A Mysterious and Deadly Black Fungus Is Infecting India’s COVID Recovered

A week after 32-year-old Sanil Nair left a hospital's COVID-19 intensive care unit, he started feeling pain in his cheekbones and getting headaches. 

“At first, we thought it was sinus,” his wife Snehal Rajani told VICE World News, adding that her husband has diabetes and other comorbidities.

“We got an MRI scan done and found out he had black fungus,” she said. An endoscopy later revealed “a greyish layer” inside Nair. 

Black fungus, scientifically known as mucormycosis, has killed more than 200 Indians in the last four weeks, adding to existing fears over a punishing surge in coronavirus cases.

“The fungal spores usually get inside through the respiratory tract because fungus usually grows in hot, moist areas. From the nose, it can grow enough that it can melt bones,” Dr. Tanaya Narendra, a medical educator who has been busting myths around COVID-19 on social media, told VICE World News. “It can even dissolve the bone that separates the brain and your nose.” 

According to official figures, there are over 11,000 cases of the deadly infection in the country, and doctors say black fungus is leaving thousands permanently disfigured after operations to prevent it from spreading.

“Early detection and strong antifungal treatment can avoid disfigurement,” Narendra said. “But disfigurement is a possibility in late detections.” 

The fungus is an alarming development against the backdrop of India’s brutal second COVID-19 wave that has killed more than 155,000 in two months. As doctors juggle the surge in fungus cases, many say they managed to save patients by removing their nose, eye or jaw bone to stop it from entering the brain. 

Nair managed to get his black fungus detected at an early stage. “The doctors were able to remove 95 percent of the fungus, while five percent of it is being treated with antifungal medicines,” Rajani said.

Across India, however, many are not so lucky. As the infection spreads fast, nine Indian states (out of 36 states and union territories) declared it an epidemic. 

This “rare” infection has an average fatality rate of 54 percent, according to the U.S. Centers for Disease Control and Prevention (CDC). The fatality rate in India for COVID-19, on the other hand, is 1.1 percent, according to official data - which some experts attribute to missing or undercounted cases. 

Here’s what you need to know about the mysterious and potentially fatal fungus.

The black fungus is a very common fungal growth that thrives in hot and moist locations. The CDC states that mucormycosis can be spread in hospitals and homes by air humidifiers, or oxygen tanks containing dirty water. The CDC says it’s not contagious. 

Dozens of mucormycosis are reported in India every year—which is still considered rare in India. A study found that 56 percent of those with black fungus had “uncontrolled diabetes”. 

It has been observed in the U.S. too. Black fungus killed five children at a hospital in Louisiana in 2008-2009. Another bout killed at least three after a deadly tornado in Missouri in 2011. 

A predominant factor in patient fatality is a pre-existing medical history of diabetes. Recent data shows that one in six people with diabetes in the world is from India. India has the second-largest number of diabetics in the world - 77 million. “The use of steroids also increases blood sugar and the fungus feeds on it,” Narendra said. 

Diabetes is associated with reduced immune response, creating a perfect recipe for fungus growth. Doctors say many diabetics got infected with the fungus 12-15 days after they recovered from COVID-19. 

It is unclear, but doctors suspect a link between the increase in steroid and antibiotic use.

“A lot of the problem lies in the way COVID-19 is being treated, with the excessive prescription of antibiotics for the COVID-19 treatment even though antibiotics have no role in it,” Narendra said. “Antibiotics treat viral and bacterial infection, but not COVID. India already has a problem of drug-resistant infections, and during this pandemic, we’re adding on to this problem.” 

She added that sanitisers do not kill fungal spores.

Experts are also concerned that fungal spores are spreading through poor quality oxygen containers that are in desperate demand in the second wave.

India is now seeing cases of “white” and “yellow” fungus. Recently, a patient recovering from COVID-19 was diagnosed with all three fungus strains. 

Narendra said that white fungus is more common than black or yellow. “These are opportunistic fungus,” she said. “If you create an opportunity for these guys to come and thrive, they will.”

Shamani Joshi contributed to the reporting of the story. 

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