to treat Covid and the High Court took note of the grim situation in the said PIL titled In Re : Uncontrolled upsurge and serious management issues in COVID control. The State was asked to file an affidavit on the situation of shortage and directed the State to explain what it is, and when, where, and to whom it should be given.

According to a report in Bar & Bench, the State clarified that the drug is not viewed as direct treatment for Covid but is currently being used as an antiviral drug to fight it. They have submitted before the court that it is to be given on an emergency basis and under supervision to patients complaining of continuous, high-grade fever and showing a lack of oxygen saturation. However, even according to the World Health Organisation (WHO), there is no evidence that Remdesivir improves survival in corona patients, says the reply.

According to the media, the State told the court that due to the dip in cases, the manufacturers reportedly scaled down their production very significantly by about 5-10% affecting the supply chain. The issue of fluctuating Remdesivir prices, over charging, hoarding, black marketing and short supply was also raised in the court. The State, as per Bar & Bench, told the court that on April 14, a communication flagging these issues was addressed to the Chairman of the National Pharmaceutical Pricing Authority, New Delhi.

The State has lastly submitted in its affidavit that the Centre has stopped the export of Remdesivir since April 2021 and that the manufacturers have also been asked to scale up production. The police have also been cracking down on hoarders and black marketeers of Remdesivir, pushing the tally to 6 cases over its illegal sale.

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