Almost a year on since the start of India’s deadly outbreak of black fungus – or mucormycosis – a study may have underlined the cause of the issue. Despite speculative links to COVID-19, the issue may be a different cause entirely – cow dung.
Black fungus 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 54 percent. However, in most people the presence of the fungus is little cause for concern.
The study, published recently in mBio, a journal of the American Society for Microbiology, hypothesised that “Mucorales-rich cow excrement, given its use in multiple Indian rituals and practices, especially during the pandemic, probably played a key role in India’s COVID-19- associated mucormycosis epidemic”
Jessy Skaria, an author of the paper and an independent researcher from Houston, Texas, told SciDev.Net what many scientists at the time had speculated, that a combination of COVID-19 infection with diabetes and treatment using steroids had led some to be more prone to severe effects of mucormycosis.
The fungus is commonly present in the mucous and in the nose of healthy people, however, most are unlikely to suffer ill effects from the condition. It was suggested that the use of steroid treatment for those with COVID-19 – itself reducing immune response – had allowed mucormycosis to spread to the lungs and cause severe infections. This often resulted in the death of the individual, being more severe due to a comorbidity with COVID-19.
“However, since the same factors existed in other countries as well, we looked at unique local causes in India that could increase exposure to Mucorales spores, such as through fumes from burning cow dung,” says Skaria. “Increased fungal spore burden in the Indian environment has been demonstrated in a recent multi-center study which showed the burden of Mucorales in areas close to hospitals to be as high as 51.8 per cent.”
India was noted as uniquely suffering from a high burden of black fungus cases, indicating other factors were at work. During India’s deadly second wave of COVID-19, and the outbreak of black fungus, India accounted for 71 percent of all mucormycosis cases across the globe, leading the team behind the study to search for other variables.
The study found that mucormycosis spores had been noted in recent research to travel long distances in smoke from biomass fires. Speculation arose from this that cow dung, a part of traditional life in India and used as an ingredient in many traditional ayurvedic medicines, could be a key suspect. Common rituals in parts of India include applying cow dung on bodies, drinking cow urine, and burning and inhaling cow dung fumes as a form of ritual purification during festivals, prayers, or cremations, the paper said.
Noted, however, was that mucormycosis rates were unevenly distributed across Indian states, with those that view cows as sacred and ban their slaughter for food showing far higher rates of black fungus cases. In these states, cow dung is more commonly used during religious and ayurvedic practices.
“Notable exceptions are Kerala and West Bengal where the incidence of mucormycosis was far lower than in Maharashtra and Gujarat where the slaughter of cattle is strictly banned and where the use of cow excreta for fuels and rituals is popular,” says Skaria. “It’s hugely pertinent that in Kerala where there is no ban on slaughtering cows and no taboo on eating beef… and where cow dung is almost never used as fuel…the incidence of mucormycosis was found to be low.”
As has been mentioned on Health Issues India previously, there is no proof that cow dung acts as a medical treatment for any condition. This new evidence would suggest that it is not even a harmless pseudo-treatment acting as a placebo, but may be actively causing further issues.
“There is no concrete scientific evidence that cow dung or urine work to boost immunity against COVID-19, it is based entirely on belief,” Dr J. A. Jayalal, national president at the Indian Medical Association told Reuters last year. “There are also health risks involved in smearing or consuming these products – other diseases can spread from the animal to humans.”
Other treatments peddled by quack doctors across the country were reported amid the COVID-19 pandemic. Health Issues India reported on some of these amid the surge in black fungus cases last year “there have been numerous accounts of quack doctors flocking to those turned away by the hospitals. Of the most well known of these quack doctors is Biswaroop Roy Chowdhury who has made claims that medications are simply a scheme by the government and “Big Pharma” companies of “lining their pockets”. He has created camps in order to peddle his “dietary treatments” that “cure COVID-19”.”
Given the tendency of these treatments to thrive in areas in which actual medical facilities and supplies are difficult to access, or in which individuals struggle to afford treatment, they often cause harm to the most vulnerable in society.
Black fungus came at the most inopportune time for India. Its health system still reeling from COVID-19’s deadly second wave – itself causing more than 400,000 cases daily for consecutive days, with 4,000 associated deaths per day at its peak – many hospitals struggled to cope.
Education regarding medical treatments and the dangers of alternative therapies such as cow dung may prove to reduce these cases. Schemes such as Ayushman Bharat may also offer protection against the kinds of scams offered by quack doctors by increasing the level of access to treatment. However, desperate times such as those witnessed at the peak of the COVID-19 pandemic often see people reaching out for any help they can find. More must be done to increase the preparedness of the health system to ensure that this help is found in the form of proven medical treatments.