In a two-one split opinion, two leading ENT doctors and surgeons have said there is a direct link between B.1.617.2, the Delta virus first found in Maharashtra and now the dominant strain of COVID-19 in India, and Mucormycosis.
They say the Delta variant damages the beta cells of the pancreas, which regulates insulin, thus causing transient diabetes and leading sometimes to Mucormycosis.
The two doctors are Dr. Ashesh Bhumkar, Head of Bhumkar ENT Hospital and a member of the Maharashtra Mucormycosis Task Force, and Dr. Shailesh Kothalkar, Consultant ENT Surgeon at the Seven Star Hospital in Nagpur. However, a third leading doctor, Dr. Deepak Haldipur, Director ENT and Surgeon at Trustwell Hospital in Bangalore, says the B.1.617.2 variant is only 33% responsible for Mucormycosis. In his opinion steroid treatment of Covid-19 is responsible for another 33% and diabetes for the remaining 33%.
However, later in the interview, Dr. Haldipur amended his position and said the mutant virus is only responsible for 15% and the other 15% is a result of the Indian practice of repeated steaming. He spoke with considerable passion against steaming and said it is a cause and mission for him to advise Covid patients not to steam.
In three separate interviews of roughly 15 minutes each and put out as a combined 45 minute package, the views of Dr. Bhumkar and Dr. Kothalkar were very similar. Both doctors said it was theoretically possible for a Covid patient who is not diabetic and has not been given steroids to still develop Mucormycosis. Both said this makes Mucormycosis a more dangerous and worrying problem than previously thought. They said just as oxygen levels have to be monitored with oximeters the new B.1.617.2 variant (the Delta variant) requires glucose levels to also be regularly monitored with glucometers. Dr. Bhumkar said this monitoring is essential from day one of getting Covid. Dr. Kothalkar said advice has been given to the Maharashtra Mucormycosis Task Force to give glucometers to all patients, so that after discharge they can continue to monitor their glucose levels.
Dr. Bhumkar told The Wire the damage the Delta variant does to beta cells of the pancreas could cause transient diabetes but this would not last. With time, he said, the diabetes will disappear and patients will recover. But Dr. Kothalkar took a very different view. He said 40% of the patients he has seen this year with Covid i.e. during the second wave have ended up with diabetes and he believes it will be long lasting. Dr. Kothalkar said he has seen over 300 patients, 174 of whom required surgery.
Dr. Bhumkar explained how he believes the B.1.617.2 variant can end up creating conditions that lead to Mucormycosis. First, he says, it creates heightened hyperglycaemia, as a result of which sugar levels “skyrocket”. Side-by-side the variant also leads to immune dissregulation which attacks iron cells creating free floating cells. He said this combination is what leads to Mucormycosis.
Asked whether Britain, another country where B.1.617.2 is spreading rapidly and causing concern, is seeing a similar rise in cases of Mucormycosis, Dr. Bhumkar said he did not know but this needs to be monitored whilst Dr. Katholkar said Britain would see an increase in Mucormycosis in 2-3 weeks.
However, Dr. Haldipur has a very different view. He said only 7 to 8% of the Covid patients he has seen and who are not diabetic and have not been given steroids ended up with Mucormycosis. As a percentage, he said, “this is very very low”.
Dr. Haldipur said 70 to 80% of the Mucormycosis patients he’s treated were diabetic and a more or less similar percentage have not been vaccinated. Therefore, he said, its “not fair to put the blame mainly on the new strain”. He first said 33% of the blame lies with the mutant virus, 33% with diabetes and 33% with treatment of Covid i.e. use of steroids. Later, he amended this to say of the 33% blame attributed to the mutant virus half should, in fact, go to the Indian habit of unnecessary steaming. Dr. Haldipur spoke with great passion against steaming. He said it kills the good bacteria in the nasal passage and reduces protection against Mucormycosis. He said it is a mission and cause for him to constantly advise people against steaming.
Dr. Haldipur said he is not aware of any increase in cases of Mucormycosis in Britain. He laughingly said this is because they don’t steam but also added diabetes is much better controlled in Britain and, additionally, there are fewer cases of diabetes. India, on the other hand, is the diabetes capital of the world.
Finally, Dr. Bhumkar identified the early symptoms of Mucormycosis through which people can detect if they are getting it. First, sinus pain. Second, a sense of numbness over the cheeks. Third, tooth problems i.e. a tooth or more feeling loose. Fourth, the swelling of an eye or loss of ability to easily move the eye.
Watch the full interview here.