The second wave of Covid-19 has ushered an epidemic of invasive fungal infections. It all started with the media reporting cases of black fungus, scientifically called mucormycosis. Subsequently yellow and white fungus was reported too. Taking cognizance of the growing number of such fungal infections, the central government declared mucormycosis a notifiable disease. Simply put, a notifiable disease is a disease of public health importance, and hence the treating doctor and hospital must inform the government about every such case detected.
Mucor is a fungus that is present everywhere around us and can cause mucormycosis or black fungus. The fungus normally does not cause disease as our immune system keeps it in check. Black fungus only causes disease in people with extremely poor immunity. Black fungus is not a communicable disease that one can get by coming in contact with a patient.
Black fungus has been quite rare in the first wave. The number of cases has alarmingly grown this time. Some experts believe the cause is the quality of oxygen. Normally medical oxygen is highly purified and has extremely low contaminants. With an acute crisis of medical oxygen in the second wave, most patients have received industrial grade oxygen. Industrial grade oxygen is comparatively less purified and contains particulate contaminants. Medical oxygen is stored in special non-porous and seepage proof containers and cylinders. The shortage of medical grade cylinders indicates, oxygen has been supplied this time around in industrial cylinders. Industrial cylinders are more seepage prone and end up breeding fungus inside the cylinders.
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Odisha supplies a huge bulk of oxygen demand of the country. It must work harder to ensure industrial oxygen is purified and stored as per medical requirements.
Lack of hygiene has been proposed as another possible cause. With a much larger number of cases, an acute shortage of beds and ICUs and ventilators arose. Working on a war footing, authorities throughout the country set up large temporary hospitals. In the midst of such a humanitarian crisis, authorities everywhere have been unable to focus on adequate housekeeping staff and hygiene standards for Covid hospitals. The massive and constant influx of desperately ill patients left hospitals with less time to disinfect ventilators and ICU beds before checking in new patients.
An acute shortage of nurses and housekeeping staff has further worsened the problem. Oxygen masks, tubes and other equipment need regular sterilization. Many hospitals have found it difficult to manage this with limited staff. Odisha needs to focus on hygiene and cleanliness in all Covid-19 hospitals. Adequate Housekeeping staff are essential for patient care. Failing to employ adequate housekeeping staff, in the name of controlling expenses, may be a case of being penny wise and pound foolish.
The use of steroids in Covid-19 can cause some suppression of the immune system. More important is the issue of steroids increasing blood sugar levels. High blood sugar levels in the body increase the risk of black fungus. Covid hospitals all over Odisha, need to be equipped with facilities to regularly check blood sugar levels of patients on steroids. Cases of increased blood sugar especially in diabetics needs prompt treatment. Our Covid hospitals need to employ physicians and endocrinologist to bring blood sugar under control. Diabetic medicines including insulin need to be provided adequately to all Covid hospitals.
Black fungus has a mortality rate as high as 50 per cent. Early diagnosis can save lives. Covid hospitals need to be provided facilities and Microbiologists to test and diagnose black fungal infections early. Black fungus can rapidly spread in the head destroying the eyes and invade the brain. Surgery is the mainstay of treating advanced disease. All Covid hospitals in Odisha need dedicated operation theatres and the services of ENT surgeons, ophthalmologists and Neurosurgeons for emergency life-saving surgeries for black fungus victims.
Amphotericin B is the main antifungal agent used in treatment of black fungus. Other antifungal drugs are not as effective. Amphotericin B may be needed for as long as eight weeks. Odisha faces a severe shortage of Amphotericin B. Prompt administrative action to solve supply problems of Amphotericin B in Odisha is urgently needed. Implementation of proper quality standards for oxygen and hospital hygiene is important in Odisha. Covid hospitals need proper facilities and trained specialists to manage the increasing burden of black fungus in the state.
(DISCLAIMER: This is an opinion piece. The views expressed are the author’s own and have nothing to do with OTV’s charter or views. OTV does not assume any responsibility or liability for the same. The author is an Orthopedic Surgeon and can be reached at sidusahu@gmail.com)
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