Thread by @barandbench

Delhi High Court will today continue hearing petitions concerning #COVID19 issues in the national capital.

Hearing to take place before Justices Vipin Sanghi and Jasmeet Singh.

#DelhiCovid #COVID19India

@CMODelhi @LtGovDelhi

Hearing begins.

#DelhiHighCourt #COVID19

Amicus Rajshekhar Rao raises issue of PSA plants.

#COVID19

We have some suggestions for GNCTD to consider: Adv Karuna Nundy

We'll try and consider: Court

#DelhiHighCourt #COVID19

We are conscious that today is the last day. Lordship may allow us to move court during the vacation if something happens: Rao

That was our apprehension: Justice Sanghi

Only if it is an emergency: Rao

Court says it will pass an order.

Not an issue: Court

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We should be able to sort it out with our officers. Hopefully we won't.. : Senior Adv Rahul Mehra for Delhi govt

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Some PSA plants have been donated to us. 14 plants of 9MT capacity have reached hospitals. Installation will be done by June 7. 20 plants will be received during June. 2 plants will come in July : Mehra

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9 plants from Centre will be installed in July... : Mehra reads the status report on PSA plants and storage plants.

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5 storage tanks with storage capacity of 171 MT : Mehra

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GNCTD has filed its status report which discloses the status of plants and storage tanks. Status is taken on record. GNCTD shall stick to the timeline mentioned. Status report be placed before the Court : Court dictates order.

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Court discusses the aspect of black fungus.

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If I recollect, court had asked if giving 1-2 vial was correct or not. How do we proceed with that. We said State govt will confirm with whatever Centre says : Mehra

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Court had flagged the issue.. our protocol explains that this is not the only medicine. Use alternatives : Kirtiman Singh for Centre

We have categorically stated that where there is intolerance.. and there is severe black fungus, other drug can be used : Anurag Ahluwalia

Anurag Ahluwalia appears for ICMR.

ICMR says limit use of Liposmal in these cases. It has to be with the fact that it is not easily available. But is it the medical standard.. there is a gap in supply: Rao

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There is nothing new. There are alternative medicines. There has to be an expert body to take a view. The protocol says that you use conventional AmphotericinB and reduce the nephrotoxic effects : Singh

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ICMR has their reputation in line. They are not the govt: Singh

They admit that AmphotericinB is nephrotoxic. They say how effect can be reduced. It doens't mean that if Liposmal is available, still give AmphotericinB. Drug of choice is still Liposmal AmphotericinB: Court

In cases where there is intolerance, you have to fall back on Liposmal AmphotericinB. I don't think we can read any direction or recommendation in the report to give AmphotericinB: Court

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How does it solve the problem at hand : Mehra

ICMR can't solve the problem of availability: Court

What do we do with the limited stock in the interim? How do we treat the patients: Mehra

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Mehra says the question of giving lesser doses than required has not been answered.

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These aspects have not been answered: Court

You can shift, is what we say. We say you can interchange therapies. Whether two vials would be enough can't be answered by the body : Ahluwalia

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This is not correct to say that only two must be given. There are alternative arrangements: Singh

We took note of two because if distribution factor.. we said taking that particular day, if you are giving 2 in place of 6, what will happen to patient: Court

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Singh says queries have been answered in th report.

Let's come to dosage schedule and see how questions have been answered: Court

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If there is a person who is not reacting badly to conventional AmphotericinB, he may be given. Liposmal can be considered in case of intolerance and cerebral infection : Singh

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Dosage for conventional AmphotericinB is mush lesser then Liposmal.: Singh as he continues to read the report.

You can use Posaconazole if AmphotericinB is not available: Singh

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Entire conspectus of how a patient could be treated.. impression was that there was nothing else apart from Liposmal to treat it : Singh

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ICMR is saying AmphotericinB is drug of choice even though it has reaction. Whereas Dr Das said that Liposmal was the drug of choice. Had Liposmal been in enough numbers, would the same order be there : Court

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It says Liposmal is plan B, there we have a problem. AmphotericinB shouldn't be primary therapy: Court

AmphotericinB is the basic salt. Liposmal is an improvement: Singh

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Tomorrow when there is a situation where there is no shortage,.. this is subject to revision in future: Singh

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If I want to save my eye and jaw and also not adversely affect my kidney, can I survive on two doses of Liposmal is the question: Court

Can we as non medical experts lay that down? It will be unfair to the patients. I can lay down parameters: Singh

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Question is best answered in the entire bouquet of medicines : Singh

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When they give dosing schedule, they would have said if Liposmal is available, it should be given : Court as it continues ti discussion the issue of giving Liposmal AmphotericinB or AmphotericinB.

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We can try and place what we have... people administrating the drug are aware of what has to be done : Singh

This protocol will create more confusion: Adv Aditya N Prasad

This is discouraging. It is unfair to sit over medical judgements : Singh and Ahluwalia

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These creative protocols need to be looked into by experts. Need to be discussed properly before they come out in general public : Prasad

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Only thing that occurs to me is that the statement from doctors that Liposmal is drug of choice.. this statement should be there. If it is not be read in a hospital.. it shouldn't be that Liposmal is available, AmphotericinB is given: Court

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Court says that doctors shouldn't straight away go to the alternative medicine AmphotericinB.

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Adv Nidhi Mohan Parashar says this issue has been clarified.

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They acknowledge the scarcity and therefore advisory has come in : Ahluwalia

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Both formulations are equal is efficacy.. nobody is shying away from nephrotoxicity : Ahluwalia and Parashar

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We'll break for lunch. Go back to ICMR if this amendment can be made that it is clearly indicated that Liposmal is drug of choice.. we don't want somebody misreading it : Court

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Your guideline is going to be there for a good time. You take instructions on where to put it. Let experts take a look. But it should be there: Court

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We are looking at a protocol and guideline as a pure, scientific guideline. If Liposmal is not available, you give the alternative: Court

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The question of classification of patients would come if we conclude that there is no drug. If alternative is available, why lay down the criteria? : Singh

Are alternative available? : Court

I will get back with answers. Point is whether I have enough resources: Singh

Whom not to give would anyway arise kn person's medical condition and not anyone else : Singh

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If medicines are available, why so manu fatalities? What is the mortality rate ? : Court

The percentage is not because of lack of medication but because the infection itself is fatal : Singh

#BlackFungus

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We'll come back at 3:30 : Court

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