NEW DELHI: At Mahatma Gandhi Institute of Medical Sciences at Sevagram in Wardha, a major tertiary care centre in rural Maharashtra, nearly 4,000 Covid patients had undergone treatment before March this year.
None of these patients, however, developed mucormycosis (black fungus) that has now offered a fresh challenge to the healthcare system in India.
Beginning April through the first week of May, when nearly 1,000 Covid patients were treated at MGIMS, 20 of them went on to develop black fungus, a dreaded disease with a reported fatality rate of nearly 50%, most of whom needed urgent life saving surgeries.
At present, there are at least 15 patients of this disease caused by a group of molds called mucormycetesin. It infects the sinuses, lungs and brain of the patients.
Raymond Savio, a critical care expert from Chennai, explains the multiple reasons behind the fungus infecting those with Covid.
“It's a combination of the virus infection, nature of treatment, steroid and other immune-suppressants, nature of body's response to Covid infection (ferritin level), uncontrolled blood sugar and humidification systems for oxygen that makes it appropriate for the spores to infect patients,” he said.
The sudden and unprecedented rise in mucormycosis cases, however, has prompted SP Kalantri, a senior doctor and medical researcher at MGIMS, like many others in different parts of India, to question whether the popular perception that indiscriminate use of steroids, suppressed immunity, history of diabetes and unhygienic conditions in ICUs may be triggering this spurt in cases.
“It’s my assumption and I may be completely wrong but maybe Covid virus and mucor are now hunting together, something about Covid virus has changed over the months,” he said, adding that more research is required to understand the rise in the disease.
“All of the factors that are being cited as reasons for rise in mucormycosis existed before March-April too, but why suddenly this fungal infection is being reported now in Covid patients across India?” he asks.
He has more questions than answers but, in his understanding, so far, it could be something to do with virulence of Covid virus, that is making it easier for opportunistic pathogens like mucor to target weak patients.
A senior doctor at AIIMS, Delhi said she has been treating autoimmune disease patients with steroids for years but mucormycosis was seen in very rare cases. “There is something that has definitely changed now, but whether it is the use of industrial oxygen or the way oxygen has been instituted in overwhelmed health facilities, I am not sure. That is for researchers and scientists to find out.”
“But we should try and probe why so many cases are happening and it is especially important because unless we know the reason, we cannot possibly prevent the large outbreaks we are seeing,” she said.
Unconfirmed data so far suggests that over 5,000 cases of this disease have been reported from several states—including about 200 in Delhi over the last few days, prompting the Centre on Wednesday, to ask states to declare it as epidemic which will make it mandatory for states to report all the cases.
States, grappling to cater to healthcare needs of Covid patients on the other hand are finding it difficult to manage the alarming rise in mucormycosis cases, especially as its first line of treatment -- amphotericinB -- has suddenly become out of stock in most places.
Savio, meanwhile, stressed that while there is no evidence so far that use of industrial oxygen may be triggering it, there are already more than many contributing factors to the rise in mucormycosis.
“If identified early and started on appropriate treatment, surgical and medical, the outlook is not as bad as is being projected. However, we are already facing a shortage on the drug-of-choice needed for this treatment and we have started resorting to second line anti-fungal agents,” he said.