As Ashish Poddar waited outside a New Delhi hospital for a black market dealer to deliver two drugs for his father, who was gasping for air inside with COVID-19, he held an ice pack on hand.
However, the drugs were never delivered, the ice that was supposed to keep the medications cold melted, and his father died a few hours later.
People in India are taking urgent steps to keep loved ones alive as a crippling surge of new coronavirus infections overwhelms the country’s health-care system. They are turning to unproven medical therapies in some cases, and to the black market for life-saving drugs in others.
The private hospital where Poddar’s father, Raj Kumar Poddar, was being treated told him that remdesivir, an antiviral, and tocilizumab, a drug that suppresses human immune responses, were required to keep the 68-year-old man alive.
Stocks had run out in most hospitals and pharmacies in the Indian capital. Desperate, Poddar approached a dealer, who offered the medicines in exchange for a nearly US$1000 ($1287) advance.
Some of the texts Ashish got while waiting read, “It’s nearby” and “coming.”
“I wish he had at least told me that he would not be attending. I should have looked in other places “”Says the bereaved son.”
With more than 379,000 new virus cases recorded on Thursday, India set a new global record for new virus cases, placing even more strain on the country’s already overburdened hospitals. In the world of nearly 1.4 billion people, over 18 million cases have been recorded, second only to the United States, with over 200,000 deaths — but the true number is believed to be higher.
Death is so prevalent that many cities are running out of room for burial grounds, and glowing funeral pyres burn all night.
Remdesivir and steroids in hospitalized patients are two of the few drugs known to better treat COVID-19. Oxygen therapy, the most basic medication, is also in short supply, resulting in premature deaths.
Also hospital beds are in short supply. On Thursday morning, there were only 14 free intensive care beds available in New Delhi, a city of 29 million residents.
India’s current treatment recommendations are similar to those of the World Health Organization and the United States, with one major exception: mildly ill patients should be given hydroxychloroquine or ivermectin, which are used to treat many tropical diseases.
There is no evidence that they function against COVID-19, and the WHO strongly advises against using hydroxychloroquine and ivermectin for COVID-19 of any seriousness except in research.
Despite the fact that India is the world’s leading producer of medicine, drug control in the country was weak even before the pandemic. And people are willing to do something to alleviate their despair.
Many prescription drugs, including emergency drugs approved by Indian authorities for COVID-19, can be purchased over the counter, according to Dr. Amar Jesani, a medical ethics expert.
“Hospitals and doctors are so used to getting a’magic bullet’ that can heal you,” he said, describing why unproven medications are being used as the number of COVID-19 cases rises.
When Suman Shrivastava, 57, was infected with the virus, her doctor in Kanpur city in Uttar Pradesh, India’s largest province, prescribed ivermectin. When her symptoms worsened, her doctor then asked her to take favipiravir, an antiviral, though it is unproven against COVID-19.Her nephew, Rajat Shrivastava, said that drug was hard to find but he eventually located it in a pharmacy which was rationing its supplies by giving a single strip daily to each patient. His aunt is now doing well after he purchased extra doses from an online volunteer on Twitter.
Dr. Anant Bhan, a public health and ethics researcher in Bhopal, warns that the do-it-yourself approach has risks. Antivirals and steroids, according to Bhan, can only be used in a hospital environment due to the chance of side effects. And, depending on the timing and severity of the symptoms, medications that are life-saving at one stage can be dangerous at another.
He said, “It’s scary because these aren’t vitamin tablets.”
According to Siddhant Sarang, a volunteer with Yuva Halla Bol, a youth activist organization that helps patients find medicines and hospital beds, black market prices for remdesivir, which is made by several Indian firms, have increased up to 20-fold to about US$1000 ($1287) for a single vial.
According to federal data released in September, Indian drug manufacturers produced over 2.4 million vials of the drug. However, as the number of cases decreased in September, businesses discarded most of their expired inventory, and demand fell.
In February, India was slow to respond to an increase in infections, and production was only ramped up in March. Merck announced a deal with five generic drug makers in India earlier this week to manufacture molnupiravir, an experimental antiviral similar to remdesivir, which is administered intravenously, but in a pill form. It is unknown when that will be available.
Because of the high demand, black market dealers are demanding cash up front, according to Sarang.
“People are going to dealers with a suitcase full of 200,000 to 300,000 rupees ($3400-$5100),” he said.
Authorities have begun to take action against the dealers. Raids on shops and people accused of hoarding oxygen cylinders and drugs are being carried out in New Delhi, for example.
Despite all of the desperate measures, many people still lack access to effective drugs.
Virus-blocking antibody drugs, which are commonly used in other countries, are not yet approved in India. Roche, which collaborates with Regeneron Pharmaceuticals to market one of these treatments, announced on Wednesday that it is in talks with India to expedite emergency use. Eli Lilly, a pharmaceutical company based in the United States that makes a similar treatment, said it is in talks with the Indian government.
This week, Stuti Bhardwaj, 37, went from one pharmacy to the next in southern New Delhi. Her parents, both in their seventies, were unable to obtain scans, but they had COVID-19 symptoms and dangerously low oxygen levels.
A doctor prescribed a variety of drugs, including hydroxychloroquine.
She finally discovered it and purchased it, despite the fact that she knew it was unlikely to succeed.
Bhardwaj said, “My parents are dying, I’m in a desperate situation.”