India faces black fungus epidemic as cases climb

NEW DELHI: At least 7,250 people are confirmed to have mucormycosis in India but the actual spread may be much wider, and authorities in several states have now sounded the alarm on the rare life-threatening disease that is rapidly popping up across the country as a Covid-19 complication.

At least 219 deaths have been recorded due to mucormycosis, as per figures shared by officials in 13 states and Union territories with HT. The Union government said on Thursday that states should declare the disease notifiable under the Epidemic Diseases Act, 1897, making it mandatory for all medical facilities to report infections to a central disease surveillance network. The Delhi government separately decided to set up special treatment facilities in three of its hospitals.

“We have asked states to add mucormycosis as a notifiable disease under the epidemic diseases act as in a communication to states yesterday (Wednesday). Doing so makes it mandatory for all hospitals to report cases so that we can consolidate data about it, and also ensures the screening, diagnosis and treatment is followed as per protocols of the Union government and Indian Council of Medical Research (ICMR),” said Lav Agarwal, joint secretary, Union health ministry, during a routine press briefing.

The Centre told the Delhi high court on Thursday that as of May 19, there were 7,251 people with mucormycosis in India, of which 200 were in Delhi.

Mucormycosis is a fungal infection with a fatality rate of at least 50%. Typically a rare disease, experts and doctors say thousands have now contracted it because of an overuse of steroids or due to suppression of their immune system, which is often a fallout of attempts to stop the life-threatening immune overreaction due to Covid-19.

ICMR director-general Balram Bhargava said these infections are of fungal spores that

health) on application.

Only four divisions — Varanasi, Agra, Meerut and Lucknow — will have medicines due to the limited stock, the order stated.

Once the attendants apply for the medicine, the case will be evaluated by divisional commissioner, the additional director and an expert from a medical college. Once approved, the patient can get a dose for three days from the local Red Cross office. The medicine can be obtained after payment of Rs 6000 for each liposomal injection vial and Rs 1500 for each emulsion vial, as per the order.

The other option is to purchase the medicine from the open market, but it is hardly available at medical stores.

Amphotericin B is almost out of stock at medical stores in the city, though government hospitals have it for admitted patients.

“In a year, about 1000 vials were sold from medical stores in Lucknow. With short expiry of these injections, not many chemists kept them. At present, the demand has gone up manifold while the supply has almost stopped,” said Suresh Kumar of the Lucknow Chemists Association (LCA). Sanjay Sah of Shree Pharma said, “The last stock received by us was in April. No delivery of the injections used for black fungus patients has been received in May.”

“Another reason for the demand going up manifold is one black fungus patient needs about 36 doses to complete the course and chemists keep limited stock due to short expiry. Also, a lot of stock might have expired as these injections have short expiry, adding to the shortage,” said Mayank Rastogi of LCA. Chemists said that the injection was also being used for preventive doses, hence the stock with them was exhausted days after black fungus started afflicting patients.

“Some hospitals are using it as preventive therapy against black fungus if the patient is admitted for long,” said Suresh Kumar.

The injection was manufactured by over 10 companies, but none of them were supplying it for over the past two weeks, said Sanjay Sah.