Investigation of an acute surge of COVID-19 associated mucormycosis (CAM) cases reported to a tertiary health care institution in Bihar, India

INTRODUCTION: Acute surge in coronavirus disease-2019 (COVID)-associated mucormycosis (CAM) cases was reported during mid-May 2021, which was later declared an epidemic in various states of India including Bihar. OBJECTIVE: We carried out a rapid investigation of CAM cases to describe the epidemiological and clinical profiles and find plausible predictors to guide the initiation of public health actions. METHODS: A team of public health specialists contacted all the CAM cases reported to our hospital to collect relevant information using a case-investigation-form. In addition, the team visited the Flu Clinic and Ear, Nose, and Throat (ENT) outpatient department (OPD) to capture CAM cases on daily basis during the period of the acute surge of CAM cases. RESULTS: About 88% of 130 CAM cases reported during the period of the acute surge were in the advanced stage of mucormycosis. The majority of the CAM cases were younger (less than 60 years) [76.2%], diabetics [65.4%], un-vaccinated [86.9%], and had used steroids for management of COVID-19 [64.6%]. Other findings of public health importance were summarized and possible public health actions were recommended for the prevention of outbreaks in future. CONCLUSION: Optimum management of diabetes including screening for each COVID case, rational use of steroids only when necessary, strict adherence to COVID appropriate behavior by health professionals as well as the public, increasing COVID vaccine coverage, CAM awareness, and setting up a CAM surveillance mechanism may be the key to prevent and control CAM outbreaks in future.