More than 9,000 cases of mucormycosis — or black fungus — have now been reported in India. Some now speculate that issues such as a lack of sanitation, and unclean oxygen canisters and ventilators could have helped in driving the surge.
Mucormycosis has become a major issue across the country in the light of India’s second wave of COVID-19. As Health Issues India recently noted
“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.”
The black fungus crisis is exacerbated by shortages of Amphotericin B, used to treat the condition. Minister of Chemicals and Fertilizers D.V Sadananda Gowda said that the Government has allocated 19,420 vials of the drug to states, union territories, and central institutions on Monday, whilst May 21st saw a dispensation of 23,680 vials. However, to combat the crisis adequately, it is crucial that the risk factors be properly understood.
The disease is not transmissible through human-to-human contact. Rather, it is a naturally occurring spore commonly found on the skin of most people. It is only where an individual is immunosuppressed to some degree that it can become an issue.
Querying whether a lack of sanitation could play a role is not an unfounded allegation. As those with COVID-19 or diabetes are far more susceptible to being infected by black fungus, any lapses in sanitation protocols puts these individuals at heightened risk.
“There is a lot of contamination in the pipes used for oxygen, the cylinders that are being used, the humidifiers used,” said Nishant Kumar, an ophthalmologist at Hinduja Hospital in Mumbai. “If you are immuno-suppressed, and you have been on these pipes and oxygens for a long period of time, then these infections get much more of an opportunity to get in.”
However, some have pointed out that the lack of sanitation in hospital settings is far from a new phenomenon. “Hospitals were dirty even before April. We need epidemiological studies to assess why these cases are rising now,” said S. P. Kalantri, senior doctor and researcher at the Mahatma Gandhi Institute of Medical Sciences in Maharashtra.
Health Issues India has covered inadequate sanitation facilities in hospitals before. Last year, we cited a report by the World Health Organization and UNICEF which attributed poor sanitation to the country’s maternal and neonatal mortality burden, with a high rate of hospital-acquired infections (HAIs). As previously reported, “in India, HAIs were found to occur at a rate of one infection for every four hospital visits. In the case of sepsis, 63 percent of patients die in the intensive care unit (ICU).”
Lapses in sanitation have plagued India for a long time before COVID-19. However, with a significant influx of patients due to the second wave, along with an already understaffed healthcare system dealing with burgeoning patient counts, what may have been minor lapses before may now become severe issues simply due to time and manpower constraints related to dealing with the caseload. Black fungus, along with the increased infection rate is simply a side effect of a larger issue — India’s chronically understaffed and underfunded healthcare system.