Covid-19 is a global menace but why is mucormycosis more rampant in India?

“Covid-19 is a global menace but why don’t we hear this from other countries and why is mucormycosis seeming like an India story?”

The language of Covid-19 is getting as painful and unpredictable as the pandemic itself. With each passing day new hard-to-pronounce drugs and symptoms are getting added to the vocabulary of desperate family members of covid-19 patients scurrying around for hospital beds and medicines. The term now doing the rounds in most conversations and in the cries for help is: “mucormycosis.”

Once a Rare Case Study

Doctors describe it as a serious but somewhat rare fungal infection that is caused by a group of fungi called mucormycetes. The worry: Cases where patients develop these are rising sharply nationally. Though there is no clarity on the overall numbers, anecdotal evidence is quite alarming. Consider this: Leading Pune-based endocrinologist and diabetologist Dr Uday Phadke, Director, Department of Endocrinology & Diabetes, at the Sahyadri Hospitals, a major chain of hospitals from Pune, says, “normally, we would see a case or two in a year and that too in immuno-compromised patients, either on account of cancer or post an organ transplant and it was always like a teaching case that we could showcase to juniors of a rare manifestation that they also need to be aware of as opportunistic pathogens that grow only when the opportunity arises, which is essentially when the immunity is low in the body. But now, across the Sahyadri Hospitals alone, just here in Pune, we have seen 30 to 35 cases in a month.” That’s roughly a patient a day!

Lethal Combo

It is therefore not without reason that most are asking the question: “Covid-19 is a global menace but why don’t we hear this from other countries and why is mucormycosis seeming like an India story?”

Financial Express Online reached out to subject experts – in this case, the go-to doctors are diabetologists/ endocrinologists like Dr Phadke (those who specialize in treating health conditions that are linked to the functioning of glands and hormones).

Also read| Black Fungus aka Mucormycosis: A doctor explains everything about the deadly infection

The answer lies in the lethal combination of high covid-19 caseload in a country that is the diabetes capital of the world with around 70 million diabetes patients in India and when as part of dealing with covid-19 steroids are administered. Here is what a leading diabetologist Dr V Mohan, chairman and chief consultant at the eponymous Dr Mohan’s Diabetes Specialities Centre, a Chennai-headquartered chain of diabetes facilities, had to say: “The reason we are seeing such large number of mucormycosis than in any other country is because of the high number of diabetic patients, that too with uncontrolled diabetes, record number of covid cases, large doses of steroids being administered for too long bordering onto indiscriminate use of steroids, especially in the first week of the virus, which can be very dangerous.” Coupled with this, he says, there are a combination of other factors that revolve around the hygiene and the contamination of the equipment used. He feels, because of the many covid-19 cases that the hospitals get inundated with, there may not be enough cleaning being done and there could be fungus deposited on some of the equipment or when proper water is not used when administering oxygen.

Steroids & Oxygen Therapy

Concurs India’s leading vaccine expert Dr Gangandeep Kang, professor at the Christian Medical College, Vellore, and she says: “what I would really like to know is what proportion of patients that develop mucormycosis are on oxygen therapy and on steroids because steroids is a clear risk factor and we already know this.” But for those on oxygen therapy, Dr Kang feels, the only thing to enquire is about the condition of the breathing apparatus that is being used be it the mask or humidifiers for contamination of these could also possibly be a reason for patients developing mucormycosis.

The ailment therefore strikes when the body’s defense systems are down due to coronavirus and on top of this, there is rampant and unchecked used of steroids, going up at times to as much as six times what may be actually needed.

The Antidote

On the treatment, Dr Phadke says, it is essentially a three-fold exercise: 1, to immediately try and rectify the situation that is causing mucormycosis that is stop administration of steroids, immediately control the sugar levels, check acidosis (too much acid in the body fluids); 2, quick and aggressive removal of dead tissues through surgical methods, which may require multiple specialists. All to ensure that the fungus does not spread further; and finally, 3, to use proper drugs to check the black fungus. One of the medicines that has often been used is amphotericin B injection. It is a complex drug that is in short supply at the moment. This is partly because these were never made in large quantities essentially because it was not much in demand and has also been an expensive drug (costs run into few thousands per vial). However, several companies have been approved by the government to make this drug apart from manufacturers already into this like Sun Pharma, Cipla, Bharat Serums among others and they are all ramping up capacities. For instance, spokesperson of Sun Pharma, India’s largest pharma company, says, “we have ramped up production of Lambin 50 injection (the company brand name for liposomal amphotericin B) to meet the additional demand and are confident of increasing our production rapidly.” While no timeline has been indicated by Sun Pharma, those in the industry say that since it is a complex product and requires sterility testing, even after increased production, it could take about two to four weeks before additional stocks hit the market.