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Black fungus deaths at 4,200 and counting

black fungus deaths illustration.
Map that shows countries where COVID-associated mucormycosis (CAM) also known as “black fungus” were detected. India is denoted by black shading. The upload is dated May 31st, 2021. Image credit: original map: Canuckguyedit: Kj1123, CC0, via Wikimedia Commons

Mucormycosis, or ‘black fungus’, deaths tally at more than 4,200 – underscoring the scourge of a condition which has only exacerbated India’s COVID-19 woes.

Black fungus, as my colleague Nicholas Parry reported in May, “is the result of exposure to mucor mould typically found in soil, plants, manure, and decaying fruits and vegetables…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.”

India now tallies more than 45,300 cases of the infection. Union Minister of Health and Family Welfare Mankush Mandaviya pegged the exact figure at 45,374. However, Bengaluru-based eye surgeon Dr Raghuraj Hegde claimed there is a “massive undercounting of both cases and deaths” in comments made to BBC News. Hegde pointed out that “typically, deaths in mucormycosis occur weeks to months after getting the disease. Our present systems are not good [enough] to capture that data.” 

Pre-COVID-19, India grappled with twenty cases of mucormycosis a year on average. However, since the pandemic’s onset and particularly since the second wave took hold, it is rapidly becoming part of a wider snowball effect of the COVID-19 crisis. Gujarat and Maharashtra are the worst-affected states, with 1,785 black fungus deaths. 

Experts attribute the emergence of black fungus to the use of steroids in the treatment of COVID-19 patients. As Parry explained, “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.” Sanitation is potentially an additional causative factor. 

The pandemic has been termed a ‘perfect storm’ for fungal infections. “Essentially, the more damage there is in the lung from a virus, the more likely you are to get a fungal infection,” said Dr Darius Armstrong-James, a clinical senior lecturer in respiratory fungal diseases at Imperial College London, quoted by The Guardian. “And the problem with fungal infections is that they’re much more lethal than bacterial infections. They’re difficult to treat, difficult to diagnose and cause a lot more mortality.”

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