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
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
