Black Fungus: Owing to costs of treatment, poor families stand helpless while Centre declares it notifiable disease

Soon after the battle for Covid-19 is over, recovered patients are falling prey to mucormycosis in huge numbers, which leads to fungal infection. The Centre declared it as a notifiable disease while 11 states have already declared it as an epidemic. Owing to the cost of the treatment of mucormycosis that goes up to atleast five lakhs, many poor families are standing helpless as their near ones continue to suffer from the deadly fungal infection.

The line of treatment in mucormycosis is urgent and needs to be started as soon as the presence of fungal infections is confirmed in the patients to avoid painful suffering and mortality. While government hospitals have started giving treatments, many of the private super/multi-speciality hospitals in the national capital told ANI that the cost of treatment can range up to Rs 10 to Rs 15 lakhs per patient excluding post discharge treatment.

A resident of Jodhpur who has a case of mucormycosis in his family (father-in-law) and has been hospitalised on the condition of anonymity stated, "During the initial four-five days, we suffered a lot following scarcity of the medicine and now we are suffering due to the cost of the treatment which is huge for any middle-class family to afford." He said, "At first we dealt with Covid-19 treatment and now mucormycosis. Doctors have told us that my father in law who has got black fungus in the nose requires atleast 80 vials. Right now, the hospital is providing the injections for free till the time he is in the Covid-19 ward. But when discharged, in another two days, I do not know how to afford all these vials."

Another patient's kin, Aman Sinha, whose brother-in-law is admitted to a private hospital in Gurugram said, "We are providing daily vials costing Rs 48,000 per day and this we have to keep on providing for another 14 days. He was admitted five days ago and till now we have spent Rs 3.5 lakhs." As per reports, Liposomal Amphotericin costs on an average of Rs 3,500 to Rs 8,000 per vial.

Amphotericin is available in three different forms. Liposomal Amphotericin, a lipid complex version and Amphotericin B deoxycholate (the older version of the anti fungal). But it has been observed by experts that the older version can cause significant morbidity because it involves damage to the kidneys as most of the patients are diabetic, for which Liposomal Amphotericin is preferred. Dr VK Monga, a public health expert told ANI, "Its diagnosis and treatment are very costly proposition. For diagnosis, a battery of costly tests like blood investigations, endoscopy, fungal staining and multiple radiology (MRI/CT) may be required. Similarly, treatment involves costly anti-fungal medicines and injections (which are in short supply) and tedious surgeries by a battery of surgeons -- ENT, ophthalmologist, Faciomaxillory, neurosurgeon and reconstructive surgeon. Most of these can only be performed at multi-specialty tertiary care centers in major cities."

A doctor from a government hospital in Delhi, who is treating patients with mucormycosis cases, told ANI on the condition of anonymity, "The treatment is definitely expensive as 100 to 150 vials are needed for a stretch of three to four weeks. It is indeed burdensome for the poor people." Eleven states and UTs that declared mucormycosis as an epidemic (under Epidemic Diseases Act, 1897) in the country reported an acute shortage of Amphotericin-B that is an anti-fungal drug used to treat the ubiquitous fungus.

Delhi, Bihar, Haryana, Gujarat, Rajasthan, Uttar Pradesh, Madhya Pradesh, Jharkhand, Tamil Nadu, Maharashtra, Telangana notified mucormycosis or widely known as black fungus as an epidemic. Union Ministry reported 5,424 cases of mucormycosis across India, out of which 4,556 patients have a history of Covid-19 infection with 55 per cent diabetics.