Decoding The Black Fungus: India Fights An Epidemic and A Pandemic Simultaneously

In times when India is still struggling to fight the deadly second wave of Coronavirus, the country is now facing an epidemic – black fungus – Mucormycosis. While doctors claim that they usually saw two to three cases in their lifetime, India has reported 11,717 cases as of May 26 this year. As this epidemic raised several questions and myths, Core Middle East spoke to doctors of prime hospitals in the National Capital Region to unravel the uncertainty of the black fungus – Mucormycosis.

Picture credits: PTI

What is black fungus – Mucormycosis? And why the sudden increase?

The Black fungus is a rare infection, which mainly affects diabetic or severely immunocompromised individuals, such as cancer patients or people with HIV/AIDS. High sugar levels or diabetes is a pitfall in COVID patients. Steroids, which are known to increase sugar levels even in healthy people, are the cornerstone of COVID treatment in severe cases.

“Though the research hasn’t been done yet, it’s clear that having COVID and the aftermath of its contraction is a big risk factor. There are drugs used in the treatment of COVID that are immunosuppressors like steroids and the usage of immunosuppression drugs in addition to diabetes are big risk factors,” says Dr. Surajit Nundy, (founder, Raxa Health and Consultant, Internal Medicine SGRH)

Even though steroids are being used worldwide, the sudden increase in the fungus can be seen only in India. Dr. Yatin Sethi, (Sr. Consultant, ENT, and Cochlear implants, Venkateshwara hospital, New Delhi), says, “While drugs and steroids are available openly in India, during the panic of the second wave, people have either with or without prescriptions managed to overdose themselves, which can now be seen as a problem.”

There have been no clear signs of the time frame within which black fungus could be contracted while there are some doctors that have strictly stated up to three weeks from COVID negative, Dr. Prateek Sharma, (ENT specialist, All India Institute of Medical Sciences (AIIMS), New Delhi) has stated that patients have seen symptoms of black fungus almost two months after COVID recovery.

What are the symptoms?

Doctors have described the basic symptoms of the fungus as headaches, cough, and nasal congestion. However, in a serious case, there can also be swelling on the face. This mainly can be seen in people aged around 45 and above.

Dr. Atul Mittal,(Director, Otorhinolaryngology, Fortis Memorial Research Institute, Gurugram) has listed the following as symptoms of Black fungus:

The symptoms of mucormycosis depend on where in the body the fungus is growing. The commonest place of involvement is para nasal sinuses invading orbit (eye) and brain.

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For rhinocerebral (sinus and brain) mucormycosis

• One-sided facial swelling.

• Reduced sensations on the face.

• Blurring or sudden loss of vision.

• Headache

• Nasal or sinus congestion/crusting.

• Black lesions on nasal bridge or upper inside of the mouth that quickly become more severe.

• Fever

For pulmonary (lung) mucormycosis

• Fever

• Cough

• Shortness of breath

• Chest pain

What are the current precautions taken by the hospitals that are facing patients with black fungus – Mucormycosis?

“Management of mucormycosis is a team effort and can involve various specialists like ENT, microbiologists, internal medicine specialists, interventional neurologists, ophthalmologists, dentists, surgeons (maxillofacial/plastic), and others. On May 10, when we saw the first case, a multidisciplinary team was immediately formulated by the hospital, to manage various aspects like diagnosis, controlling diabetes, specialty surgical debridement of the affected organ, drug administration, and management, and/or prevention of side effects of various drugs,” says Dr. Mittal.

Meanwhile, Dr Nundy says it is primarily a surgical disease. “We take patients and we, of course, control the blood sugars and try to reduce immunosuppression as much as possible. But once the black fungus sits in it, often if there’s a surgical option, and sometimes there isn’t a real option, that’s probably the definitive treatment. But there are antifungal drugs that we can sometimes use to control it, not cure it.” Dr. Nundy.

Speaking on how the hospitals are handling the incoming patients, Dr. Sharma said: “We’re getting a lot of patients, maybe 10 to 15 every day. We are admitting them. We are prioritizing them for surgery, different centers, like main trauma centers, we’re trying to understand the disease, and operate every day. And as soon as the patient comes to emergency investigation is sent and amputation is started.”

People are constantly recommended for MRIs and swarming in due to panic, which should be avoided as it may exhaust the resources when actually needed, Dr. Sharma added.

“The equipment has been regularly changed like after 48 to 72 hours, water supply to the oxygens, the humidification everything has been tightly controlled with all aseptic precautions and all the diabetic patients on oxygen are being continuously monitored till the end; which is also been a part of the team effort. So we are closely watching these high-risk patients who can catch these infections,” says Dr. Sethi.

Dr. Sachin Ambekar (Laparoscopic Surgeon FIAGES, FMAS,FALCS Medical Administrator Moolchand Medcity Hospital New Delhi) has explained how their hospital has not only treated black fungus patients but hospitalized and observed suspected cases until proved by the radiological findings.

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Any immediate help from the government?

“We are a population of 2 billion people, the government has been sailing through this crisis and doing well despite the shortage of vaccines.” Dr. Ambekar explains the role of the government.

Some praised the efforts of the Indian government in terms of raw materials and distribution of drugs. “The government has taken complete control on augmenting drug manufacturing by ordering requisite raw materials. The distribution of the drug is also being controlled based on quotas and is being released to hospitals on a case-to-case basis,” Dr. Mittal said, adding that this has curbed black marketing of the drug, and people in India are getting the drug at the right price.

Apart from the pharmaceutical companies already manufacturing ampho B, the government has given license to 4-5 more companies to start manufacturing the drug to decrease the already widened demand-supply gap, he added.

Rahul (name changed), 28, has his father admitted to one of the prime hospitals of Haryana and he says that the hospital has taken full care of the hygiene and treatment of his father. The oxygen cylinders are often cleaned and he is monitored very carefully every 24-48hrs. It is fortunate that his father is still in the first stage of the infection cycle.

The after-effect of COVID is said to be the main reason for the increase in black fungus, but doctors have blamed the large population of the country. While there were over 30,000 cases in several states in the second wave due to lack of oxygen, beds, and medication too, it only shows the sheer ignorance and insensitivity of the officials that blame the citizens who were just trying to save their lives in a government-enabled crisis.

Another anomaly to take note of is how China, a country with the largest population in the world and double the population of India, has managed to produce over 52 Cr shots of vaccines and innoculate its citizens while India is still stuck on 20.1 Cr, creating an unstable condition for their people, it is criminally erroneous to blame the population rather than the government.