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In the Wake of India’s Covid Crisis, a Black Fungus Epidemic Follows

#mucormycosis has sickened former #coronavirus patients across #India. Doctors believe that hospitals desperate to keep #COVID19 patients alive made choices that left them vulnerable.


AHMEDABAD, India — In the stifling, tightly packed medical ward at Civil Hospital, the ear, nose and throat specialist moved briskly from one bed to the next, shining a flashlight into one patient’s mouth, examining another’s X-rays.

The specialist, Dr. Bela Prajapati, oversees treatment for nearly 400 patients with mucormycosis, a rare and often deadly fungal disease that has exploded across India on the coattails of the coronavirus pandemic. Unprepared for this spring’s devastating Covid-19 second wave, many of India’s hospitals took desperate steps to save lives — steps that may have opened the door to yet another deadly disease.

“The pandemic has precipitated an epidemic,” Dr. Prajapati said.

In three weeks, the number of cases of the disease — known by the misnomer “black fungus,” because it is found on dead tissue — shot up to more than 30,000 from negligible levels. States have recorded more than 2,100 deaths, according to news reports. The federal health ministry in New Delhi, which is tracking nationwide cases to allot scarce and expensive antifungal medicine, has not released a fatalities figure.

The coronavirus pandemic has drawn stark lines between rich nations and poor, and the mucormycosis epidemic in India stands as the latest manifestation. During the second wave, which struck India in April, its creaky, underfunded medical system lacked beds, oxygen and other necessities as infections and deaths soared.

AHMEDABAD, India — In the stifling, tightly packed medical ward at Civil Hospital, the ear, nose and throat specialist moved briskly from one bed to the next, shining a flashlight into one patient’s mouth, examining another’s X-rays.

The specialist, Dr. Bela Prajapati, oversees treatment for nearly 400 patients with mucormycosis, a rare and often deadly fungal disease that has exploded across India on the coattails of the coronavirus pandemic. Unprepared for this spring’s devastating Covid-19 second wave, many of India’s hospitals took desperate steps to save lives — steps that may have opened the door to yet another deadly disease.

“The pandemic has precipitated an epidemic,” Dr. Prajapati said.

In three weeks, the number of cases of the disease — known by the misnomer “black fungus,” because it is found on dead tissue — shot up to more than 30,000 from negligible levels. States have recorded more than 2,100 deaths, according to news reports. The federal health ministry in New Delhi, which is tracking nationwide cases to allot scarce and expensive antifungal medicine, has not released a fatalities figure.

The coronavirus pandemic has drawn stark lines between rich nations and poor, and the mucormycosis epidemic in India stands as the latest manifestation. During the second wave, which struck India in April, its creaky, underfunded medical system lacked beds, oxygen and other necessities as infections and deaths soared.

“Mucormycosis will tail off and go back to baseline as the Covid cases subside,” said Dr. Dileep Mavalankar, an epidemiologist. “But it may come back in the third wave unless we find out why it is happening.”

Many doctors in India think they know why. The bone-and-tissue-eating fungus can attack the gastrointestinal tract, the lungs, the skin and the sinuses, where it often spreads to the eye socket and the brain if left untreated. Treatment for the disease involves complex, often disfiguring surgery and an uncommon and expensive drug, contributing to a mortality rate above 50 percent.

Mucormycosis is not passed from person to person. It develops from commonplace spores that sometimes build up in homes and hospitals. Doctors believe India’s crowded hospitals, and their dire lack of medical oxygen, left the fungus an opening.

Without enough oxygen to go around, doctors in many places injected patients with steroids, a standard treatment for doctors battling Covid globally. They can reduce inflammation in the lungs and help Covid patients breathe more easily.

Many doctors prescribed steroids in quantities and for durations that far exceed World Health Organization recommendations, said Arunaloke Chakrabarti, a microbiologist and the co-author of a study examining the causes of India’s mucormycosis outbreak. Those steroids may have compromised patient immune systems and made Covid-19 patients more susceptible to fungal spores.

The steroids may have also dangerously increased blood sugar levels, leaving people with diabetes vulnerable to mucormycosis. It could also increase the chance of blood clots, leading to malnourished tissue, which the “fungus attacks,” Dr. Prajapati said.

Desperate doctors may not have had the chance to ask patients about whether they had diabetes or other conditions before resorting to steroids.

“Doctors hardly had any time to do patient management,” Dr. Chakrabarti said. “They were all looking at how to take care of the respiratory tract.”

According to the health ministry, about four out of five mucormycosis patients have had Covid-19. More than half have diabetes.

Alok Kumar Chaudry, a 30-year-old engineer with surgical tape over his left eye and hooked up to an I.V. drip at Civil Hospital, is one of those with mucormycosis who first came down with Covid.

He was studying for India’s civil service exam in April in New Delhi when the second wave hit. After testing positive for the coronavirus, and with hospital beds, drugs and oxygen scarce, he jumped onto a train to his older brother’s home in rural Gujarat. There, his oxygen levels plummeted to a potentially lethal 54 percent.

After two weeks on oxygen support and steroids at a local hospital, he recovered from Covid-19 but developed an acute headache on the left side of his brain. Doctors thought that steroids may have caused it and that it would go away.

Alok Kumar Chaudry, a 30-year-old engineer with surgical tape over his left eye and hooked up to an I.V. drip at Civil Hospital, is one of those with mucormycosis who first came down with Covid.

He was studying for India’s civil service exam in April in New Delhi when the second wave hit. After testing positive for the coronavirus, and with hospital beds, drugs and oxygen scarce, he jumped onto a train to his older brother’s home in rural Gujarat. There, his oxygen levels plummeted to a potentially lethal 54 percent.

After two weeks on oxygen support and steroids at a local hospital, he recovered from Covid-19 but developed an acute headache on the left side of his brain. Doctors thought that steroids may have caused it and that it would go away.

Dr. Chakrabarti said that if Mr. Chaudry kept his eye, he could still lose his life, since surgeons couldn’t remove the thin layer of infection behind his eye without removing the eye itself.

“I’ve lost vision in my left eye, my studies have suffered,” Mr. Chaudry said. “Definitely I want to know why mucor has formed. If it’s faulty treatment, then someone is responsible. If it’s the wrath of God, what can I do?”

The study that Dr. Chakrabarti co-wrote, published this month by the U.S. Centers for Disease Control and Prevention, said that heavy use of steroids, the correlation with diabetes and the unsanitary conditions at some hospitals had played a role.

Read more at:

https://www.nytimes.com/2021/06/20/world/asia/india-covid-black-fungus.html




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