“In my entire career I have not seen as many cases of Mucormycosis as I have seen in the last fortnight. It is like an earthquake after a tsunami that we are expecting right now and with this complication people are getting mutilated for no reason,” a top Delhi doctor, pulmonologist Vivek Nangia told me last week in an interview he could only manage at midnight.
Since then almost 9000 cases of a rare fungal infection Mucormycosis, commonly called Black Fungus, have been reported as recovering COVID-19 patients face another life test.
Several states have notified Mucormycosis as an epidemic at a time India was turning a corner, at least in the urban curve. First though some good news, the infection is not contagious- it does not spread from people to people.
Unfortunately that seems to be the only good news at this point. “This Fungus is omnipresent — it is present in the soil and in the air in the form of spores. Bread that is kept outside in the open gets black fungus after 4-5 days, this is exactly that.
An opportunistic infection
These spores are everywhere and settle in dead decaying tissue,” explains Dr Arvinder Soin, Chairman, Liver Transplant Institute, Medanta Hospital. “This fungal infection is an opportunistic infection which means the fungus invades the body only when it gets the opportunity of lower immunity.”
As things stand, a vast population of the country is immuno-compromised, making them vulnerable, additionally they now have to watch out for any new complications for 3-6 weeks post COVID-19. Doctors say the infection usually spreads through the nose and impacts the sinuses, lungs and sometimes even the brain.
Among the early symptoms are discolouration around the nose, facial pain, frontal headaches, loosening of teeth and blurred or double vision. To save a life sometimes serious surgical interventions are being done. There have been more than a few reported cases of patients’ eyes being removed to stop the fungal spread.
Last year countries like Italy and the US were in a position that India is in now with its explosion of the second wave. But why has this deadly disease only hit our country? Black Fungus is not unheard of especially in transplant patients but they are usually a rarity. So, what changed?
“India is the diabetes capital of the world and coupled with the strong use and many times abuse of steroid that results in the elevation of sugar levels, it has led to an intensely immune compromised community which also includes people with underlying malignancies especially blood cancer,” Dr Soin tells me. Doctors admit that the sheer volume and severity of the cases in the second wave has not helped.
Questions will be asked
When the dust settles, there will be questions on whether the somewhat blanket use of steroids in treating COVID-19 in the country crossed a line. In hindsight it seems so.
Some medical experts agree that the health care sector was so overwhelmed that the use of steroids became a norm — almost like a standard, knee jerk procedure. But who draws the line in a heaving system where one doctor always had more patients than the hours of a day?
There is another thought that is now more than just a niggle. During the oxygen rush where hospitals were themselves struggling for basics, families many times procured what was needed from dubious sources. In the panic and chaos, industrial oxygen also substituted medical oxygen- a recipe for un-hygiene and infection.
By most accounts, these cylinders are far from safe for personal consumption on an ordinary day and in these times a ripe environment for the fungus to feed on could have been created. Doctors admit it is a plausible theory.
Abandoned by the government, citizens fended for themselves and it is déjà vu again. Not so long ago social media was full of desperate pleas for the drug Remdesivir and plasma. It now turns out both were never a game changer.
But there is panic once more, this time for drugs to treat Black Fungus and in a replay, there is an acute shortage with events playing out not too differently from the vaccine control raj. States are scampering again waiting for a consistent supply, citizens following bureaucratic protocol don’t know whether to break down or scream.
Till the government drastically moves beyond the 2% allocation on the health care sector, our cup will always be more than half empty. But not for people like Yoga guru Ramdev, who runs an empire selling misconceptions but escapes with an indulgent nod or a light pat like the teacher’s favourite student that he is.
His attack on allopathy as a killer has made a mockery of evidence-based medication and the mixed signals have put an additional strain on the medical staff.
How then will we ever give our health care workers a break? Dr Nangia says he has been working a 20 hour day and yet hasn’t been able to serve those closest to him. As I write this, there is news coming of another variant called Yellow Fungus that reports describe as being even more lethal.
“My daughter had COVID-19 and she was admitted in my hospital only. Tears rolled down my eyes when I got a message one day after 10-12 missed calls that it seems you have forgotten your daughter is admitted with you.
That is the guilt — that you could not give time to serve anybody and everybody who is reaching out to you.” What more can I do, he asks. I have no answer.