Black Fungal Injection Price, effects, availability, shortage reason

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Black Fungal Injection Price, effects, availability, shortage reason

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Housing and Health: Time Again for Public Health Action

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Covid-19 crisis The battle against Black Fungus, White Fungus and Coronavirus" width="715">

The Centre on Thursday directed all state and UT governments to declare Mucormycosis, known as ‘Black Fungus’, a notifiable disease under the Epidemic Diseases Act, after reports came about 126 deaths due to this deadly disease till now across India. Nearly 5,500 cases have been officially reported till now from different states.

The key drug, Liposomal amphotericin B, used for the treatment of Black Fungus, has now become scarce in Delhi and nine other states and the Centre has asked pharma companies to ramp up production on a war scale. In Delhi, there are more than 200 patients suffering from Black Fungus undergoing treatment in different hospitals. Most of them are aged above 50 years. Maharashtra is the worst-hit state with 90 deaths so far, followed by 14 deaths in Haryana. Meanwhile, reports came in of White Fungus surfacing in Patna, the capital of Bihar.

With the AIIMS issuing guidelines about detection and treatment of Black Fungus disease, I spoke to Dr Nikhil Tandon, Head of department of endocrinology, metabolism and diabetes, in my prime time show ‘Aaj Ki Baat’ on Thursday night, about various issues relating to this deadly epidemic. He is considered an expert on fungal infection.

During the interview, Dr Tandon made some points clearly: One, neither black fungus nor white fungus are new diseases, there are fungii in our environment, but earlier there were very, very few such fungus-related  cases, but due to widespread use of strong steroids during Covid-19 treatment, the black fungus surfaced and targeted mostly diabetics, who have lower immunity. This black fungus attacks the small blood vessels and capillaries.

Two, timely detection of the disease can save a patient. Dr Tandon advised people not to self-medicate if they have problems like cough, cold and fever. Secondly, he asked people to be on the look out for symptoms like red eyes, swollen face, blurred images and spots on face. Do not be scared, go to a specialist and get yourself checked through different tests. This disease cannot be treated at home. It can be treated only in hospitals. Dr Tandon also explained what precautions people should take after recovering from Covid-19. Both the Centre and state governments are now alert about Black Fungus disease, and efforts are being made to provide adequate stocks of the key drug to all states.

White Fungus disease has been detected in Patna Medical College hospital, where nearly 50 Black Fungus patients are undergoing treatment. On Thursday, four new cases of White Fungus were detected. Doctors in the Patna hospital became worried when they noticed this deadly white fungus disease, which attacks the lungs and the chest cavity first, and then spreads to other organs in the body.

Our Patna reporter Nitish Chandra reported that in all the white fungus patients, the initial symptoms were cough followed by fever. When the oxygen saturation level started dipping, HRCT scan was carried out, which showed patches on lungs of patients. The symptoms were similar to those of Covid-19 patients. The surprising part was that all Rapid Antigen and RT-PCR tests conducted on these patients showed negative, but the patches on lungs gave vital clues to doctors.

One of the patients was a doctor himself, who insisted on getting his sputum tests done through culture, and the white fungus was detected. He was given anti-fungal drugs, and he recovered within three days. Our reporter spoke to the doctor Dr Basant Kumar, who said, he had a clear inkling that he has caught a fungal infection. When the Covid-19 test showed negative, he insisted on fungal infection test, and the fungus was caught in time.

White fungus is basically one, which is also known as Candidosis, that grows in moist skin parts of a human body. It basically surfaces due to weakened immune system, but can also be a side-effect of chemotherapy or antibiotic treatment. Fungi are generally found in water, air and surface. When kids wear diapers, they get skin rashes, while some people get ulcers inside their mouth. These are due to presence of fungus. Such fungi are treated with normal medicines, but if the fungus reaches the lungs, it becomes deadly. Both black fungus and white fungus attack those who have a weakened immune system, or those who are suffering from diabetes, AIDS or cancer. Doctors say, use of ordinary tap water in place of distilled water by people using oxygen cylinders in home, can also cause fungus infection in the lungs through nose and throat while inhaling oxygen.

The Centre has said that a multi-disciplinary approach is required for treatment of all black fungus and white fungus patients. Eye surgeons, ENT specialists, general surgeon and neuro surgeons should be part of this team. Health Ministry and Indian Council of Medical Research has formulated guidelines to be followed by all government hospitals, medical colleges and private hospitals for screening, diagnosis and management of all black fungus and white fungus cases. New cases are being reported daily from Delhi, Gurugram, Mumbai, Ahmedabad, Lucknow, and other cities of Maharashtra, Haryana and Bihar.

