Key Factors Fuelling India's Second COVID Surge


COVID-19 pandemic
diabetes mellitus

How to Cite

Chakravorty, I. (2021). Key Factors Fuelling India’s Second COVID Surge: Editorial. The Physician, 7(1), 1-6.


Having declared in autumn of 2020, that India had defeated Coronavirus, the steep rise of cases in April-May 2021, caught the authorities unawares. The health care infrastructure was rapidly overwhelmed at every level and equally in the national capital, large and small cities and the vast rural populace. The human catastrophe that was unfolding in front of the digitally connected world was heart-breaking.

The natural ingredients of a battered economy (-23.9% GDP), a large populace (1.34 billion), poor public health, a chronic epidemic of diseases such as tuberculosis, diabetes, hypertension or kidney disease, chronic underfunding of healthcare infrastructure (1.8% of GDP), deficiency of healthcare workforce (estimated deficit of 600,000 doctors and 2 million nurses) and disjointed, disordered leadership combined with an incoherent, incohesive healthcare policy led to the disaster.

After relative stabilisation from the first few weeks of the impact of colossal lack of hospital beds, oxygen, supported ventilation, life-saving drugs, safe and dignified disposal of the dead, and any form of coordinated disaster response, there is now the new epidemic of the black fungus. This editorial explores the emergence of this new health challenge for India and issues a call to rally.


India COVID: 26,738,220 Cases and 303,355 Deaths - Worldometer. (accessed 23 May 2021).

Page ML. Indian covid-19 variant (B.1.617). New Scientist. (accessed 23 May 2021).

GISAID - hCov19 Variants. (accessed 23 May 2021).

Rees JR, Pinner RW, Hajjeh RA, et al. The epidemiological features of invasive mycotic infections in the San Francisco Bay area, 1992-1993: results of population-based laboratory active surveillance. Clin Infect Dis 1998;27:1138–47.

Chakrabarti A, Singh R. Mucormycosis in India: unique features. Mycoses 2014;57 Suppl 3:85–90. doi:10.1111/myc.12243

Prakash H, Chakrabarti A. Epidemiology of Mucormycosis in India. Microorganisms 2021;9. doi:10.3390/microorganisms9030523

Kontoyiannis DP, Marr KA, Park BJ, et al. Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients, 2001-2006: overview of the Transplant-Associated Infection Surveillance Network (TRANSNET) Database. Clin Infect Dis 2010;50:1091–100. doi:10.1086/651263

Davies BW, Smith JM, Hink EM, et al. Increased Incidence of Rhino-Orbital-Cerebral Mucormycosis After Colorado Flooding. Ophthalmic Plast Reconstr Surg 2017;33:S148–51. doi:10.1097/IOP.0000000000000448

Novosad SA. Notes from the Field: Probable Mucormycosis Among Adult Solid Organ Transplant Recipients at an Acute Care Hospital — Pennsylvania, 2014–2015. MMWR Morb Mortal Wkly Rep 2016;65. doi:10.15585/mmwr.mm6518a5

Prakash H, Ghosh AK, Rudramurthy SM, et al. A prospective multicenter study on mucormycosis in India: Epidemiology, diagnosis, and treatment. Medical Mycology 2019;57:395–402. doi:10.1093/mmy/myy060

index-mucor-285.jpg (285×190). (accessed 23 May 2021).

Ravani SA, Agrawal GA, Leuva PA, et al. Rise of the phoenix: Mucormycosis in COVID-19 times. Indian J Ophthalmol 2021;69:1563–8. doi:10.4103/ijo.IJO_310_21

Revannavar SM, P S S, Samaga L, et al. COVID-19 triggering mucormycosis in a susceptible patient: a new phenomenon in the developing world? BMJ Case Rep 2021;14. doi:10.1136/bcr-2021-241663

Ahmadikia K, Hashemi SJ, Khodavaisy S, et al. The double-edged sword of systemic corticosteroid therapy in viral pneumonia: A case report and comparative review of influenza-associated mucormycosis versus COVID-19 associated mucormycosis. Mycoses Published Online First: 16 February 2021. doi:10.1111/myc.13256

Yang J-W, Yang L, Luo R-G, et al. Corticosteroid administration for viral pneumonia: COVID-19 and beyond. Clin Microbiol Infect 2020;26:1171–7. doi:10.1016/j.cmi.2020.06.020

COVID-19 Rapid Guideline - Organisation and Management in Low Resource Countries | The Physician. (accessed 23 May 2021).

