Dr. Surrinder Sodhii
When the second wave of deadly Covid-19 wreaked havoc across the nation, many people were seen gasping for the want of Oxygen, using it in whatever form they received. With the sparse supply of oxygen concentrators, the hospitals across the country started reporting a rash of cases involving a rare infection— called the “black fungus” – among recovering and recovered Covid-19 patients, leading to upsurge in mortality rate.
In medical parlance, this disease is called Mucormycosis and it is fatal. It catches on to those who have been on oxygen support for five days or more. So, the oxygen which gives you life actually becomes the major source of infection, which is dangerous for life.
Mucormycosis, simply known as “Black Fungus”, develops in the nasal tract due to use of unkempt and unsterile water in the humidifier bottle, through which the piped oxygen in hospitals passes to make it hydrated oxygen, before it reaches the patient’s nostrils. It’s very much like the fungus which develops on bread due to moisture, if kept for a long time.
It starts from the nostril, travels towards the eye and then towards the brain. It paralyses the nerves it travels through. So, first it’s the eye that loses vision very swiftly and permanently! If not stopped, it enters the brain and then it’s a matter of a day or two before the person is paralysed, has multiple organ failure or sudden heart attack and dies.
For anybody on oxygen support in a hospital, it’s crucial to keep looking around the nostrils for any black pigmentation. As soon as it’s noticed even as the smallest dot, alarm bells should be sounded, and anti-fungal vaccination should start immediately, because this is the only treatment of the disease.
It has been observed in the past couple of days that many Covid-19 patients, who had happily recovered have to lose their lives due to ‘Black Fungus’, because after spending days together on oxygen, they had developed this fungus and before their family notice black pigmentation, this fungus claimed their lives. The most unfortunate part is that there is complete ignorance about this contamination in oxygen supply and about the deadly disease itself.
According to the prevention of mucormycosis protocol in high risk Covid patients released by association of otorhinolaryngologist of India we have to do HbA1C when diagnosed with Covid 19 followed by strict control of blood sugar levels. There must be rational use of steroids and no steroids for home isolation patients. Maintenance of nasal hygiene by saline isotonic nasal spray and or betadine drops and consideration to amphotericin solution in nasal washing in highly suspected cases. We must maintain proper hygiene of the equipments used for oxygenation e.g nasal prongs, nasal cannula, ventury masks, bipap, ventilators. Provision of proper education of all the patients about current scenario regarding post Covid 19 mucormycosis infection.We must watch out for the symptoms like blood tinged nasal discharge, blockage, discolouration of oral cavity or nasal cavity mucosa, facial pain, eye swelling and redness. To do CT and MRI PNS and ORBIT for early detection.Considering the role of inhaled amphotericin (LIPOSOMAL) in high risk Covid diagnosed patients or suspects of mucormycosis patients.
As a doctor, I feel that in addition to ensuring smooth flow of oxygen to the patients, proper sanitisation of these equipments should also be made imperative and volunteers from social organisations with required expertise in the field should come forward to help medical staff in cleaning and refilling of humidifier bottles and other equipments, so that collective efforts can help us to fight this pandemic.