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Black, Yellow and White Fungus: the damage misinformation causes in COVID-19 crisis

By Akshat Jain 

India is seeing the second wave with COVID-19 crossing all metrics by leaps and bounds. As if COVID related pulmonary infection and “Long Covid” wasn’t enough in making lives of common folk miserable, the resurgence of “Black Fungus” and now the “White Fungus” is sending people for cover and hoarding of antifungal medications is causing their critical shortage for patients who actually need that.  

Black Fungus

Mucormycosis or wrongly touted “Black Fungus” named after the color of the ulcer base when this infection spreads to the skin, is a very rare condition, and only usually seen in patients who are the sickest, most ill and immunocompromised. As of this week, about 9,000 cases of Mucormycosis have been reported all over India. As a cancer specialist I come across this infection once or twice a year (and that is a bad year) but given the death rate of over 50%, this is particularly dangerous infection to have. Caused by a fungus that is very difficult to eradicate from the body once it homes itself in the skin and tissues of the face (nose, sinuses, mucosal surfaces etc.) the treatment is usually a painful surgery where everything in the path of the fungus that spreads like a root of the tree, needs to be scooped out.

Alerting signs of the infection

1.     Facial pain, swelling

2.     Loss of sensation to parts of skin

3.     Low grade fever along with swelling of skin

4.     Black spots that turn into bleeding ulcers on any part of the body

In patients who are immunocompromised due to severe COVID infection or patients who have received a lot of steroid medication (dexamethasone, prednisolone, methylprednisolone) for COVID infection are particularly at high risk.

Prevention

·        Water in oxygen supply routes in COVID patients should be cleaned daily – ventilators, humidifiers, cylinders, oxygen concentrators

·        Clean water source needed for practices like “steam” therapy, Jal Neti

·        Judicious use of steroids – not all COVID 19 patient needs steroids

·        Avoid “cocktail” therapy and judicious use of only proven therapies: remdesivir, monoclonal antibodies, steroids for moderate-severe infection patients, IVIG for children with COVID.

But misinformation about this infection has made people run and stock up on amphotericin B, the lifesaving intravenous antifungal treatment medications, causing widespread shortage, just like the oxygen crisis.

Misinformation and false sense of security

Having taken part in video conferencing with health ministers of various Indian states, medical leadership and power brokers over the past month, one thing is very clear to me. This pandemic has left no household big or small untouched.  Everyone is doing their level best to ease access to care.

Remarkably while the “Bhilwara Model” in Rajasthan failed miserably when it really mattered, decentralized approach in empowering area rural health centers (RHCs) and Primary Health Centers (PHCs) to supply them with pulse oximeters, oxygen cylinders, and oxygen concentrators being practiced now, will give long lasting dividends. Especially keeping sick rural patients in the comfort of their villages and establishing a supply chain once the “Vaccine apartheid” ends ,will make roll-out smooth and accountable – something that most state governments need to optimize at the regional levels.

Correct information about vaccine availability, side effects, safety features and most importantly the lifesaving protection that one gets from this first line of defense needs to be hammered in great detail. Earlier in the year this misinformation on the vaccines spread by politically motivated folks led to vaccine wastage and again misinformation spread by certain actors led to poor vaccination acceptance rates, which certainly did not help in prevention of the second wave.

The author is Hematologist Oncologist and Stem Cell Transplant Specialist based in Los Angeles, CA

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Latest News USA

Indian Americans chant mantras, pray for Trump outside military hospital

A prayer vigil was held on Sunday evening for President Donald Trump and First Lady Melania Trump by the Indian American community to wish them a speedy recovery. His supporters not only gathered outside the hospital but also showed support virtually from cities across the United States.

“I would like to thank the people of our community who are there at the Walter Reed hospital, praying for our President Trump and the First Lady. Despite being diagnosed with COVID-19, our President and his supporters have done more than what Biden has done in 47 years,” said Nisha Sharma, Congressional candidate from California District 11.

The community members chanted mantras and echoed the sound of the conch shell or Shankha for the speedy recovery of President Trump and the First Lady.

Sentinels of Dharma, a Hindu American organization hosted the event. During the prayer meeting, Indian Americans also endorsed President Trump in his re-election bid and reached out to other community members all over the country to campaign in his favor.

President Trump could be released from the Walter Reed National Military Medical Center as soon as Monday, his medical team said in an update on Sunday to members of the White House press pool, as the president continues his treatment on dexamethasone and Remdesivir to fight coronavirus.

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coronavirus International Latest News

A cheap steroid proves first life-saving drug in Covid-19 fight

London: An inexpensive and widely-used steroid called dexamethasone has become the first drug to save lives among Covid-19 patients in what scientists said is a “major breakthrough” in the coronavirus pandemic.
Trial results announced on Tuesday showed dexamethasone, which is used to reduce inflammation in other diseases such as arthritis, reduced death rates by around a third among the most severely ill of Covid-19 patients admitted to hospital.

The preliminary results suggest the drug should immediately become standard care in patients with severe cases of the pandemic disease, said the researchers who led the trials.
The researchers said they would work to publish the full details of the trial as soon as possible, with some scientists saying they wished to review the evidence for themselves.
Britain’s health ministry wasted no time in acting on the findings, saying the drug had been approved for use in the state-run health service, export restrictions had been introduced and Britain had stockpiled 200,000 courses of the treatment.
“This is a (trial) result that shows that if patients who have Covid-19 and are on ventilators or are on oxygen are given dexamethasone, it will save lives, and it will do so at a remarkably low cost,” said Martin Landray, an Oxford University professor co-leading the trial, known as the RECOVERY trial. “It’s going to be very hard for any drug really to replace this, given that for less than 50 pounds ($63), you can treat eight patients and save a life,” he said in an online briefing.
His co-lead investigator, Peter Horby, said dexamethasone was “the only drug that’s so far shown to reduce mortality – and it reduces it significantly.”
“It is a major breakthrough,” he said. “Dexamethasone is inexpensive, on the shelf, and can be used immediately to save lives worldwide.”
The RECOVERY trial compared outcomes of around 2,100 patients who were randomly assigned to get the steroid, with those of around 4,300 patients who did not get it.
The results suggest one death would be prevented by treatment with dexamethasone in every eight ventilated Covid-19 patients, Landray said, and one death would be prevented in every 25 Covid-19 patients that received the drug and were on oxygen.

Among patients with Covid-19 who did not require respiratory support, there was no benefit from treatment with dexamethasone.

“The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment, so dexamethasone should now become standard of care in these patients,” Horby said.

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