The Union health ministry on Thursday wrote to all states and Union Territories asking them to declare post-Covid complication mucormycosis, or “black fungus”, a notifiable disease under the Epidemic Diseases Act 1897, ANI reported. All government and private health facilities have been asked to follow guidelines for screening, diagnosis and management of mucormycosis issued by the ministry and the Indian Council for Medical Research.

The move would mean that medical facilities will have to report all suspected and confirmed cases to the health department of the respective states. Medical superintendents of all private and government hospitals will have to send a daily report about cases of “black fungus” to the Integrated Disease Surveillance Programme.

In a letter to the state governments, Lav Agarwal, joint secretary at the health ministry, said that treatment of the disease required a multidisciplinary approach and the use of Amphotericin B as an antifungal medicine, Mirror Now reported.

The fungal infection, which has been found in several coronavirus patients across the country, mostly after they have recovered, involves headache, fever, pain under the eyes, nasal or sinus congestion, and partial loss of vision. The rare infection is caused by a fungus named mucor, which is found on wet surfaces.

The disease which was initially spotted among Covid patients in Gujarat and Maharashtra, has now spread to other parts of the country as well. Various state governments had already started taking steps against the disease before the Centre’s directive was issued.

Earlier on Thursday, the Telangana and Tamil Nadu governments issued orders declaring “black fungus” a notifiable disease.

Tamil Nadu Health Secretary J Radhakrishna told ANI that the state had so far reported nine cases of the infection and all the patients were stable.

The official said that more data will be obtained from private hospitals. “We have created a 10-member committee at the level of director, medical education with medical experts to go through it [the data] and give us a clear picture,” he added. “We have some stocks and have ordered 5,000 more vials of amphotericin [an anti-fungal drug]. We’re expecting stocks soon.”

Delhi Chief Minister Arvind Kejriwal announced that separate wards would be set up at the city’s Lok Nayak Jai Prakash Narayan Hospital, Guru Teg Bahadur Hospital and Rajiv Gandhi Hospital for treatment of the fungal infection. He also said that the government will ensure sufficient supply of the required medicines and that awareness programmes would be initiated regarding precautions against the disease.

MV Padma Srivastava, the head of neurology department at the All India Institute of Medical Sciences in Delhi on Wednesday said that cases of the disease has crossed the three-figure mark at the hospital, adding that mucor wards have been made separately at AIIMS Trauma Centre in Delhi and AIIMS Jhajjar in Haryana. The Sir Ganga Ram Hospital in Delhi has recorded nearly 100 cases of black fungus since May 7.

On Wednesday, Rajasthan had declared the disease an “epidemic” in the state. The Madhya Pradesh government has also decided to conduct nasal endoscopy process in Covid-19 patients and survivors who are admitted in the district hospitals and the government medical colleges.

Last week, the Gujarat government had announced that all government-run hospitals reporting incidents of mucormycosis will set up separate wards to treat the infection. The Maharashtra government has also said it will cover the cost of mucormycosis treatment under its health insurance scheme.

One of the potential causes of the fungal infection is reportedly the use of steroids for Covid-19 treatment, which increases blood sugar levels.

Steroids reduce inflammation in the lungs for Covid-19 and the body’s immune system goes into overdrive to fight off the virus. However, they also may reduce immunity and push up blood sugar levels in both diabetic and non-diabetic Covid-19 patients, according to doctors quoted by the BBC. The drop in immunity might then exacerbate the “black fungus”.