For the past week, Hemanth Thakur has been waiting for 50-60 vials of medicine for his 58-year-old father, who is being treated in a private hospital at Kukatpally in Hyderabad for mucormycosis, also known as ‘black fungus’ infection. Although it is not contagious, the fungal infection is known to affect a person’s central nervous system, eyes, nose, mouth, sinuses and lungs. More than 700 people in Telangana have been affected by the rare yet serious infection, which is commonly noted among individuals who just recovered from COVID-19. Amid the rise in ‘black fungus’ infections, the drugs used to treat the infections have been in short supply. "We applied for the Liposomal Amphotericin B vials on May 26 and have been waiting since then. Doctors are saying that the fungus is spreading rapidly into the other organs,” said Hemanth, urging government authorities to provide the medicine soon. His father had just recovered from COVID-19.
Another 58-year-old female patient who is undergoing treatment for the black fungus infection at a hospital in Hyderabad’s Somajiguda was given five vials of the drug last week. However, she needs more vials. “We applied to the Telangana government, via email, for the antifungal drugs, but so far, we have not received any response. Doctors are saying other alternatives are showing less impact on my mother," Harikrishna G, the patient’s son, told TNM. His mother, too, had just recovered from COVID-19.
Several patients infected with mucormycosis are facing difficulties in availing treatment in Hyderabad due to the shortage of medicines. Liposomal Amphotericin B intravenous injection is a common antifungal drug used to treat the ‘black fungus’ infection, although alternative medicines such as Posaconazole and Isavuconazole are used in case of shortage. According to the family members of many patients, the unavailability of Liposomal Amphotericin B, which is proven to be more effective against this infection compared to alternative drugs, is delaying the treatment.
Added to this, patients and their caregivers told TNM that certain private hospitals in Hyderabad are refusing to admit or treat ‘black fungus’ cases due to the shortage of drugs, while government hospitals are holding admissions owing to the occupancy of the beds. On the night of May 26, Asfiya Anjum, who was infected with the ‘black fungus’ infection, was allegedly denied admission to hospitals. She eventually died at her home in Nizamabad. According to social activist Khalida Parveen, the patient was bleeding from her eyes, nose and mouth. Although KTR’s office responded to her request for a hospital bed, Asfiya was unable to find any hospital.
“It’s really the failure of our system. KTR Sir, are we prepared for the future?” wrote Kahlida, urging the Telangana government to ensure the availability of medicines.
Mucormycosis is caused by a group of fungi called mucormycetes. If the fungus spreads to other organs, the infection may result in surgeries to remove the infected tissues, which could result in losing eyes or upper jaw. In some cases, it leads to death, especially in those patients who have diabetes, and if their immunity has been affected due to steroids as part of COVID-19 treatment. It must be noted that the ‘black fungus’ infection is not a communicable disease and not everyone who is exposed to the fungus is infected.
Scores of family members are reaching out to the Health Department and state COVID-19 Task Force Chairman and IT Minister K Taraka Rama Rao (KTR) on Twitter requesting to provide the antifungal medicine. The pan-India supply of the Liposomal Amphotericin B is undertaken by the Union government; no individual is authorised to sell the drug.
According to G Kishan Reddy, Minister of State for Home Affairs, the Union government has provided an additional 1,889 vials of Amphotericin B for 744 patients who are under treatment for the infection as of May 25. One patient requires 20-60 vials of Amphotericin B per week and the treatment can last for about four to six weeks, depending on the severity of the infection. One vial costs about Rs 7,800 in Telangana.
To fight the rising #Mucormycosis cases, GoI has allocated 29,250 Addl vials(approx. 11,717 patients across country) of #Amphotericin-B vials to all States/UTs.— G Kishan Reddy (@kishanreddybjp) May 26, 2021
Addl Allocation to Telangana stands at 1890 vials(approx 744 patients)@narendramodi @DVSadanandGowda @mansukhmandviya pic.twitter.com/65e7y14py8
On May 19, the government introduced an online application system to regulate the allotment of Liposomal Amphotericin B, Posaconazole and Isavuconazole. Families of the patients can directly apply for these medicines. Accordingly, patients must send applications in a prescribed form to ‘email@example.com’. After considering the application, the state government will communicate the details of the store from where these medicines can be bought, to the applicant.
However, a staff member who handles the medical logistics at a city-based hospital, which is treating ‘black fungus’ cases, said that it has become difficult to procure the drug as the approval from the government is slow, owing to low stock. "We are applying to the state government with the required documents and medical investigation reports, but there is a delay in getting the drug. At present, we get a total of 29 vials per day which can be used to treat four patients," the staff said.
Noting that the rising mucormycosis cases have led to an increase in demand for the drug, thereby causing a shortage, Dr Sanjeev Singh Yadav, Vice President of Indian Medical Association (IMA) Telangana, said, "Usually, the production of Amphotericin B is less in the country as these are used to treat a few chronic diseases. Though there are a few alternatives to this drug, only Amphotericin B has proven to be effective in treating mucormycosis."
It was earlier this week Chief Minister K Chandrashekar Rao (KCR) directed the Telangana officials to increase the beds for treating the ‘black fungus’ infections. CM KCR wanted the capacity of beds for mucormycosis cases to be increased to 1,500 across the state, in which 1,100 beds should be in Hyderabad and 400 beds in other districts. The CM also asked the officials to allot 160 beds in Gandhi Hospitals and 200 beds in Sarojini Devi Hospital as well. The medical and health officials informed the CM that as many as 150 beds in Gandhi Hospital and 250 beds in ENT Hospitals have been allotted for treating the ‘black fungus’ infection.
Sree Harsha Tanneeru, a Hyderabad-based social activist, said while patients require 60-70 vials of Amphotericin B, the government is able to give less than 10 vials, which are not adequate for treating such cases. "Besides, in one case at Gandhi Hospital, the patient was not even moved into the special ward for mucormycosis,” he said.
Apart from the designated government hospitals, several private hospitals are also treating the ‘black fungus’ infections. As per volunteers engaged in helping patients find hospitals, around 28 hospitals are providing treatment for the infection.
#AsfiyaAnjum #Nizamabad was suffering from #BlackFungus breathed her last breath yesterday night. It was really painful for her n to her family members to see her bleeding from her eyes, nose and mouth.Though @KTRoffice responded2our request, unable to admit her in any hospital. pic.twitter.com/QL0FhhXWAu— Khalida Parveen (@kparveen2005) May 27, 2021
Watch: All you need to know about mucormycosis