With the state-wide lockdown in place until June 14, the number of COVID-19 cases being reported in Karnataka have been reducing in the last two weeks. However, cases of mucormycosis or ‘black fungus’, which is seen as a COVID-19-complication, is rampant, especially in Bengaluru. With the number of cases on the rise, families of patients have been scrambling to arrange for Liposomal Amphotericin B, the drug used to treat mucormycosis, even as they risk contracting the coronavirus themselves. Activists in the city say that they have been receiving phone calls every day to help procure the drug.
According to the state Health Department, as many as 1,370 cases of black fungus have been reported in Karnataka until June 1. With the high caseload and each patient requiring 40-60 doses of Amphotericin B through the course of their treatment, the state is grappling with a shortage of the drug. Zia Nomani, a Bengaluru-based activist, said that he receives at least 20 calls a day from relatives of patients with mucormycosis, for help to procure Amphotericin B. “When we call the Drug Controller, he says that they don’t have supply from the government. They said that they supply whatever stock they receive through the Karnataka Private Medical Establishment (KPME) website indent process,” he told TNM. Amphotericin B is administered as an injection, and is only used to treat serious cases of fungal infections.
Mucormycosis is seen as a post-COVID-19 complication, as it affects those whose immune systems are compromised. Only a handful of hospitals in Bengaluru treat the disease. Dr Sanjiv Lewin of St John’s Hospital told TNM that they had to prohibit the intake of patients due to the shortage of the drug. “The hospital is facing an acute shortage of Amphotericin B. We have had to turn away patients since we did not have adequate medication to treat the patients already admitted,” he said. Trustwell Hospital, another one of the centres treating mucormycosis, also told TNM that they face an acute shortage of Amphotericin B.
State-run Victoria Hospital has been admitting mucormycosis patients who also have COVID-19, while Bowring Hospital, where patients without COVID-19 or those who have recovered are also being taken in. Dr Jayanthi, the director of Victoria Hospital, told TNM, “We do have an acute shortage of the Liposomal Amphotericin B. We have many patients who have been hospitalised for black fungus, however, not all patients require Amphotericin. Patients with mild symptoms are administered posaconazole (another anti-fungal drug),” she said.
The Karnataka High Court has been hearing a series of cases pertaining to the COVID-19 management in the state. While hearing a case on the shortage of Amphotericin B, a special division bench of Chief Justice Abhay Shreeniwas Oka and Justice Aravind Kumar directed the state and Union governments to ensure that enough doses are available for patients. A report in The New Indian Express stated that the bench also ordered the state government to furnish the exact details on the number of black fungus cases in Karnataka. According to the report, an advocate had written a letter addressed to the Chief Justice, highlighting the shortage of the drug. Advocate General Prabhuling K Navadgi assured the court that the Karnataka government will look into the matter on priority.
On May 24, seeking an increase of Amphotericin B from the Union government, the Karnataka government had told the High Court that the state is expected to witness about 400 cases of black fungus infections every week, LiveLaw reported. Considering that each patient needs about 40-60 vials of Amphotericin B over 10-12 days, the state government requested 20,000 vials from the Union government. However, of these, the state only received 12,710 vials, with an additional 1,930 vials allocated on May 31.
According to the report the government had asked for 20,000 vials as one patient needs 40-60 vials during the course of treatment. The state, though, had only received a total of 12,710 vials of Amphotericin B with additional 1,930 vials allocated on May 31. On June 2, Karnataka Health Minister Dr K Sudhakar had announced that the state is procuring more vials of the drug used to treat the infection.
Additional 1930 vials of #Amphotericin-B have been allocated to Karnataka today.
— Sadananda Gowda (@DVSadanandGowda) May 31, 2021
Total allocation to the state till now: 12710 vials #blackfungus#AmphotericinB pic.twitter.com/qKbt15HgGf
Speaking about the procurement process of Amphotericin B from the Drugs Control Office, Zia Nomani said, “The Drugs Control Officer says the requirement in Bengaluru alone is around 14,000 vials, but they are able to allot only 1,000 vials.” He added that, according to a nodal officer in charge of distribution of the drug, the manufacture of Amphotericin B was low as the caseload was low. However, with the sudden rise in cases, the low manufacturing rate is fuelling the shortage.
Amphotericin B is the most commonly-used to treat mucormycosis as it is strong enough to tackle the infection. However, in light of the shortage, hospitals have been prescribing other drugs too. These include generic Amphotericin (which is different from Amphotericin B) and posaconazole tablets.
Dr Satish Nair, an ENT specialist working at Apollo Hospital in Bannerghatta, Bengaluru, cautioned that generic Amphotericin cannot be administered in equal doses as the Liposomal Amphotericin B, as over-usage can result in nephrological or kidney-related issues. “The general Amphotericin works as effectively as Liposomal Amphotericin B, but the doses cannot be administered in equal amounts as Amphotericin B. The Amphotericin family of drugs is in short supply, though, during this hour,” he noted.
Dr Satish said that another drug that can be used to treat black fungus is Isavuconazonium sulfate, also known by the trade name Cresemba. He added that the shortage of Amphotericin B has prompted doctors to use other anti-fungals like Fluconazole, without knowing if these could treat mucormycosis infections in the first place.