Black fungus now an epidemic, govt to be informed of all cases
NEW DELHI: The Delhi government on Thursday declared mucormycosis an epidemic and made it mandatory for all health care institutions in the city to report suspected and confirmed cases of the infection to them, amid a sharp spike in incidences of the fungal infection over the past few weeks as a complication among patients with Covid-19.
The move comes a week after the Centre urged all states to categorise the infection as a notifiable disease after an increase in cases following the second wave of Covid-19 in April.
Delhi chief minister Arvind Kejriwal on Wednesday said over 620 patients are being treated for mucormycosis, known commonly as black fungus, in city hospitals, and flagged a severe shortage of Amphotericin-b, the only lastline drug used to treat the fungal infection.
Instances of black fungus are extremely rare, and major hospitals in the Capital like the All India Institute of Medical Sciences (AIIMS) and Sir Ganga Ram Hospital see between six and 15 cases of the infection in an entire year, usually.
The Delhi Epidemic Diseases (Mucormycosis) Regulations 2021, which will remain in force for a year, forbid any organisation from “spreading information or material” or using “print or electronic or any other form of media for mucormycosis” without prior permission from the health department.
This means that hospitals will not be allowed to share, without approval, details about infections and the number of cases with the press. However, it is unclear whether rule this will cover requests for medicines and other information put out on the social media.
As of Tuesday, the city received 3,850 vials of Amphotericin-b, against a requirement of over 30,000 doses a week, said senior officials in Delhi’s health department.
The Delhi government estimates that the city will need around 100,000 doses of the medicine over the next two months.
To help address these shortages, the Delhi high court on Thursday allowed the duty free import of Amphotericin-b, on furnishing a bond by the importers till the Centre takes a decision on the tax waiver.
The regulations, Dr Nutan Mundeja, Delhi’s director general of health services, said all health care facilities in the Capital must follow guidelines issued by the Union health ministry and the Indian Council of Medical Research (ICMR) on screening, diagnosis, and management of mucormycosis.
The order also mandates that a committee be constituted under every chief district medical officer (CDMO) comprising doctors specialising in internal medicine, ophthalmology, ENT, as well as epidemiologists to review instances of individuals or organisations disobeying the order.
In the event the regulations are flouted, the district magistrate concerned will issue a notice and ask for a response within a fixed period. If a reply is not received or found to be unsatisfactory, action can be taken under Section 188 of the Indian Penal Code that allows for imprisonment up to six months or a fine of ₹1,000 fine or both for disobeying a public servant’s order.
Mucormycosis mainly affects those who are severely immunocompromised, have uncontrolled diabetes, have had Covid-19, and were treated using steroids. It mainly affects the mouth, nose, eye and later spreads to the brain. It can kill almost half the people it infects if left untreated.
“The high number of cases could be because there was no glucose control in patients during the pandemic. Also, steroids were used in high quantities when there was a shortage of oxygen. And, we are yet to study the immune dysregulation caused by the new variants of Sars-cov-2 and whether it is different from the old ones,” said Dr Arunaloke Chakrabarti, head of the department of microbiology at Post Graduate Institute of Medical Education & Research in Chandigarh.