Among the 287 mucormycosis cases of Sept-Dec 2020, 187 (65%) were associated with COVID-19, or “CAM”.
154 out of 187 were “late CAM” or occurred >8 days after diagnosis of COVID-19.
33/187 (17.6%) patients were managed for COVID-19 at home before developing CAM.
2/12
Among the total 187 CAM patients, only 63% had diabetes.
The % of underlying diabetes was the same as non-COVID-19 mucormycosis.
COVID-19 was the ONLY underlying disease in 61/187 (33%) CAM patients, among whom 48 (79%) received glucocorticoid treatment for COVID-19.
3/12
13 of these 61 (previously apparently healthy except for COVID-19) cases did not receive glucocorticoid or other immunomodulatory therapies.
2.7% of the CAM patients in this study received tocilizumab.
4/12
The median time to CAM diagnosis was 18 days.
Among 187 CAM patients, 158 (84.2%) were classified as “late” CAM (>8 days after COVID-19 onset)
Inappropriate glucocorticoid use was associated with late COVID-associated mucormycosis “late CAM”
5/12
“Appropriate” steroid use was defined as dexamethasone-equivalent doses of 6 mg/day used for <10 days. Any excess in dose or duration was classified as “inappropriate”.
More mucormycosis cases were identified during the 2020 study period than the same period in 2019.
6/12
The number of mucormycosis cases unrelated to COVID-19 did not differ much during both the study periods (112 cases in 2019 vs. 92 cases in 2020), indicating the increase in 2020 was chiefly attributed to CAM.
7/12
No information is available in this retrospective analysis about home remedies, excessive steam use, nasal swabs, supplement or other medication use, antibiotics use, environmental factors or mask hygiene as potential predisposing factors.
8/12
The site of mucormycosis involvement and the survival at 6 and 12 weeks was similar in CAM and non-CAM groups.
No increase in pulmonary cases was found in the CAM group (but there are diagnostic limitations).
9/12
Rhizopus arrhizus, Rhizomucor pusillus, Apophysomyces variabilis, Lichtheimia corymbifera were the main species.
Diabetes was newly detected in 20% in COVID19 group, compared to 10% of non Covid mucormycosis group.
10/12
The incidence of mucormycosis doubled, compared to the same period in 2019, this increase was directly from COVID-19 associated mucormycosis.
11/12
Thanks @Nainamishr94 for alerting me about this paper. It answers some questions, but due to its retrospective nature, the study does not address other risk factors that might play a role in the sudden surge in India.
A case-control study is required; shall await results.
12/12
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The latest COVID-19 guideline from Directorate General of Health Services at Ministry of Health & Family Welfare @MoHFW_INDIA, are pristine no-nonsense science.
Antibody titre 115 AU/ml for Covishield and 51 for covaxin.
27 breakthrough infections occurred (4.9%) after both doses: 25 were mild, 2 were moderate, no deaths.
Risk of breakthrough infection:
5.5% with covishield
2.2% with covaxin
2/5
Listing some facts which will help understand the context of the study:
1. Anti Spike antibody is not the same as neutralising antibody. Its level is not known to reliably correlate with NAb, which is typically measured only in research labs. See my earlier tweet on this.
3/5
The neutralizing ability of vaccine drops with time, and age. The variants of concern B.1.617.2, B.1.351
and B.1.1.7, have a 5.8, 4.6 and 2.6 - fold reduction respectively when compared with the original Wild type strain. Study from UK comparing variants against vaccines.
The study measured neutralizing ability of post-vaccine serum against variants. Theoretically, it means VOC are more likely to get past vaccine protection, esp. those who had only 1 dose.
However, such lab studies are best interpreted along with clinical observations.
2/5
The reason for seeking clinical correlation is that immunity is multi-pronged, and we are not measuring T cell protection in such studies.
While neutralizing antibodies stop the virus from infecting our cells, what happens AFTER the infection is largely decided by T cells.
3/5
Among 506 healthcare worker infections from a cohort of 12,248 at PGI Chandigarh, 64% were unvaccinated, 9.5% were fully vaccinated (>2 weeks past II dose)
However, the shorter follow up post 2nd dose (time bias) means the real % could be higher.
The graph does not factor in the duration of follow up. During an ongoing vaccination process, those who are unvaccinated “get longer time” (compared to the vaccinated healthcare workers) to pick up the infection.
2/10
Cont’d
Since vaccination takes time, those who were 2 weeks past second dose in the pie chart would have had fewer days of observation, than others.
This means that the odds of picking up infection will be smaller by default. This also gets reflected in the pie chart.