More complications

Adding to India's Covid woes, a new, deadly 'black fungus' is being observed in some of the nation's most vulnerable patients. The Indian Council of Medical Research has asked doctors to be on the lookout for tell-tale signs of mucormycosis or black fungus. The signs to look out for include, sinus pain, nasal blockages on one side of the face, swelling or numbness, toothache and loosening of teeth. If symptoms are allowed to progress, additional observable symptoms include, blackening or discolouration of the nose, blurred or double vision, chest pains, breathing difficulties accompanied by the tendency to cough up blood. While doctors have been told to look into cases where the person's immune system is compromised, a strong link has been established between mucormycosis and the presence of diabetes in patients. Indeed, the presence of poorly controlled diabetes in India may be the leading factor behind the increased prevalence of mucormycosis in India as compared to other nations where relatively few cases have been reported. Many cases of this fungus infection are also reported when people are treated for Covid at home and receive medicine or oxygen in less than sterile surroundings, increasing the risk of this spore infecting the weakened human body. As of now, similar cases have been reported in countries that include the UK, US, France, Austria, Brazil and Mexico but the volume of such cases is much more in India. The ICMR has urged people not to panic as there is no widespread prevalence of this fungus in India though the nation has no official count of how many such cases have actually been registered. But what is this fungus? The infection of mucormycetes is incredibly rare because the fungus does not usually pose a serious threat to those with healthy immune systems. But for those with compromised immune systems, the naturally present group of moulds is able to infect their lungs and sinuses. While doctors have urged caution, being overly paranoid is not useful in the current times. Not every case of a blocked nose should be considered a symptom of this black fungus infection. That said, persistent symptoms of the sort listed above must be investigated post-haste. Once the mucormycosis is detected in a patient, it may be treated with antifungal drugs. Serious cases, however, would likely call for more specific antifungal therapies and multiple operations. Controlling diabetes, reducing the intake of steroids and other drugs that affect the immune system is also a must for recovery. As rare as the serious cases are, the outcomes are quite grim. Recovered patients could end up losing their upper jaw or even one of their eyes. Patients would have to come to terms not only with the loss of function from losing their jaw or eyes but also have to face loss of facial aesthetics and self-esteem. Prosthetic reconstruction can help alleviate some of these more painful and harrowing outcomes. All said and done, this is not a welcome development for India as it battles a tide of Covid cases. The fungus has a greater opportunity to spread in India where the health system is already overburdened to the extreme, with hospitals tightly crammed. Increasing use of steroids to treat patients alongside untreated or poorly treated diabetes is creating a 'triple-whammy' situation for some patients. More unfortunate still, doctors describe the treatment of Mucormycosis to be both difficult and expensive in most cases. The mortality rate for the same is also upward of 50 per cent. The surgery for removing the spores can also be quite invasive and somewhat risky as there is a need to clear out the internal source of the fungus, usually the sinus, back of the throat or back of the nose. In some cases, the surgery can even be done in even more sensitive places like the base of your brain. As of now, the ICMR and Union Health Ministry has issued guidelines asking people to wear shoes, long trousers and long sleeve shirts and gloves if possible when handling soil, moss, manure, etc. There is also an advisory for people to keep good hygiene standards while also making sure cases of diabetes are controlled. Sadly, mucormycosis is not likely to be the only bacterial and fungal disease that will be encountered in greater numbers during such times. Major health bodies like CDC have warned doctors that the use of certain drugs alongside compromised immunities of Covid patients is fertile ground for the spread of a wide number of fungi and bacteria. An abundance of caution is the only real pre-emptive solution to this problem.