Dr Mangala Borkar
Professor, Geriatrics.
The blame game has started, what is the cause of mucor attacking a Covid patient whose immunity is low for a few weeks due to steroids, sometimes tocilizumab, maybe raised sugars and a prolonged ICU stay? He may have inhaled spores of the fungus in the hospital or after discharge, that may germinate in his nose and spread, causing black fungus disease. Source? Most likely - tap water in humidifiers, contaminated pipes and tubes - or is it the oxygen itself?
Dr Anil Joshi
Associate Professor, Medicine, GMC
·Liquid oxygen being transported by oxygen express trains and airlifted from other countries is the main source of oxygen for patients at present and saving thousands of lives.
·Industrial and Medical liquid oxygen are produced in the same plant, same place, by same equipment.
·Earlier, about 95% of liquid oxygen produced by the major suppliers was used in industry and hardly 5% was used medically, for patients.
·During this second wave, suddenly, the number of Covid patients needing oxygen increased tremendously and SC has ordered that 100% of this oxygen should be used only for Covid patients.
Dr Rajashri Virshid Sonavane,
HOD, Anaesthesia dept, In charge, Oxygen Committee, GMC, Abad
·As per the information given by officials (of FDA, Supplier of liquid oxygen and the company that stores oxygen as a back-up, officially, for our region) the industrial and medical oxygen that is produced by the company is the same and obviously safe.
·It is under very high pressure of 3000 PSI (200 BARS) at a temperature of MINUS 182 degrees Celsius and is transported in cryogenic tanks
·If we just remember that the freezer of our refrigerator is 4 to 0 degrees, we can realize how cold this is! From these cryogenic tanks, it is filled in the liquid oxygen tanks in the hospital.
·You may have seen mucor fungus occasionally on stale vegetables or even on stale curds or idli batter in the non freezer part of the refrigerator, but never in the freezer. The temperature in the tank of liquid oxygen is almost 180 times lower than in the freezer of our domestic refrigerator.
Dr Amol Joshi,
Executive in-charge, Oxygen committee, GMC.
·The liquid oxygen produced by the suppliers for medical and industrial purposes is the same. Medical oxygen contains nearly 93% oxygen. In fact, that which is produced for industrial use is said to be even purer chemically, as the processes for which it is used need pure oxygen!
·Humidification has to be carried out at the local level-humidifier bottles attached to oxygen pipe outlets on the walls, in case of central oxygen supply, or on cylinders. The chance of oxygen getting contaminated is more if there are leakages or if tap water is used for humidification, rather than distilled water.
Dr Ajit Damle, Professor, Microbiology.
·Mucor is present in air, water, decaying matter, grows best at about 21 degrees temperature in acidic environment, thrives on iron.
·Spores may be carried in air, often from moist patches on walls, or in water. They may survive but not grow in pure oxygen as they need moisture and decaying matter to germinate and grow.
·They are opportunistic and only attack a person whose immunity is low, as it happens in serious COVID.
Dr Ajit Bhagwat
Consultant Cardiologist
·Mucor mycosis, caused by the black fungus is seen in Covid infected patients who have diabetes and are given steroids.
·The root cause, however, is administration of industrial oxygen - instead of medical oxygen which is pure and humidified. Industrial oxygen lacks these qualities, damages the inner lining of the sinuses and predisposes a diabetic patient to black fungus particularly when given steroids.
·It is of utmost importance to use medical oxygen (and not industrial oxygen) particularly in diabetic patients and avoid premature use of steroids.