[Though cases of what is known as “black fungus” remain rare, its lethality and increasing prevalence have prompted government warnings, put doctors on high alert and added to the country’s health crisis.]
The culprit was a deadly fungal
infection called mucormycosis that physicians say is increasingly preying on
people with immune systems weakened by covid-19 and the steroids used to treat it.
Though cases of what is known as
“black fungus” remain rare, its lethality and increasing prevalence have
prompted government warnings, put doctors on high alert and added to the
country’s health crisis.
[In
India’s surge, a religious gathering attended by millions helped the virus
spread]
“The death rate from mucormycosis
is 50 percent,” said Amarinder Singh Malhi from All India Institute of Medical
Science, a public hospital in New Delhi. “The death rate from covid is 2.5
percent. So we have to use these steroids very cautiously.”
Malhi said his hospital had not
seen a spike in mucormycosis cases. But about a week ago, a journalist
connected him on WhatsApp with a woman who had lost vision in one eye and was
going blind in the other.
“I referred that case to the
emergency room,” he said, suspecting the woman had mucormycosis. “She needed
antifungal drugs immediately.”
Unless treated early, the
aggressive fungal infection can often only be stopped with surgery.
One Mumbai-based eye surgeon said he
saw 40 mucormycosis cases last month alone, and 11 had to have an eye removed.
“I will be removing her eye to save
her life,” the doctor, Akshay Nair, told
the BBC shortly before operating on a 25-year-old woman who had
recovered from covid three weeks ago only to contract mucormycosis. “That’s how
this disease works.”
“I’ve seen 24 cases in 2 weeks!” he
tweeted recently. “Scary.”
Nair told the BBC that between
December and February, six colleagues in five cities reported 58 cases of the
infection, most contracted 12 to 15 days after the patient recovered from
covid.
P Suresh, head of ophthalmology at
Fortis Hospital in Mulund, near Mumbai, told Reuters his hospital had treated at least 10
mucormycosis patients in the past two weeks — twice as many as in the year
before the pandemic. All had been infected with covid-19, he said, and most
were diabetic or had received immunosuppressants, such as steroids.
Mucormycosis infections are now
four to five times what they were before the pandemic, infectious diseases
specialist Atul Patel told AFP.
India has not released nationwide
data on mucormycosis cases, but officials say the country is not suffering from
a major outbreak.
“It’s not something to panic about,
but you have to be aware of when to seek consultation,” Aparna Mukherjee, a
scientist at the state-run Indian Council of Medical Research, told Reuters
Mucor mold spores can be found in
soil, manure or the air but normally don’t affect healthy people, doctors say.
For the immunocompromised, however, the fungus can be deadly.
[In
an Indian city, obituaries reveal missing coronavirus deaths and untold
suffering]
“In the pre-covid era, this type of
fungus would come in immunocompromised patients, patients with severe diabetes,
leukemia, lymphoma and other immunodeficiencies,” Malhi said.
He blamed the recent increase in
mucormycosis on the overuse of steroids to stem the pandemic.
“We are seeing a 100 to 200 percent
increase in cases in some states,” he said. “We did not see that previously in
the first [covid] wave. Now, in the second wave, we are seeing it because we
are using steroids more. These steroids are a double-edged sword.”
Prince Surana, a doctor and CEO of
several private hospitals in Mumbai, said reports of mucormycosis at other
local hospitals had led his group to tighten policies on steroid use that have,
so far, prevented black fungus infections.
“We have not been giving steroids
... to every covid patient,” he said, “especially if the patient is susceptible
to that type of cross-infection or has a comorbidity, like diabetes.”
Surana said doctors needed to tell
covid patients when they are discharged to monitor for symptoms of
mucormycosis, such as sinus pain, swelling or numbness, or vision loss — a
warning also issued over the weekend by the ICMR.
But the crush of covid cases has
made checking on discharged patients more difficult, Surana said, and has also
complicated sterilization.
“In normal times we’d fumigate the
ICU every 14 days. Now, with covid, complete fumigation is not possible,” he
said, adding that his hospitals had compensated by putting extra effort into
deep-cleaning surfaces.
Read more:
In an Indian city, obituaries reveal missing coronavirus deaths
and untold suffering
In India’s surge, a religious gathering attended by millions
helped the virus spread
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