New Delhi, Jun 4 (PTI) The Delhi High Court on Friday was surprised with the submission of Centre's counsel that Amphotericin B, one of the medicines used for treating Black Fungus was readily available in the market.
When the court said if the medicine was available in abundance there should not have been so many deaths, the counsel said people were not dying because of lack of medicines but the disease Black Fungus itself is dangerous.
Central government standing counsel Kirtiman Singh, replying to the remark of the court that nearly one-third people affected with Black Fungus have died, said people are not dying of lack of medicines otherwise there would have been a lot of noise and disturbance.
The submission did not go well with a bench of Justices Vipin Sanghi and Jasmeet Singh, which said “there is already a lot of noise and if you choose not to hear it, that is your choice.” However, during the hearing the High Court expressed satisfaction over the guidelines issued by the Indian Council for Medical Research (ICMR) on possible treatment options for Black Fungus for which Liposomal Amphotericin B is the drug of choice and asked the expert body to review it on regular interval.
The court was informed that the criteria for prioritising patients for administering Liposomal Amphotericin B for treating mucormycosis (Black Fungus) is young patients and those in whom surgical debridement is not possible or incomplete.
The ICMR, in its latest guidelines, initially adviced the use of ‘Amphotericin B deoxy cholate’ as the standard treatment while observing that it causes nephrotoxicity and also adviced as to how it should be administered to reduce nephrotoxicity.
The court observed that on June 1 proceedings itself, it was informed by a senior government doctor that Liposomal Amphotericin B is the drug of choice to treat Black Fungus and asked the Centre’s counsel to clarify the same.
Later, an ICMR scientist joined the proceedings and stated that either an amended guidelines or addendum will be issued to indicate that this is framed in light of shortage of Liposomal Amphotericin B and will be reviewed after every two weeks for three months.
“In light of this, we are satisfied with the guidelines issued by the ICMR and it shall issue necessary addendum and continue to review the guidelines every two weeks for the next three months,” the bench said.
The guidelines, placed on record through advocate Anurag Ahluwalia, were framed in pursuance to the court’s June 1 order in which the various questioned were posed relating to treatment for Black Fungus.
The guidelines discuss all possible treatment options as well as preventive measures including appropriate management of co-morbidities.
At the fag end of the day-long hearing, all the advocates thanked the two judges for conducting a marathon hearing on management of COVID-19 crisis in Delhi since April 19. The lawyers also thanked each other and also the court staff for their immense efforts put in the hearings and wished happy vacations.
The high court on June 1 said it was passing with 'a heavy heart' a direction for the Centre that a policy on distribution of Liposomal Amphotericin B drug for treating black fungus be made giving priority for patients of younger generation who can build and take the country forward.
It had said the administration of drug has to be prioritised for those with better chances of survival as also the younger generation, having promise of future over the older ones who have lived their lives and added that this could at least save some lives, if not all.
It had made it clear that it was not at all saying the lives of older people are not important as the emotional support which the elderly persons provide to a family cannot be discounted.
The high court had said it was high time that the ICMR, which is a statutory body constituted to lay down guidelines for medical treatment of patients suffering from various ailments, comes out with clear guidelines on the use of Liposomal Amphotericin-B, plain Amphotericin-B and Posaconazole, for Black Fungus treatment.
The court said several questions are arising which can only be answered by medical experts committee like the ICMR and explained some of them including, whether it is medically prudent to administer two vials of medicine to a patient suffering from Black Fungus on daily basis even if the advised dosage is 6 vials per day.
The other questions were if due to shortage of medicine, a patient is given two vials per day, what are the other drugs he can be given to cure to disease and if there is loss of any body part and possibly eventual death, whether it is medically prudent to identify patients who should be given the dose first at the cost of others.
The issue of shortage of the medicine for treating black fungus was raised by advocate Rakesh Malhotra who said these cases are rising.
According to the Union Health Ministry, Mucormycosis or Black Fungus is a complication caused by a fungal infection. People catch mucormycosis by coming in contact with the fungal spores in the environment. It can also develop on the skin after the fungus enters the skin through a cut, scrape, burn, or other type of skin trauma.
The disease is being detected among patients who are recovering or have recovered from COVID-19. Moreover, anyone who is diabetic and whose immune system is not functioning well needs to be on the guard against this, the ministry has said. PTI SKV SKV RKS RKS