As Black Fungus Cases Spike, Pharmacies Run Out of Antifungal Drug Amphotericin

"Please help us. We have no money. Without him, we have no life. They said one eye is gone and will have to be removed. Now he is getting pain in the other eye too." This desperate appeal for help was by Kalyani for her husband Anji Babu, a driver in West Godavari, Andhra Pradesh, who recovered from Covid but developed eye pain three days before discharge from a government hospital.

In a video, Kalyani was seen crying and making the appeal as her two children and husband stood next to her with folded hands. She narrated how after multiple visits to various hospitals and tests, her husband was diagnosed with Mucormycosis, commonly known as the black fungus disease. He has lost one eye and the other too is infected.

After Kalyani's plea for help went viral, the government has now admitted him to a private hospital in Vijayawada, where doctors say they would have to wait for two days to know if the medication will work.

A fungal infection caused when fungal spores are inhaled, black fungus is known to affect the lungs, brain, eyesight and can also turn fatal if not properly treated. Risk factors include use of immunosuppressants such as steroids, high blood sugar levels and prolonged ICU stay, according to a Union Health Ministry advisory issued recently.

The country is currently battling the second wave of Covid infections that has pushed up the number of patients requiring hospitalisation. Against this backdrop, the black fungus infections have emerged as an additional threat among those recovering from the disease.

The cases of black fungus infection have been rising across India. The maximum number of cases have been reported in Maharashtra (about 2,000) and Gujarat (1,163).

Madhya Pradesh has reported 281 such cases and 27 deaths, followed by Uttar Pradesh (73 cases, 2 deaths) and Telangana (60 cases).

But the fight against the disease is getting tough due to the shortage of an antifungal drug -- Amphotericin B.

Even at Delhi's biggest pharmacy hub in Yusuf Sarai, next to prominent hospitals like AIIMS and Safdarjung, the drug is nowhere to be found.

Thirty-one-year old Tarun Wadhera has been struggling to find the drug for his friend's father. "I have been searching for Amphotericin for the past 2.5 hours but did not get it anywhere. Neither shops at Green Park nor in Yusuf Sarai have Amphotericin," Wadhera told NDTV.

Charu Gupta, 47, is trying to find the drug for her friend's cousin. "This is the 20th shop I have tried but it is not available. I have been trying to get Amphotericin since last evening. Chemist shops at RK Puram, Green Park and even around AIIMS don't have it. We are now enquiring in Chandigarh if we can get it from there."

Pharmacists in Yusuf Sarai said they have been out of stock for five days and at least 50 enquiries are coming in daily.

The situation is similar in Old Rajinder Nagar. Nitish Singh , a pharmacist, told NDTV, "We are getting 50-100 inquiries everyday for Amphotericin. But we have run out of stock. For a week we have been trying to get new stock from our distributor but have not succeeded so far. He says we may not be able to get it for another week."

Major hospitals like Sir Ganga Ram Hospital and Apollo do have enough stock at their pharmacies for patients admitted there, but doctors are concerned about long-term implications for the rest.

Dr Ajay Swaroop, Chairman of the ENT Department of Sir Ganga Ram Hospital, said, "In 35 years of my career, I have never seen so many cases of Mucormycosis. Now we are seeing 20-25 cases everyday. Earlier, we used to see only 3-4 cases of this fungal infection in 6 months. We are hearing about drug shortage in pharmacies across the city. We want to discharge patients and they may need the drug once they are at home.We are concerned whether people will be able to get it at the chemist shop near their homes."

The sale of steroids is also going to get affected as its usage is connected to Mucormycosis.

Deputy Commissioner of Faridabad in Haryana, Yashpal Yadav, tweeted on Monday, "No chemist shop will sell steroids of any kind without proper prescription to avoid Black fungus disease. No sale of any steroids without a prescription ... action to the tune of suspending the licence will be taken if instructions are not followed."

Dr Swaroop said, "We definitely need to ensure that there is no irrational use of steroids. Diabetic patients are more vulnerable to Black Fungus. Use of steroids is essential for reducing inflammation due to Covid but one has to be careful with its use. There has to be strict monitoring, especially for diabetic patients and other high-risk patients who face immunodeficiency disorders. Even mild patients in home isolation start taking steroids, that has to be avoided."

State governments have announced measures to tackle the disease.

The Telangana government has said Amphotericin should not be sold without approval of a government committee. All manufacturers, stockists and distributors have been informed that the drug can be sold to hospitals where patients are undergoing treatment only after recommendation from a government panel headed by the Director, Medical Education. In Haryana, black fungus has been declared a notified disease. If a patient is diagnosed with the condition in any government or private hospital in the state, it will have to be reported to the CMO of the district concerned so that appropriate steps can be taken.

The Union Health Ministry on Monday said it has identified five suppliers of Amphotericin and is making efforts towards optimal allocation. Over the past two weeks, states across India have been supplied 1 lakh vials of the drug. The government is also exploring the option of importing the drug.

(With inputs from Uma Sudhir)