India faces antifungal drug shortage as rare complication adds to Covid-19 woes

India said on Friday it was working to alleviate a shortage of a medicine used to treat a rare fungal disease hitting Covid-19 patients as its healthcare system reels under a massive wave of coronavirus infections.

Cases of mucormycosis, or "black fungus," a potentially serious condition that causes blurred or double vision, chest pain and breathing difficulties, have surged in India, mostly among Covid-19 patients.

At least 7,250 such cases have been found across the country as of May 19, local media reported.

"In this battle of ours, another new challenge of black fungus has also emerged these days," Prime Minister Narendra Modi tweeted on Friday.

India has the second-highest tally of confirmed Covid-19 cases in the world and has been reporting some 250,000 infections and 4,000 deaths daily.

With mucormycosis cases rising, India's health ministry said it was looking for more companies to produce the antifungal drug amphotericin B used to treat it and also increase imports of the medication.

That would lead to a nearly 250% increase in supply to around 570,000 vials in June, the ministry said on Friday.

Some Indian states like Maharashtra, home to the financial capital Mumbai, said they were running low on amphotericin B as black fungus cases spiked and had asked federal authorities to provide more.

"One patient needs 60 to 100 injections (of amphotericin B) depending on severity of illness. With current case load, we need more than 150,000 injections," Maharashtra health minister Rajesh Tope told reporters.

The western state has reported 1,500 cases of mucormycosis so far, and 850 patients are undergoing treatment.

The state governments in the two southern states of Kerala and Karnataka have extended lockdowns to try to keep the Covid-19 related infection from spreading further.

The lockdown in Kerala is likely to last until the end of this month, while it has been extended to June 7 in Karnataka.

After several other states, New Delhi will also halt vaccinations for people in the age group of 18-44 years due to supply shortage, the state government said in a statement on Friday evening.

Rural Testing

Overall, India's Covid-19 infection tally stands at more than 26 million, with a death toll of 291,331, health ministry data showed on Friday.

The country conducted roughly two million tests on Thursday, but experts have said infections and deaths could be between five-to-10 times higher than official estimates as the virus spreads to the vast hinterland. 

India aims to double its testing capacity to 4.5 million per day by the end of June, of which 60% would be through rapid antigen tests, according to the government.

As part of the effort, the state-run Indian Council of Medical Research (ICMR) this week approved home testing for Covid-19, using rapid antigen tests.

These tests, less accurate than the RT-PCR method, are advised only for symptomatic cases and immediate contacts of laboratory-confirmed positive cases, according to the state-run ICMR.

"In rural areas or in field level areas, rapid antigen test is the backbone of testing and that should be encouraged," Balram Bhargava, head of ICMR, told reporters.

Here are 10 important facts about the fatal fungal infection: 

1. According to a report published on NDTV's website, the Indian Council of Medical Research (ICMR) said at the weekend that doctors treating Covid-19 patients, diabetics and those with compromised immune systems should watch for early symptoms including sinus pain or nasal blockage on one side of the face, one-sided headache, swelling or numbness, toothache and loosening of teeth.
2. The disease strongly linked to diabetes can lead to blackening or discolouration over the nose, blurred or double vision, chest pain, breathing difficulties and coughing blood
3. According to ICMR, Covid-19 patients who, during their treatment, have had prolonged stays in hospital ICUs and used steriods to treat the viral infection are more susceptible to contracting the fungal infection. 
4. In an interview with Reuters, David Denning, a professor at Manchester University and an expert at the Global Action Fund for Fungal Infections charity, said "There have been cases reported in several other countries - including the UK, the US, France, Austria, Brazil and Mexico, but the volume is much bigger in India,". Reports suggest that diabetes can in turn be exacerbated by steroids such as dexamethasone, used to treat severe Covid-19.
5. Media reports have pointed to cases in Maharashtra and state capital Mumbai, and Gujarat, reports NDTV. Aparna Mukherjee, a scientist at ICMR, said, "It's not something to panic about, but you have to be aware of when to seek consultation."
6. Fead of the Centre of Advanced Research in Medical Mycology in India's Chandigarh, Arunaloke Chakrabarti said that even before Covid-19, mucormycosis was more common in India than in most countries, "partly because of the millions who have diabetes".
7.  Head of opthalmology at Fortis Hospital in Mulund, Mumbai P Suresh said his hospital had treated at least 10 such patients in the past two weeks, roughly twice as many as in the entire year before the pandemic. All had been infected with Covid-19 and most were diabetic or had received immunosuppressant drugs. Some had died, and some had lost their eyesight, he said.
8. The Indian health ministry on Sunday released an advisory on how to treat the infection reports NDTV. In an interview with AFP, Ahmedabad-based infectious diseases specialist Atul Patel, a member of the state's Covid-19 taskforce, said "The cases of mucormycosis infection in Covid-19 patients post-recovery is nearly four to five times than those reported before the pandemic."
9. Some 300 cases have been reported so far in four cities in Gujarat, including its largest Ahmedabad, according to data from state-run hospitals. The state ordered government hospitals to set up separate treatment wards for patients infected with "black fungus" amid the rise in cases, reports NDTV. 
10. Treatment of the deadly fungus involves surgically removing all dead and infected tissue and administering a course of anti-fungal therapy. But in an interview with AFP,  Yogesh Dabholkar, an ear, nose and throat specialist at Mumbai's DY Patil Hospital, said that the drugs used to treat those infected with the fungus were expensive, reports NDTV.