Delhi government has started preparing separate black fungus wards in LNJP hospital, GTB Hospital and Rajiv Gandhi Hospital. More than 400 black fungus patients are presently admitted in Ahmedabad Civil Hospital. Doctors and patients in almost all states are facing problem of availability of Liposomal injections.

With fungal infections spreading in states, the Centre on Thursday issued an alert about Coronavirus transmission. The office of the Principal Scientific Adviser to the Government of India issued an advisory titled “Stop the Transmission, Crush the Pandemic”. It cautioned people about aerosols carrying the deadly virus can travel in air up to a distance of 10 metres.

The advisory said: “Always Remember: People who show no symptoms can also spread the virus”. Proper ventilation can prevent the spread of the virus. Running air conditioners while keeping windows and doors shut, traps infected air inside the room, and increases risk of transmission from an infected carrier to others.” The advisory also recommended use of gable fan systems and roof ventilators in offices, auditoriums, shopping malls and other closed public spaces. “Frequent cleaning and replacement of filters is highly recommended.”

On aerosol and droplet transmission, the advisory said, saliva and nasal discharges in the form of droplets and aerosols by an infected person in the primary mode of virus transmissions. “Droplets emitted by an infected person land on various surfaces (where they can survive for a long time). As such, frequent cleaning of high contact points such as door handles, light switches, tablets, chairs and the floor with disinfectants like bleach and phenyl is recommended.”

The advisory said, community level testing and isolation will have to be ramped up in semi-urban and rural areas. Rapid antigen tests are a must for outsiders entering a locality, and wearing of N95 mask by health workers is essential. The Centre has a target of achieving 45 lakh Covid tests daily. Orders have been issued to procure  rapid antigen kits. This will help in early detection and treatment of people infected with Covid-19.

It is a fact that thousands of people faced hardships and ordeals till last week due to the deadly second wave of the pandemic. There were severe shortages of oxygen supply and oxygen cylinders during those one and half months. They had to run from pillar to post in search of hospital beds and ICU ventilators. They had to wait in long queues with the bodies of their dear ones for cremation outside crematoriums. The situation has now turned for the better. There is no shortage of hospital beds. In most of the hospitals, beds are now available. Oxygen is now available in plenty, thanks to the wartime-like efforts made by Indian Railways, Indian Air Force and Navy. Army and paramilitary forces set up Covid hospitals to treat the needy.

Now that the situation has somewhat eased, let us vow never to drop our guard and be eternally vigilant against this deadly virus. Get yourself tested at the first hint of any Covid symptom, and isolate yourself immediately. Please do not self-medicate. It enhances the risks by several times. Consult a doctor. Do not take your mask lightly. Better wear a double mask which should fully cover your nose and mouth. The nation can survive only if all of us survive. The next important part is: vaccination. Every Indian needs to be vaccinated. The stocks of vaccines may be low presently, but the Centre has promised to bring in more stocks by next month. The next three months will witness a flurry of vaccination doses. Our war against Corona shall continue till the time 70 percent of Indians are not vaccinated.

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Kin of patients affected by Mucormycosis shelling out lakhs for treatment

Even after winning the battle against Covid-19, there is no respite for many patients who are falling prey to a black fungus infection — mucormycosis. A serious but rare fungal infection, mucormycosis is caused by a group of molds called mucormycetes. It causes blindness, organ dysfunction, loss of body tissue and even death if not treated on time, said doctors.

Due to the sudden surge in the price of life-saving antifungal medicines, patients at private hospitals have to shell out lakhs during their treatment that stretches between four-six weeks.

Siddhesh Parulekar, 71, who recovered from Covid-19, lost his left eye to mucormycosis. The Girgaum resident was detected with Covid-19 in April. With moderate infection - his oxygen saturation levels were around 92 -he underwent treatment at the Worli Covid care centre for almost two weeks and returned home. But within a month, his left eye started drooping and he started squinting. When he was rushed to an ophthalmologist, his MRI report revealed that he had been infected with mucormycosis. On May 9, he was admitted to Saifee Hospital. Struggling to arrange ₹10 lakh for the treatment, the family has started a campaign on the crowdfunding portal—Impactguru.com.

“Last week, he underwent surgery where his left eye was removed. His condition is quite critical as the fungus has reached his brain. Currently, he is in the intensive care unit (ICU),” said his son Sunil Parulekar.

