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Doctors across Maharashtra all agree that we are seeing a massive, massive surge in mucormycosis cases since mid-March - that we crucially did not see during the first wave. There were also just 41 post-Covid mucor cases globally by March 1 So, what has changed?

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Dr Shailesh Kothalkar, the leading ear, nose, and throat (ENT) surgeon at Nagpur's Seven Star Hospital, has treated over 280 patients and operated on 151 people. He would see several cases annually prior to 2021. This pattern was repeated to us again and again by doctors

The surge was initially blamed on over-prescription and long-term use of steroids. While doctors say steroids do suppress the immune system, they argue it is incorrect to blame this sudden explosion in mucor cases on this factor alone. Why?

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Steroid overuse has been endemic in India for a long time. If this was the cause, doctors would see large numbers of mucor cases in other patients. They aren't. Steroids were also prescribed en masse during the first wave - we didn't see this huge mucor surge then, either.

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Across Maharashtra, doctors say instead, the new "Delta" B.1.617 variant - which became dominant in the spring - is causing unprecedented damage to the beta cells of the pancreas, which regulates insulin. They have seen a huge spike in post-Covid patients developing diabetes

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“We need more investigation into this but we are seeing this concerning new pandemic, around 40 per cent more patients are developing diabetes after having Covid-19 during this second wave,” said Dr Kothalkar - some with blood glucose levels as high as 700mg/dL

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Mucormycosis is a fungal infection. Prior to Covid it was almost exclusively reported in chronic diabetes patients in India Soaring bloody glucose levels provide it with the perfect conditions to thrive

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Vikram Trivedi was one of them. Previously he was in fine health - he went to the gym daily and had a blood glucose level (BGL) below 140mg/dL After almost asymptomatic Covid, his BGL rose to 200mg/dL He presented late with mucor, and had to have eye, sinus & pallet removed

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This is another key point to make. There is a lot of fear around mucor but if we detect it early, it can be treated very effectively. If we wait, even a few days, the fatality rate can be as high as 50-80% Symptoms: discharge from the nose, headache, blurred sight, toothache

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The vast majority of patients we saw in a critical state were from remote, rural areas Post-Covid, they had not monitored their BGL and local doctors misdiagnosed them Salim Nanded, 45, a farmer from Jalgaon, presented late and was lucky to survive despite losing his eye

There is already research to suggest a link between Covid and diabetes. Studies in the British Medical Journal and Nature found 5-14% of hospitalised Covid patients developed diabetes Doctors here strongly believe the Delta variant is now causing this to happen more regularly

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“I had seen 45 patients in my entire career & now we have had 66 patients admitted in just one month. Over the last five days, we’ve barely slept, we’ve done 40 surgeries,” said Dr Shrinivas Chavan, the Head of the ENT Department, Mumbai's Grant Medical College & Sir JJ Hospital

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The key takeaway of our week in the field - doctors say we need to study the link between "Delta", post-Covid diabetes & pancreatic damage, and mucormycosis to understand the link

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And, doctors ay that the blood glucose monitoring of post-Covid patients needs to become mandatory The hospitals we visited that were doing this did not have one of their own Covid patients admitted for mucor - which is pretty striking

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