Via The Guardian: ‘Black fungus’ is creating a whole other health emergency for Covid-stricken India. Excerpt:
Covid-19 has killed millions around the world, but for some who are lucky enough to survive the infection, the nightmare is not over: adding insult to injury are deadly fungal infections that follow in the wake of the virus. Making matters worse, inequities that long predated the pandemic have left some countries without the capacity to combat these serious infections.
In India, a fungal infection called mucormycosis has emerged in patients with Covid-19. This infection is caused by a group of fungi that are everywhere on the planet. In fact, all of us are probably inhaling spores of these fungi every day, but these are rapidly controlled by our immune systems. Rarely, our defences are breached, and the fungus takes hold, with devastating consequences. After establishing itself in the nose and sinuses, it begins to invade the tissue of the face, the jaw, the eyes and brain, blocking blood flow and causing tissue death. It is the black discoloration of dead tissue that conferred upon this mould its fearsome moniker in the Indian media: “the black fungus”.
Although the fungi are ubiquitous, mucormycosis is usually rare, and most specialists around the world will see fewer than a dozen cases in their entire careers. Even before the pandemic, rates of mucormycosis in India were estimated to be about 70 times higher than in the rest of the world.
Even so, the tsunami of cases occurring in the wake of Covid-19 is of an unimaginable scale. More than 11,700 people were reported by a government minister to be receiving care for mucormycosis on 25 May. Two states, Maharashtra and Gujarat, have confirmed more than 5,500 cases. Whereas a large referral hospital in London might see three or four cases a year, some Indian hospitals are caring for more than 500 patients with mucormycosis right now.
Mucormycosis cases in Covid-19 patients have also been linked to poorly controlled diabetes and therapeutic steroids, a triad of risk factors some have dubbed “the unholy trinity”. Although steroids can be lifesaving in Covid-19 patients needing supplemental oxygen, they are a double-edged sword: they weaken the immune system that normally keeps fungi we inhale at bay.
Undisciplined prescribing is likely to be playing a major role in driving the epidemic: one study at 16 Indian hospitals found that nearly two in three steroid prescriptions for Covid-19 patients were inappropriate (they were either used in patients who weren’t sick enough to warrant them, or the dose was too high). Lack of access to oxygen may have resulted in doctors overcompensating by prescribing higher-than-recommended doses.
Additionally, rates of diabetes have been increasing in India, and high blood sugars further weaken the immune system and increase the growth of fungi in the body. High blood sugars are also a well-known side-effect of steroids, particularly in diabetic or prediabetic patients, and overstretched healthcare workers have been unable to adequately monitor blood sugar levels of Covid-19 patients on crowded wards.
The confluence of these risk factors, plus higher-than-average background rates of mucormycosis, high numbers of spores in both indoor and outdoor environments, and the lack of hospital infection-control resources (like efficient air particle filters in ICU rooms, standard in resource-rich settings to filter out airborne spores) have allowed the fungus to run amok.
