February 5, 2023

Great Indian Mutiny

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Black fungus kills Govit-19 survivors in India

(CNN) – Srinivas S. lying on Gurney in the operating room at St. John’s Hospital in Bangalore. Surgeons carefully removed pieces of black tissue and rotten bone from his face.

The 41-year-old driver was one of more than 45,000 citizens affected Black mushrooms, Or myormomycosis, since the onset of the country’s second wave of Govt-19 in late March.

Like Srinivas, the majority of patients, about 85%, are COVID-19 patients, according to the Indian Ministry of Health. By July, more than 4,300 people had died from the fungal infection.

Srinivas ’sister, Shyamala V., sits on his bed and thinks about what life will be like for his brother’s wife and two children aged two and four.

“I’m so scared of him; he has two small children. Who will take care of them?” She said.

Black fungus is India’s second Govt-19 crisis. Prior to this year, the disease was rare in India, although it was 80 times more prevalent there than in developed countries.

It is caused by a type of fungal myrcomycete that people are exposed to on a daily basis, but when their immune system is attacked by COVID-19, they become more susceptible to infection. If left untreated, black fungus can cause permanent facial damage, vision loss and death; It has a mortality rate of more than 50%.

The number of cases has increased in India and a lower number in other places: Nepal, Afghanistan, Egypt and Oman, according to the respective Ministries of Health.

The number of black fungus patients in India is now much higher than the country’s first wave corona virus last September. This may be due to the rapid spread Delta variant P.1.617.2 of the virus.

Diabetes causes high blood sugar levels, the right conditions for a sugar-eating fungus. In India, at least 77 million people There was diabetes in 2019, next to China, with 116 million (31 million in the United States) according to the International Diabetes Federation, which partly explains why black fungus cases are so high in India.

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The World Health Organization says diabetes is on the rise in low- and middle-income countries rather than in high-income countries. With the increase in COVID-19 cases, doctors predict that black fungus will become more common worldwide.

Surgeons perform X-rays of Srinivas’ brain for signs of infection.

Unbearable pain

Srinivas, who uses only one name, thought he had won the worst position of Kovit-19, but his left eye soon began to swell. The pain was excruciating.

He had never heard of the black fungus, but was worried when it started to bleed in his eyes and nose in May. “A lot of blood came out, so I thought what was going on?” Srinivas told CNN from his hospital bed before the third surgery to remove the affected tissue.

He went to four hospitals and was referred to a fifth hospital before doctors diagnosed him with black fungus, where he was finally treated.

Prior to the epidemic, there were 3,000 to 4,000 cases of myeromycosis in India every year, according to figures provided by Health Minister Mansuk Mandavia in the Indian Parliament.

At the time, the disease was not reported, meaning states were not required to report cases to the federal government. That changed in May as the number of cases increased. By the end of June, more than 40,845 cases had been reported across the country.

Two weeks later, that number had risen by about 9% to 45,374. Of those patients, half are still receiving treatment, the health ministry said on Tuesday.

Lack of drugs

There is no quick fix for myormomycosis. Patients undergo surgery and the affected tissue is removed through a surgical procedure. Liposomes are treated with amphotericin B fungicide to prevent them from becoming infected again.

As the number of cases increased in May, several states declared shortage of drugs and the Ministry of Chemicals and Fertilizers of India offered to regulate the supply. Five more companies in India were approved to manufacture the drug and new import orders were issued.

On June 5, surgeons removed myormomycosis from a patient who had recovered from Kovit-19 at Swaroop Rani Hospital in Allahabad, India.

In early June, doctors at St. John’s Hospital said they were forced to do a ration dose due to irregular supplies. “This is a big challenge because I reduced them to 11 patients and gave them a [dosis] When should I give three to each patient? Should I select patients receiving this amphotericin B? It was very difficult, “said Dr. Sanjeev, head of the hospital’s medical services.

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Later that month, Levin’s drug delivery improved slightly, but was unpredictable. At the time, Srinivas’ sister said she had not received a liposomel amphotericin B dose for three days.

“We have been looking for injections all over Bangalore, but even private hospitals have to order the medicine from government hospitals. It is not available anywhere,” Shyamala said.

The drug costs about $ 95 and is not available outside of hospitals. Srinivasan’s family has relied on the help of their employers and low-interest loans to pay for medicine and private hospital fees.

Need at least three meals a day for 28 days, doctors say, means the cost of treatment can be as high as $ 8,000, which is unaffordable for many.

When the health minister of India, Mandavia, reported on myromomycosis in May, the country produced about 150,000 bottles of amphotericin B. “At that time the world helped us … They sent us wherever there was ambodiris in the world. We imported 1,300,000 bottles,” Mandavia said on Tuesday.

“I agree that some people do not get drugs, but the government did everything it could,” he added.

Dr. Prajpal Singh Tiyagi performed surgery on a patient at a hospital in Ghaziabad on June 1, 2021 to remove black fungus.

What causes black fungus?

Doctors say there are several factors behind the increase in black fungus in patients after the second wave of Govit-19 in India, including the drugs used to treat them.

Senior health officials from India’s Covit-19 task force and the Indian Institute of Medical Sciences have said that overuse of steroids to treat Covit-19 can suppress patients’ immune system and make them susceptible to black fungus.

Under India’s Govit-19 management protocols, steroids may be prescribed in moderate and severe Govit-19 cases, although recent guidelines released in May recommend “prudent use” to prevent and manage conditions such as myormomycosis.

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Some doctors suspect that a lack of clinical oxygen may have played a role, arguing that prolonged low oxygen levels can make patients more susceptible to infection.

People wait for Govit-19 patients to refill their oxygen cylinders at an oxygen filling station in Allahabad in April.

Some doctors believe there may be a link between the increased black fungal infection and the delta variant, a contagious strain of Govit-19 that was first detected in India in December.

Since then, the delta variant has spread to 96 countries and the World Health Organization hopes it will soon become the world’s most dominant strain.

Although several studies have confirmed that COVID-19 patients are more susceptible to black fungus, researchers have not determined whether the delta variant produces higher risk factors than other strains.

Spread around the world

India’s second Govt-19 wave has passed, but there are fears about a third wave and what it means for a black fungus outbreak in India. The infection does not spread among the population, but there is clearly an environment conducive to its spread.

So far, although the delta variant has spread worldwide, no other country has reported a sharp increase in cases. For example, in mid-June, the delta variant accounted for 99% of Govt-19 cases in the UK, but no cases of myrgomycosis were reported.

Srinivas S. He drives for a living to support his wife and two small children.

Srinivas is a Govt-19 survivor, but it takes him a while to get back to work. Initially she was unable to speak for several weeks after surgery to remove traces of black fungus due to pain and swelling, and then the esophagus was inserted as she lost part of her jaw.

“I can see … I feel better, I will try to get back to work soon. I have two young children. I have been in the hospital for a long time and I have not even seen them,” Srinivas commented in early July.

Srinivas was discharged last Saturday after two months in hospital, although although his left eye was closed due to swelling he had to go to the hospital every week to monitor his progress.

“I don’t think I can go back to work for a year, but her sister Shyamala,” but it’s hard to keep her at home. “

Corona virus, delta variant: global threat 40:14