Explained: Four states & UT Chandigarh has declared 'Black Fungus' as an epidemic

The COVID-19 second wave in India, after already leaving the healthcare system humbled, has significantly seen a surge in the number of cases of black fungus called Mucormycosis. With a high average death rate of almost 50 per cent, just one in a million people were reported to be infected with this fungal infection before the onset of the pandemic. Now with Mumbai alone reporting 100 new cases of black fungus in previous weeks, this pandemic has certainly changed the statistics among many other aspects of our life.

Black fungus has been officially declared an epidemic by the state governments of Rajasthan, Telangana, Tamil Nadu, Odisha, and the Union Territory of Chandigarh under the Epidemic Diseases Act 1897. Meanwhile, Gujarat, Delhi, Uttar Pradesh, Uttarakhand, Maharashtra, Andhra Pradesh, Haryana, and Madhya Pradesh have also reported significant instances of the disease. After the states and Union Territories have been cautioned by the Centre to flag black fungus under the Epidemic Diseases Act, more states are expected to follow up.

What is black fungus?

Black fungus or Mucormycosis is an omnipresent fungus and can be present in the nostrils of a healthy individual. The fungus looks for a weakened immune system to attack and starts as skin infection in the nose which further festers to different parts of the body like oral cavity, lungs, jaws, eyes, and sometimes even distant parts like gastro-intestinal tract and the brain, resulting in facial deformities and partial or complete loss of vision. Doctors might have to operate and remove an eye or sometimes even the jaw bone to stop the spread of infection to the brain.

Some early symptoms of Mucormycosis includes:

· Blackish nasal discharge with nasal congestion

· Facial or head pain

· Disturbed/double vision

· Loss of colour of nose bridge

· Chest ache and difficult respiration

· Difficulty in breathing

· Coughing of blood

Experts have warned that COVID-19 patients who have recovered or still recovering but were suffering from diabetes mellitus, Cancer, HIV or kidney problems or have undergone organ implantation are most vulnerable. Unlike the coronavirus, it isn't contagious and serious complications have been found in young individuals also.

Why the surge in black fungus cases?

Prolonged or early use of steroids while treating COVID patients is one of the main reasons behind the recent spike in black fungus cases. Steroids, not antiviral drugs, have proven very effective in hypoxia (not enough oxygen reaching tissues) COVID patients but at the cost of a compromised immune system. Steroids are commonly prescribed by health professionals which leads to overuse and self-medication of steroids. Drugs such as Tocilizumob and Itolizumab, used for COVID-19 treatment, also suppress the immune system and provide an opportunity for the fungal infection to thrive.

Dr. V.K. Paul, a member of the health department, NITI Ayog, emphasized on judicious use of steroids and said, "Steroids should never be administered at an early stage of COVID-19. It should be taken only after the sixth day of infection. Patients should stick to appropriate doses of the drug and take the drug for a specific number of days as advised by the doctor. Rational use of medicines should be ensured to avoid adverse side effects of the drug."

Healthcare facilities overwhelmed by a flood of patients, particularly during the second wave, may have exposed people to unhygienic environment and contaminated oxygen cylinders, harbouring black fungus, which might explain why Mucormycosis cases are exceptionally high as compared to last year.

What is the treatment?

An anti-fungal medication Amphotericin-B which kills the fungus by destroying its cell wall is the only drug effective in the treatment of black fungus. The patient has to take one injection intravenously every day for four-six weeks which costs around Rs. 4,000 per dose.

On Wednesday, a two-judge Bench of the Delhi High Court told the Centre, "You have to get the medicine from wherever in the world. You have to take steps right now. Wherever it is available in the world get it."

The Indian Medical Association (IMA) has also requested the Prime Minister to permit eligible pharmaceutical manufacturers to produce Amphotericin-B.

On Thursday, the minister of state for ports, shipping , and waterways, Mansukh Mandaviya, assured that the production of Amphotericin-B would be ramped up to meet the demands and said five new companies have been granted permission to produce the drug in addition to the existing six companies.

AYUSH has recommended:

As it is well aware that Homoeopathy is a system of medicine which is based on Individualisation and the mucormycosis is not an exception for this.Mucormycosis can be prevented by treating them with two medicines:

One is Arsenic (Alb 200), taken daily two times with six pills each time, for five days. The second one is Phos 6x tablets. Three tablets of the medicine to be taken daily two times for 30 days.

Specific (symptomatic) treatment for mucormycosis can act as an adjuvant. It is well aware that Homoeopathy is a system of medicine which is based on individualisation and the mucormycosis is not an exception for this. In the treatment of mucormycosis one must strictly go through individualistic presentation of each case.

Here is the complete list of medication prescribed by the AYUSH fraternity:

Condition-Drugs- Potency Dosage

1.Rhinocerebral mucormycosis- Arsenic-Alb Kali Bich, Merc.Iod. Rubrum, Merc. Iod. Flavum, Merc. Sol, Cinnabaris, Thuja Carbo Animalis- 200 potency Daily two times 6 pills each time for 5 days.

2.Pulmonary mucormycosis- Arsenic – Alb Phosphorous Bryonia Carbo Animalis Ant.Tart- 200 potency Daily two times 6 pills each time for 5 days.

3.Cutaneous mucormycosis-Arsenic –Alb Sulphur Merc. sol Anthracinum-200 potency Daily two times 6 pills each time for 5 days.

4. Gastrointestinal- Arsenic – Alb Phosphorous Nitric Acid mucormycosis- 200 potency Daily two times 6 pills each time for 5 days.

(Note :The following medicines as per the indications can be used individually one medicine at a time on the advice and under supervision of qualified Homoeopathic physician in the treatment of mucormycosis)

Warning: Apart from these lists of medicines any other medicine and any other . Potency may be prescribed basing on the symptom similarity in a given case