Sinha P, Linas BP. Combination therapy with tocilizumab and dexamethasone cost-effectively reduces Coronavirus disease 2019 mortality. Clin Infect Dis Published Online First: 6 May 2021. doi:10.1093/cid/ciab409

Group RC, Horby PW, Pessoa-Amorim G, et al. Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): preliminary results of a randomised, controlled, open-label, platform trial. medRxiv 2021;:2021.02.11.21249258. doi:10.1101/2021.02.11.21249258

REMAP-CAP Investigators, Gordon AC, Mouncey PR, et al. Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19. N Engl J Med 2021;384:1491–502. doi:10.1056/NEJMoa2100433

RECOVERY Collaborative Group, Horby P, Lim WS, et al. Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med 2021;384:693–704. doi:10.1056/NEJMoa2021436

Moorthy A, Gaikwad R, Krishna S, et al. SARS-CoV-2, Uncontrolled Diabetes and Corticosteroids-An Unholy Trinity in Invasive Fungal Infections of the Maxillofacial Region? A Retrospective, Multi-centric Analysis. J Maxillofac Oral Surg 2021;:1–8. doi:10.1007/s12663-021-01532-1

Singh AK, Khunti K. Assessment of risk, severity, mortality, glycemic control and antidiabetic agents in patients with diabetes and COVID-19: A narrative review. Diabetes Res Clin Pract 2020;165:108266. doi:10.1016/j.diabres.2020.108266

Kalra S, Verma M. Justice, equality and liberty: Inspiration from the Indian Constitution for effective diabetes management. Indian J Med Ethics 2021;:1–4. doi:10.20529/IJME.2021.012

Ayoubkhani D, Khunti K, Nafilyan V, et al. Post-covid syndrome in individuals admitted to hospital with covid-19: retrospective cohort study. BMJ 2021;372. doi:10.1136/bmj.n693

Ghosh A, Anjana RM, Shanthi Rani CS, et al. Glycemic parameters in patients with new-onset diabetes during COVID-19 pandemic are more severe than in patients with new-onset diabetes before the pandemic: NOD COVID India Study. Diabetes Metab Syndr 2021;15:215–20. doi:10.1016/j.dsx.2020.12.033

Kashyap S, Bala R, Madaan R, et al. Uncurtaining the effect of COVID-19 in diabetes mellitus: a complex clinical management approach. Environ Sci Pollut Res Int Published Online First: 21 May 2021. doi:10.1007/s11356-021-14480-7

Zhou Y, Chi J, Lv W, et al. Obesity and diabetes as high-risk factors for severe coronavirus disease 2019 (Covid-19). Diabetes Metab Res Rev 2021;37:e3377. doi:10.1002/dmrr.3377

Gupta R, Misra A. Clinical considerations in patients with diabetes during times of COVID19: An update on lifestyle factors and antihyperglycemic drugs with focus on India. Diabetes Metab Syndr 2020;14:1777–81. doi:10.1016/j.dsx.2020.09.009

Balducci S, Coccia EM. Sedentariness and Physical Activity in Type 2 Diabetes mellitus during the COVID‐19 Pandemic. Diabetes Metab Res Rev Published Online First: 27 June 2020. doi:10.1002/dmrr.3378

Which top economies have suffered worst GDP fall due to COVID-19? (accessed 23 May 2021).

P.Ch.Roysays: The Cancel Culture and Indian Intelligentsia. Borderless. 2020. (accessed 23 May 2021).

Team T. This is the next generation of intellectuals in India. ThePrint. 2018. (accessed 23 May 2021).

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Copyright (c) 2021 Array