Is COVID causing a black fungus that has a 50% mortality rate?

Black fungus - mucormycosis
Photo via Yale Rosen/Flickr (CC BY-SA 2.0)

India is currently experiencing a “humanitarian disaster” due to soaring COVID-19 infection rates and deaths. Exacerbating the current crisis, doctors are reporting a rare infection called mucormycosis—aka “black fungus”—among recovered and still-recovering COVID patients. The highly deadly condition has a mortality rate of around 50%.

Mucormycosis is caused by exposure to mucor mold that thrives in wet environments. It’s commonly found in soil, plants, manure, and decaying fruits and vegetables. The fungal disease attacks through the respiratory tract, where it then infects the brain, sinuses, or lungs. If the infection takes hold in the brain, it can quickly cause severe tissue damage to the face, along with blurriness or a complete loss of vision.

Other symptoms include a stuffy bleeding nose, swelling and pain in and around the eyes, drooping eyelids, and sometimes black patches of skin around the nose. In some extreme cases, patients lose vision in both eyes or require a drastic surgery to prevent the disease from spreading, sometimes requiring removal of the eyes or jawbone.

The condition was already present in India before the pandemic. Dr. Akshay Nair, a Mumbai-based eye surgeon, told the BBC that mucormycosis “is ubiquitous and found in soil and air and even in the nose and mucus of healthy people.” Those most at risk for life-threatening infections are immunocompromised individuals with health issues including diabetes, cancer, HIV, or AIDS.

Doctors believe steroids triggered the sudden outbreak of black fungus in India, as they have been used to treat severe and critically ill COVID-19 patients. Steroids reduce inflammation in the lungs, which occurs when the body’s immune system “goes into overdrive” to fight off the virus. They also reduce immunity and elevate blood sugar levels in people with diabetes, as well as in non-diabetic patients. Some experts are connecting these steroid-induced drops in immunity to surges in mucormycosis cases.

Hospitals in India are additionally overwhelmed with a second wave of COVID-19, prompting many families to self-medicate at home. Without proper guidance from doctors, mucormycosis may go untreated until it’s too late. Most patients are already losing vision when they arrive at the hospital, and by that point, doctors may be forced to surgically remove an eye to stop the infection from reaching the brain.

“Diabetes lowers the body’s immune defenses, coronavirus exacerbates it, and then steroids which help fight COVID-19 act like fuel to the fire,” Nair, who works at three hospitals in Mumbai, said.

Nair saw as many as 40 COVID-19 patients suffering from the fungal infection in April. Many of these patients had diabetes and attempted recovery at home, and the majority contracted mucormycosis between 12-15 days after recovery. Out of the 40 patients, 11 required an eye to be surgically removed.

Is there a cure or treatment for black fungus?

Dr. Rahul Baxi, a Mumbai-based diabetologist, says the best way to prevent mucormycosis is to ensure COVID-19 patients in active treatment and recovery are administered the correct dose and duration of steroids.

“Doctors should take care of the sugar levels after the patients are discharged,” Baxi, who treated approximately 800 diabetic COVID-19 patients over the past year, said. None of Baxi’s patients contracted the fungal infection. 

Dr. V.K. Paul, who heads India’s coronavirus task force, said they are “watching and monitoring” the situation during a recent press conference.

“We have heard that in some areas, people who are COVID-infected or recovered suffer from mucormycosis, but there is not a big outbreak of it,” Paul said. “It is a fungus that has a strong relation to diabetes. If the person is not diabetic, it is very uncommon that the person would have mucormycosis.”

When caught early, an intravenous antifungal injection—the only known drug to show effectiveness against the disease—can be administered every day for up to eight weeks to treat mucormycosis. The drug costs 3,500 rupees—or around $48—per dose.

Sources: BBC, New York Times

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