Modi govt asks states to make mucormycosis a notifiable disease as cases rise across India

The health ministry invokes the Epidemic Diseases Act 1897, urges states to follow guidelines for screening, diagnosis, and management of black fungus.

File image of beds set up by the BMC for Covid-19 care in Mumbai | Photo: ANI

New Delhi: India is now officially in the midst of two epidemics after the central government asked states to make mucormycosis a notifiable disease Wednesday.

A notifiable disease means the government has to be mandatorily informed about any case that is detected. Among the other notifiable diseases in the country are tuberculosis, cholera and diphtheria.

Invoking the Epidemic Diseases Act 1897, Joint Secretary Lav Agarwal wrote to states, asking them ensure that all government and private health facilities and medical colleges follow guidelines for screening, diagnosis, and management of mucormycosis.

“You are requested to make mucormycosis a notifiable disease under Epidemic Diseases Act 1897, wherein all government and private health facilities, medical colleges will follow guidelines for screening, diagnosis, management of mucormycosis, issued by MOHFW and ICMR and make it mandatory for all these facilities to report all suspected and confirmed cases to health department through district level chief medical officer and subsequently to IDSP surveillance system,” Agarwal wrote in a letter dated 19 May.

Mucormycosis, more commonly known as black fungus, has increasingly been reported across the country, especially in diabetic patients who have been put on steroids after testing positive for the SARS-CoV-2 virus.

There are concerns also about the quality of water used in oxygen concentrators that are being used in small medical establishments or at home. Many states such as Telangana and Rajasthan have already made it a notifiable disease.

“In recent times a new challenge in the form of a fungal infection namely mucormycosis has emerged and is reported from many states amongst COVID-19 patients especially those on steroid therapy deranged sugar control. This fungal infection is leading to prolonged morbidity and mortality amongst COVID-19 patients,” noted Agarwal in the letter.

Mucormycosis a rare infection

Mucormycosis is a serious infection but is usually rare. However, the numbers of cases in India during the second wave of the pandemic are threatening to overwhelm hospitals, especially because when the disease enters a hospital with piped oxygen supply, infection in one patient may quickly spread to all those that are on the same gas line.

The infection is often fatal when it spreads to the brain. The symptoms of mucormycosis infection in the lung are often the same as that of Covid-19 — fever, cough, shortness of breath and could aggravate the condition of a patient.

“Disseminated mucormycosis typically occurs in people who are already sick from other medical conditions, so it can be difficult to know which symptoms are related to mucormycosis. Patients with disseminated infection in the brain can develop mental status changes or coma,” notes the Centers for Disease Control and Prevention, the national public health agency of the US.

In his letter to the states, Agarwal elaborated on a “multidisciplinary approach” to treat the infection.

“The treatment of this fungal infection requires a multidisciplinary approach consisting of eye surgeons, ENT specialist general surgeon, neurosurgeon and dental maxillofacial surgeon et cetera and institution of amphotericin B as an antifungal medicine,” he wrote.

(Edited by Rachel John)