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Black Fungus – An Epidemic Amidst The Pandemic
By Subhash Yadav
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When epidemics hit the health system of a developing country amidst pandemic, then its an extraordinary situation and health governance require extraordinary solutions. India has been facing high rates of COVID-19, with more than 27 million confirmed cases since January 2020. Also, the World Health Organization recently announced that the B.1.617 variant of the virus in India is a “variant of global concern.”
The virus is a challenge of its own kind. Some scientists believe that severe COVID-19 could potentially weaken the body’s immune response. This could lead to increased vulnerability to other infections, especially for people who are immunocompromised. Of particular concern is an infection called mucormycosis, commonly referred to as ‘black fungus.’ In India, hundreds of people who recovered from COVID-19 died from the black fungus, and there are calls by India’s health authorities to declare black fungus an epidemic.
Dr Rakesh Nagar says, “Black Fungus is a rare type of fungal infection that occurs through exposure to fungi called mucormycetes. These fungi commonly occur in the environment, particularly in leaves, soil, compost, and animal dung. This can enter the body through breathing, inhaling, and exposed wounds in the skin.” Doctors hold that the symptoms of black fungus are akin to that of the coronavirus itself – mainly respiratory-related. This includes cough, fever, headache, chest
pain, nasal or sinus congestion and pain, blackened skin tissue, redness, swelling and so on. Dr Aditya Sharma holds that people with severely weakened immune systems are at increased risk of the black fungus. This includes people conditions like diabetes, cancer, HIV and previous surgery are at great risk.
Doctors can treat the infection by administering antifungal medication or performing surgery to remove the affected area. If left untreated, black fungus can be fatal. The travesty is that the mortality rate of black fungus is more than 50 per cent. It affects the sinuses, the brain and the lungs and can be life-threatening in diabetic or severely immunocompromised individuals, such as cancer patients or people with HIV/AIDS. Steroids reduce inflammation in the lungs for Covid-19 and appear to help stop some of the damage that can happen when the body's immune system goes into overdrive to fight off coronavirus. But they also reduce immunity and push up blood sugar levels in both diabetics and non-diabetic Covid-19 patients.
Higher rates of black fungus cases in India are due to a combination of factors. For instance, more than 30 million people in India have a diabetes diagnosis. Despite this, the number of cases of black fungus before the COVID-19 pandemic was relatively low, although prevalence was rising.
Since the start of the COVID-19 pandemic, however, there has been a dramatic increase. Dr. Aditya Sharma notes that he has “seen more cases of black fungus in the past week than we normally treat in 2 years.” “The virus, as part of its replication cycle, suppresses the immune system, so the immune system cannot clear other bacteria or fungi. The most famous example of this is HIV, of course, which causes long-term immune suppression. But, other viruses do this on a much shorter timescale — i.e., the immune system is only slightly suppressed for a few days or weeks while the virus is there.”
GUARDIAN:
A number of states have declared the black fungus as an epidemic at the state level and the number of such states is increasing. Tamil Nadu, Odisha, Gujarat, Rajasthan and Telangana, have declared black fungus to be an epidemic, and more are expected to follow. The Indian Council of Medical Research has issued an advisory on the diagnosis and treatment of the disease.
State After State Reeling Under Epidemic
Maharashtra, the first state to be hit hard by India’s second Covid wave, has already reported upwards of 1,500 cases and 90 deaths, the highest in the country. Hospitals in Delhi have also begun reported an unprecedented rise in cases – as much 15 to 20 new cases a day in some hospitals, compared with previous rates of one or two cases a month. In Delhi and Bangalore, there are now waiting lists for beds for treatment for the disease.
Dr Amit Thadhani, the director of Niramaya hospital in Mumbai, said colleagues had begun to see cases of black fungus in severe Covid patients. “Nearly all patients are diabetic or immunocompromised,” he said. The health minister in Delhi, Satyendar Jain, said recently that there were about 200 cases of black fungus in hospitals across the city, and special black fungus wards have now been set up in the large government hospitals to deal with the influx of patients. Jain has categorically blamed the “very dangerous” misuse of steroids to treat Covid-19 as a cause of the epidemic.
Balram Bhargava, the director of the the Indian Council of Medical Research, said of the black fungus: “If a person’s immunity is suppressed, it will infect them. If the spores have access to high sugar [levels], it will grow. We have seen this happen with Covid-19 patients with diabetes and uncontrolled sugar, or who are immunocompromised or have been given immune-suppressants.”
The epidemic is spreading fast. In Gujarat, there were 371 cases in the state capital, Ahmedabad, and another 400 in Rajkot, a city hit hard by Covid-19. Goa has so far recorded six cases of black fungus. The first case in Kashmir is also detected. n
