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A sharp rise in black fungus cases during India’s catastrophic Covid-19 wave has exposed the consequences of overdedication as stretched doctors reject prescription guidelines and patients self-medicate.
The overwriting of steroids, in particular, for treating patients with Covid-19, it has been blamed for a deadly infection of black fungus infections and a lack of medication to treat it.
Doctors have reported an increase in patients suffering from black fungus or mucormycosis, an infection with a mortality rate of at least 50% that starts in the nose and spreads rapidly to the eyes and brain.
Experts have warned that the mass administration of steroids and other drugs could trigger secondary infections and antibiotic resistance in the country.
“The number of cases I see is devastating. We usually see four to five cases in life, now we see four to five cases a day, ”said Dr. Atul Mittal, an ear, nose and throat surgeon at the Fortis Memorial Research Institute, a hospital located outside New Delhi. “I think they’re all due to irrational steroid use.”
People with mucormycosis infections often require surgery to scratch the dead tissue that has killed the fungus. Many patients have recovered from coronavirus only to lose their eyes or upper jaw to save lives.
Once the infection begins to spread, it can kill people in a few days, Mittal said. “We can’t let the disease grow, it will continue to invade like a termite,” he said.
Officials fear increased cases of black fungus because many covid patients are being treated with steroids © Rebecca Conway / Getty
The Mucor mold is found everywhere in everyday life: on the ground, in decaying plants and fruits. But cases of mucormycosis are rare and sometimes only affect people with diabetes or a weakened immune system, such as cancer patients.
However, doctors said thousands of Covid-19 patients who took high doses of steroids for an extended period of time against medical guidelines are more susceptible to infection.
Steroids are prescribed to help prevent the “cytokine storm,” an excessive inflammatory response that hurts the body without stopping the infection, caused by the coronavirus. But they also reduce immunity and increase sugar levels, creating fertile ground for the fungus to grow. India, home to the largest number of diabetics in the world after China, has thousands of patients at risk.
Across the country, hospitals are creating ad hoc units to deal with a growing number of black fungus cases. With many patients in India still undergoing steroid therapy for Covid-19, officials fear the numbers will only increase. The Minister of Health of Maharashtra, headquarters of the commercial capital Bombay, warned last week there could be more than 2,000 cases in the state.
But just as there were desperate ones oxygen requests and the antiviral drug remdesivir in India in recent weeks, there are now appeals from relatives of people suffering from mucormycosis to secure life-saving drugs, such as B. liposomal amphotericin.
Harsh Gupta, a 28-year-old software engineer from Bhopal, Madhya Pradesh, said he has visited more than 50 pharmacies in the past four days to find the injectable drug.
Her diabetic father had just recovered from Covid-19 when she was diagnosed with mucormycosis and had surgery on Friday.
“There is a possibility that the infection may develop again in the area. To avoid this, this injection is very necessary, “said Gupta. “There’s no chance a surgery could happen twice.”
Without the drug, his father is unlikely to survive. “It’s not available anywhere,” Gupta said. “It simply came to our notice then. We don’t know what to do. ”
Gilead, who manufactures the drug, said he was “preparing several hundred thousand additional materials of our antifungal drug with shipments to begin this week.”
Lancelot Pinto, a pulmonologist at PD Hinduja Hospital in Mumbai, said the increase in cases of mucormycosis reflected a broader trend of steroid abuse in India.
The World Health Organization advises coronavirus patients receive a daily dose of 6 mg of dexamethasone, a corticosteroid or its equivalent for seven to ten days to reduce mortality in patients who are severely or severely ill.
“I have seen prescriptions of up to 500 mg a day. It’s not uncommon, ”Pinto said, adding that patients in India were often prescribed steroids for a month.
Taking steroids too early in the course of a Covid-19 infection can also affect the immune system and is suspected to lead to unnecessary hospitalizations of young adults who might otherwise fight the disease, Pinto said.
Under intense pressure from the second wave, doctors have prescribed a list of medications that include steroids and antibiotics for people with mild symptoms.
Local governments in India have also sent conflicting messages about what medicines should be taken, sometimes against the world convention.
For example, several states in India are distributing the antiparasitic medication Ivermectin as a prophylactic treatment for Covid-19, despite WHO warnings against its use. Others have included antibiotics and steroids in Covid-19 home care packages.
Leena Menghaney, a public health lawyer, said many people self-medicate with antibiotics, which increases the risk of antibiotic resistance.
“Every family I know accumulates or has used azithromycin,” he said, referring to an antibiotic that Donald Trump, then U.S. president, said. avalat last year. “We’re burning a drug that’s very important.”
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