In another case, Sudhir Mishra, 56, is raising funds for his father’s treatment who has been diagnosed with mucormycosis. Only last month, Mishra spent ₹4 lakhs on his father Anand who was tested positive for Covid-19. Currently, Anand is at Lotus hospital, Borivali that has given the family an estimate of ₹12lakhs towards the treatment of mucormycosis.

Pre-Covid-19, patients with mucormycosis were treated at half the current expense. With the sudden surge in mucormycosis cases, however, there has been a severe shortage of life-saving drug — Liposomal Amphotericin B in the market. Taking advantage of the increasing demand, drug suppliers have increased the price of one injection from ₹8,000 to over ₹10,000, said doctors.

“There are two types of drugs—Liposomal Amphotericin B and plain Amphotericin B.

During pre-Covid days, the first one used to cost ₹3000-5,000. The latter one was ₹150. However, we preferred giving Liposomal Amphotericin B as it is more effective even for Rhino mucormycosis when the infection reaches the brain. So, during the second wave, when cases increased, suppliers surged their price to over ₹10,000. While the price of Amphotericin B has been raised to ₹500,” said Dr ChandraVeer Singh, consultant otorhinolaryngologist, head and neck onco-surgeon, Wockhardt Hospital, Mira Road.

As per treatment protocol, when the black fungus infects the nose, sinus or palate, doctors give 5mg dose per kilogram (kg) of body weight. For instance, if a person is 60kgs, he would require 300mg of the dose. Each vial consists of 50mg of the drugs. So, a patient needs six vials which costs ₹60,000 daily. But when the infection reaches the brain, doctors have to give 8-10mg per kg of the body weight. This doubles the daily medical expenditures.

Dr Milind Navalakhe, consultant ENT, Global Hospital, Parel said that plain Amphotericin B often affects the kidneys so patients who can afford the medical expenditure opt for Liposomal Amphotericin B. “Patients have to spend a minimum of ₹60,000 daily on the medicines for four-six weeks,” he said.

After receiving several complaints of overcharging and channelise the supply of these drugs, hospitals have been instructed to procure the injections directly through the collector’s office.

“For the last two-three days, case wise, we send the details to the collector’s office who then supply us the injections. This has helped break the chain of middlemen and over-pricing of doses,” said Dr Singh.

Abhay Pandey, national president of All Food and Drug Licence Holder Foundation (AFDLHF) said mucormycosis before Covid-19 was considered an extremely rare fungal infection. A handful of pharmaceutical companies produce the Liposomal Amphotericin B. Now, with the surge in cases, companies are struggling to meet the demand and arrange for raw materials. “When the pandemic started in March last year, the suppliers increased the price of masks and sanitisers for their profit. So now, as cases of mucormycosis have increased, they are using the opportunity by surging prices of the injections,” he said.

A spokesperson from Cipla which is one of the manufacturers of the injection said, “The demand for the antifungal medicines has increased by 3-4 times. We are getting orders from all across the country. We have escalated the production and we believe the demand will soon be met.”

Meanwhile, doctors said unlike last year the black fungal infection during the second wave is more aggressive which deteriorates the condition of the patients faster.

“In the second wave, the infection rate is not only more but it is also affecting younger patients. I have a patient who is just 25-year-old. Also, the infection is so aggressive that it is quickly spreading to eyes, palate and even brain,” said Navalakhe.

Doctors said incidences of mucormycosis can be controlled by stopping the unregulated usage of insulin. “This black fungus was earlier visible among patients with immunosuppressants like diabetes and cancer. Patients with Covid-19 are unnecessarily given a large number of steroids which compromises their immunity. So, it (dispensing steriods) needs to be controlled,” said Dr Shashank Joshi, part of the state’s Covid-19 task force.

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Herd immunity for Covid only after October but vaccination needs to be scaled up: SBI report

Treatment and Shortage of Drugs

On the treatment front, doctors use an anti-fungal injection known as Amphotericin B to treat life-threatening cases. However, with growing demand, hospitals in Pune are facing severe shortages of the drug that could lead to patients racking up hefty bills for treatment.

Daily demand for the drug in the city has reached 1,000 vials, even though supply is limited to 200 to 500 vials a day, according to a report by The Times of India. Fearing a blow up in prices, doctors have urged the Centre to cap the retail price as it did with Remdesvir.

While the resurfacing of the fungal disease is concerning, cases of Mucormycosis had been seen in patients last year as well. Hospitals in Ahmedabad, Delhi and Bengaluru had flagged cases in November-December last year.

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