The Jeopardy in our fight against covid seems to be far from getting over. Who would have imagined that as we scuffle with covid 19 fight, another aggressive fungus would join its hands with covid 19 and create havoc in this miserable pandemic? Mucormycosis, a very serious and life-threatening infection with mortality rate of 40- 60%, is striking covid patients and pushing them back into operation theaters and ICUs. Mucor mycosis starts spreading in days if not recognized and intervened at early stages of disease. Working at tertiary care center, in last one month we have seen more than 50 mucormycosis cases, out of which 16 patients are having good progress, 6 patients have succumbed to disease and remaining are fighting out with mucor in ICU s and wards. Treatment includes aggressive surgery/radical debridement exenteration of effected/blind eye, long term follow up along with anti-fungal medications. Apart from surgery, prolonged anti-fungal treatment plays a major role in curing the patient. Cost of such medicines runs into lakhs for prescribed quantity and duration. It is quite sickening for doctor fraternity to see patients recovering from covid but succumbing to such aggressive diseases, which can be avoided by early recognition. This undercurrent of Mucormycosis can be addressed only with a coordinated and informed support system of not just doctors, pharma companies, and government, but also,we the readers of this article. One of the major reasons for the exponential rise in cases in covid patients is the excessive usage of steroids. Steroids are leading to extremely uncontrolled sugar levels, which makes it a fertile field for the Black fungi to grow, multiply and invade at a rapid rate! Though on many occasions usage of steroids is invariably necessary, but the dosage, and duration needs to be reconsidered, especially for diabetic patients. The problem in the supply chain is not just about huge spike in demand for medicines and pharma companies unable to ramp up the production. In usual times, most of the Mucormycosis cases were treated primarily in big corporate hospitals and most the smaller hospitals used to refer such cases to these hospitals. It was a clear-cut system, where corporate hospitals used to request the pharma firms for medication, and they used to cater to the needs of these hospitals through their strong pharma supply chain. Now with Covid entering the battlefield: literally this whole system has been disrupted. Every corporate hospital in India is working above its full capacity. Thus, the patients being treated for Covid in smaller hospitals once infected with Mucormycosis are not able to find any hospital beds in the corporate hospitals. The toughest challenge with Mucor is the need for treatment at least within 48 hours. On the other end, these pharma companies are not able to provide in-time medication to the patients being treated in smaller hospitals as they are not even aware of the need. By the time, the firms are informed about the need, it invariably is becoming too late for the treatment. Now, is the story all well in the corporate hospitals? Doctors and all health care staff have already been over-burdened with just Covid. Now coordinating to and fro with the distributors, and the company is invariably getting delayed. And all of us know that for a disease which spreads in hours and days, delayed treatment is no better than no treatment. Is there something we can do? Remdesivir was extremely difficult to procure all of April, but it has relatively become more coordinated with the efforts of sea of volunteers all across India. It’s time for the sea of volunteers to address this undercurrent of Mucormycosis by building a credible network of medication through which all hospitals can reach out for immediate medication, pharma companies are informed about the need immediately, andare supported by a coordinated distribution network for the logistics.Thus, making sure every patient gets timely treatment for this deadly disease. Last, but not the least watch out for facial pain, headache, nasal congestion, redness of eye, discoloration of skin color on face or in mouth and immediately rush to the hospital.
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