Just when we thought we had finally begun to understand the rhythm of the virus, it threw a new, terrifying curveball at us. In mid-2021, as the second wave of COVID-19 was supposedly receding, the clinical picture shifted. Patients were no longer coming to us just struggling for breath; they were complaining of a dull, sinister pain behind their cheekbones and around their eyes. Some presented with blurred vision, others with black crusts forming inside their nostrils.

We realized with horror that we were witnessing the start of an epidemic within the pandemic: Mucormycosis, colloquially known as “Black Fungus.”

This was not a simple infection. Caused by a group of molds called mucormycetes, it is an aggressive invader that attacks the sinuses and facial bones, often eating its way into the eye socket and toward the brain. If left untreated, it is nearly 100% fatal. If treated late, the cost is often the surgical removal of the patient’s eye or jaw.

The first tremors of the “Black Fungus” epidemic didn’t arrive in the form of a patient at our doorstep, but as a warning from the neighboring state of Gujarat. Priya alerted me to a disturbing spike in Mucormycosis cases there, connecting the dots that many were missing: this wasn’t just a fungal infection; it was the wreckage left behind by uncontrolled diabetes and the aggressive over-use of steroids. It was a canary in the coal mine, signaling that the “panic prescribing” of the second wave was beginning to extract its delayed and terrible price.

The physiology was damningly simple, yet the implications were catastrophic. By flooding diabetic patients with high-dose steroids to treat mild Covid, doctors were essentially rolling out a red carpet for the fungus. We realized that we were facing a man-made disaster—a secondary epidemic fueled not by the virus, but by our own medical hubris. The solution, therefore, couldn’t just be antifungal drugs, which were already disappearing from the shelves; it had to be aggressive prevention. We needed to stop the fire before it started.

We didn’t wait for national guidelines or bureaucratic approval. Priya Smathkumar from Tata Memorial Hospital, Mumbai proposed a rapid counter-attack: we would create comprehensive patient education materials on Mucor prevention and deploy them within twenty-four hours. It was a race against ignorance. In the midst of clinical chaos, we pivoted to public health pedagogy, designing simple, vernacular guides to warn patients about blood sugar monitoring and the dangers of self-medication. It was a small, unglamorous intervention, but in a pandemic defined by helplessness, the ability to arm our patients with knowledge felt like our most potent weapon.

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The Perfect Storm: Diabetes and Steroids

As I told journalist Maryn McKenna for Scientific American in May 2021, “The black fungus has painted the country red.” But the question we had to answer as administrators and clinicians was: Why India? And why now?

We discovered that this was a man-made disaster born of a deadly collision. India was already the “Diabetes Capital of the World,” and mucormycosis was a known, albeit rare, risk for those with uncontrolled blood sugar. When the pandemic hit, this vulnerability met a trigger: Steroids.

As I had feared and warned against in our “War Room” meetings, the irrational, high-dose use of steroids for mild COVID cases—often prescribed by panicked doctors in the first week of illness—had wreaked havoc. The steroids dampened the immune system and spiked blood sugar levels, creating the perfect petri dish for the fungus to thrive. We were seeing the visceral consequences of “panic prescribing.” Our stand for evidence-based medicine at Sevagram had protected our own patients, but we were now the ones tasked with rescuing those who had been mistreated elsewhere.

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The Administrative Rescue

Fighting this enemy was harder than fighting the virus. Unlike COVID, there was no rapid antigen test. Diagnosis required a high index of suspicion, a biopsy, and specialized CT scans—resources that rural hospitals rarely possess.

Once diagnosed, the treatment was even more difficult to secure. The only effective weapon was Liposomal Amphotericin B—a powerful, expensive, and notoriously scarce antifungal injection. As demand surged, the drug vanished from the market. It became unaffordable for the farmers and laborers of Wardha, leaving families in a state of absolute despair.

Here, the District Administration—the same team we had built trust with in the War Room—proved to be our lifeline. Recognizing the shortage, the government centralized the distribution of the drug. The district administrators came to our rescue, providing Amphotericin B injections free of charge for patients with proven mucormycosis admitted to MGIMS.

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The Double Siege

We established a rigorous protocol. We documented every vial, justified every dose, and kept the administration informed of every step. This was a complex, multidisciplinary war; it required our physicians, ENT surgeons, and ophthalmologists to work in a seamless loop.

Over those grueling months, we admitted and treated about fifty patients. These were heart-wrenching cases. I remember the look on the faces of people who had survived COVID, only to be told they might lose an eye to the fungus. While we could not save every eye, we saved nearly every life. Most of our patients were eventually discharged—survivors of a double siege.

Looking back, the “Black Fungus” chapter was one of the darkest periods of the pandemic. It reinforced a crucial, painful lesson that I have carried with me ever since: in medicine, the cure must never be allowed to become more dangerous than the disease.