Covid associated mucormycosis has hit the country. The fungus has also made its way in Covid wards and ICU in Sevagram.
The fungus is fast and furious, it destroys the skin, soft tissue and bones as it invades the blood vessels and causes infarction and necrosis of tissues.
It enters into paranasal sinuses, quickly spreads beyond them, destroys the palate and invades the orbit. If not stopped, it can enter the brain wreaking havoc in the cavernous sinus, carotid artery and frontal lobes.
Why is the fungus deadly? For, several reasons. First, it kills its victim. The mortality ranges between 50% and 100%. Second, the treatment is unaffordable. All patients require liposomal amphotericin B, which costs Rs 25,000 per day to a 60-kg person. The anti-fungal medicines need to be given for weeks and months before the patients can be put on oral antifungal drugs, which are as costly. Moreover, liposomal amphotericin B is no longer available in the market and its price has hit the rooftops. Third, patients need a team of ENT surgeons, ophthalmologists, neurosurgeons, plastic surgeons, anesthesiologists, microbiologists and physicians for effective management. Fourth, patients need to stay in the hospital for weeks and months, enduring the debridement and IV infusions of drugs.
In Pune alone, a single centre has treated 120 cases of mucor in a month. In private hospitals in Nagpur, patients have spent unthinkable amounts for prolonged treatment. By contrast, MJPJAY has created a new package for the fungus and it offers a princely sum of Rs 40,000 for the entire treatment of hospitalized mucor patient.
When we inject steroids in Covid positive diabetics and fail to control the sugar, we create a perfect milieu for the fungus to grow, thrive and proliferate. Unless we use steroids only in hypoxic hospitalised patients and refrain from using fancy drugs such as favipiravir (it makes the glucose go up) we wonโt be able to stop the fungus bruising us barbarously.
The black fungus has painted the entire country red. We must not let it hit our patients black and blue.
