Just when we thought we understood the rhythm of the virus, it threw a new, terrifying curveball. In mid-2021, as the second wave was supposedly receding, patients stopped coming to us only for breath — they came with a dull, sinister pain behind the cheekbones, blurred vision, black crusts inside the nostrils. We were watching the start of an epidemic within the pandemic: Mucormycosis, “Black Fungus” — an aggressive mould that eats into the sinuses, the eye socket, sometimes the brain; untreated, nearly always fatal; treated late, often costing an eye or a jaw.
The first tremor came not from a patient at our door but as a warning from Gujarat, where colleagues were seeing a spike in cases. It wasn’t a stray fungal infection; it was the wreckage of uncontrolled diabetes meeting the aggressive over-use of steroids — a canary singing about the price the second wave’s panic-prescribing was about to extract. Flooding diabetic patients with high-dose steroids for mild Covid had rolled out a red carpet for the fungus. This was a man-made disaster, and it needed aggressive prevention as much as antifungal drugs already vanishing from the shelves. Priya Smathkumar at Tata Memorial proposed a rapid counter-attack — vernacular patient-education material on Mucor prevention, deployed within twenty-four hours — and we pivoted, in the middle of clinical chaos, to public-health pedagogy.
As I told the journalist Maryn McKenna for Scientific American in May 2021, black fungus had painted the country red. The question was why India, and why now. India was already the “diabetes capital of the world,” and mucormycosis a known if rare risk for the uncontrolled. The pandemic supplied the trigger: steroids, prescribed too readily by panicked doctors in the first week of illness, dampened immunity and spiked blood sugar, and created the perfect petri dish. Our stand for evidence-based medicine had protected our own patients; now we found ourselves rescuing those mistreated elsewhere.
Diagnosis alone was hard — no rapid test, only a high index of suspicion, biopsy, and CT scans rural hospitals rarely have. Treatment was harder still: Liposomal Amphotericin B, powerful, expensive, and suddenly scarce, unaffordable for the farmers and labourers of Wardha. Here the District Administration, the same team we had built trust with in the War Room, became our lifeline, centralising distribution and providing the drug free for proven mucormycosis cases admitted to MGIMS.
We built a rigorous protocol — every vial documented, every dose justified, physicians, ENT surgeons, and ophthalmologists working in a seamless loop. Over those grim months we treated about fifty patients: people who had survived Covid only to be told they might lose an eye. We couldn’t save every eye, but we saved nearly every life — survivors of a double siege. The Black Fungus chapter remains one of the darkest of the pandemic, and it left me with a lesson I’ve carried since: the cure must never be allowed to become more dangerous than the disease.