CM orders 3 hospitals to set up black fungus care centres
NEW DELHI: Three Delhi government hospitals will set up dedicated wards to treat patients who contract mucormycosis, also known as black fungus, Delhi chief minister Arvind Kejriwal announced on Thursday, after medical facilities in the city reported an increase in the number of cases of the fungal infection over the few days. He also said the state will ensure the adequate supply of an anti-fungal medicine needed to treat the infection, following an order the previous day that the state government will directly regulate its supply to hospitals.
“Chaired an important review meeting with experts in the light of increasing black fungus cases. We have to stop black fungus cases and ensure that those infected by it get treatment. We have taken some important decisions to contain spread and treatment of black fungus,” Kejriwal tweeted.
At least 203 patients are currently admitted with the infection to Delhi hospitals, hospitals and officials have told HT over the past two days.
The wards have been set up in Lok Nayak, Guru Teg Bahadur, and Rajiv Gandhi Superspeciality hospitals – three of the Delhi government’s largest hospitals treating Covid-19 patients.
Both Guru Teg Bahadur and Lok Nayak hospitals have earmarked 20 beds each, while Rajiv Gandhi hospital has set up a 16-bed ward.
Black fungus has been found mostly among people with uncontrolled diabetes, whose immunity is compromised, or among people who are given excessive steroids or immunitymodulating drugs such as tocilizumab. According to doctors, if left untreated, it could kill up to 80% of those infected. If not detected early, it affects the orbit of the eye and the mouth, resulting in people losing their vision or jaw during debridement — the process of removing dead tissue from an infection or wound.
“A team of five specialists — an ENT surgeon, a general surgeon, a chest physician, and doctors from the medicine department — has been created to treat patients. All of the cases received at the hospital are referred here from other facilities and smaller nursing homes in the city where medicine to treat the infection (Amphotericin B) is unavailable,” said a senior doctor from Lok Nayak hospital who asked not to be named.
Doctors have said Amphotericin B is the only drug which can treat the fungal infection.
He added, “We haven’t had any case of mucormycosis in patients treated for Covid-19 at Lok Nayak. These cases usually happen due to an overuse of steroids.”
There are three patients with the infection admitted to GTB hospital, according to a senior doctor, all of whom have been referred from other hospitals for the want of the drug.
“The treatment for the infection needs specialists from various departments including ENT, ophthalmology, and neurosurgery doctors since dead tissues need to be debrided from the nose and eyes. The brain may also be affected in some cases. The key is to detect the infection early. However, the medicine needed is manufactured by only one company and is currently in short supply,” said a doctor from Guru Teg Bahadur hospital.
On Wednesday, the Delhi high court asked the Delhi and central governments to report on the steps taken to resolve the shortage of Amphotericin B.
Currently, the Centre supplies the medicine to the states. In Delhi, a four-member committee evaluates hospitals’ applications for the medicine and allocates it when doses are available.
“We are seeing a large number of mucormycosis cases because of several reasons. One, the sheer number of people who got Covid-19 during the second wave; when there is a huge denominator more cases of such secondary infection are likely to be detected. Two, the infection this time around was more severe, meaning patients were on steroids and oxygen for longer. Three, there was also indiscriminate use of steroids by people, some of whom might have been pre-diabetic and might not have monitored their sugar levels putting them at risk. Four, Covid-19 in general leads to an increase in ferritin level in blood; ferritin contains iron which is a food source for mucormycosis,” said Dr Ameet Kishore, senior consultant of ENT at Apollo hospital.
Meanwhile, chief minister Kejriwal urged doctors to control the use of steroids on Covid-19 patients to prevent a rise in instances of mucormycosis.
“We appeal to all doctors and hospitals to reconsider the use of steroids in Covid-19 treatment. It has come to light that the excessive use of steroids have contributed to cases of black fungus across states. Also, people should maintain their sugar levels,” Kejriwal said later in the day, on the sidelines of his visit to the residence of a frontline worker who died of Covid-19.
He also acknowledged the shortage of the antifungal drug, but said he was confident the Centre will help with its stocks.
“We are also preparing an SOP (standard operating procedure) for hospitals for treatment of black fungus cases,” he said.
On being asked whether Delhi too would declare black fungus an epidemic, Kejriwal said, “We will take all necessary steps”.
Earlier in the day, the Union health ministry asked states and union territories to declare mucormycosis a notifiable disease under the Epidemic Diseases Act.
So far, several states, including Telangana and Rajasthan, have declared black fungus an epidemic.