India’s COVID-19 situation is bleak. Daily new cases, while lower than their record peaks of 400,000, are lingering in the mid-300,000 range. To add to the list of issues, hospitals are reporting cases of “black fungus” that are reaping their own death toll in the country.
As Health Issues India noted earlier this week, “India reported 403,000 new infections and 4,000 deaths on Sunday [May 9th], indicating that — though the country may have hit a plateau — its figures remain at a global high. Global new daily cases currently range between 700,000 and 900,000, indicating that India now accounts for around half of all global cases.”
The emergent black fungal infection, called mucormycosis, “is very serious, has a high mortality, and you need surgery and lots of drugs to get on top of it once it takes hold”, said Professor Peter Collignon, who sits on the World Health Organization’s (WHO) expert committee on antibiotic resistance and infectious diseases.
The infection is the result of exposure to mucor mould typically found in soil, plants, manure, and decaying fruits and vegetables. “It is ubiquitous and found in soil and air and even in the nose and mucus of healthy people,” said Dr Akshay Nair, a Mumbai-based eye surgeon.
The condition affects the sinuses (where it can cause damage to tissue in the nose or eyes), but can spread to both the lungs and brain — in these cases often proving fatal. The overall mortality rate for the condition is around fifty percent. However, in most people the presence of the fungus is little cause for concern.
It has been determined that the use of steroids in COVID-19 patients may be the causative factor behind the sudden surge in deaths associated with the condition. These steroids help in relieving severe inflammation within the lungs of patients affected by COVID-19, thereby relieving symptoms. However, this reduces immune response as well as raises blood sugar.
With the reduced immune response it becomes possible that the otherwise harmless fungus can begin to infect tissue and become a major issue, as has been seen in numerous cases across the country. Rajesh Tope, health minister of Maharashtra — currently the worst-hit state in India by COVID-19 — said the region could alone have as many as 2,000 cases of black fungus.
With the nation reeling to attempt to treat the tides of individuals suffering from severe COVID-19 infections amidst the second wave, many will find themselves on steroid treatments. Given the considerable burden placed on doctors and medical staff many of these individuals may be infected by the black fungus infection and not receive adequate medical treatment to be able to address the situation. As with many other issues faced during the COVID-19 pandemic, this has been worsened by a lack of staff and medical supplies.
India, in particular, given its high rate of diabetes is particularly prone to the condition. “Sugar feeds the fungus and then the fungus is stronger than [the] immune system that is trying to fight it off,” said Dr Rasa Kazlauskaite, an endocrinologist at Rush University Medical Center. This, coupled with the steroids and the COVID-19 infection, creates a perfect storm in which individuals face a deadly situation. Experts have, however, noted that diabetics in India should not opt to forego treatment with steroids, as this could place them in further danger from adverse effects from COVID-19.