A second crisis is killing survivors of India’s worst Covid wave
Srinivas S. lies on a gurney in an operating theater in St John’s Hospital in Bengaluru as surgeons carefully remove bits of blackened tissue and rotten bone from his face.
The 41-year-old driver is one of more than 45,000 Indians infected with black fungus — or mucormycosis — since the start of the country’s second Covid-19 wave in late March.
Like Srinivas, the vast majority of sufferers — around 85% — were Covid-19 patients, according to India’s Health Ministry. By July, more than 4,300 people had died from the fungal infection.
Srinivas’s sister Shyamala V. sits by his bed and considers what life will be like for her brother’s wife and two young sons, ages 2 and four months, if he becomes one of them.
“I am very scared for him; he has two small kids. Who will look after them?” she said.
Black fungus is India’s second Covid crisis. Before this year, the infection was rare in India, though it was around 80 times more common there than in developed countries.
It’s caused by mucormycetes, a type of fungi, that people are exposed to every day, but when their immune systems have been battered by Covid they become more vulnerable to infection. Unless treated quickly, black fungus can cause permanent damage to the face, loss of vision and death — it has a mortality rate of over 50%.
Cases have surged in India, and a small number of cases have been detected elsewhere — in Nepal, Afghanistan, Egypt and Oman, according to their respective health ministries.
India’s black fungus cases numbers are far higher now than after the country’s first coronavirus wave last September. That may be due to the rapid spread of the Delta or B.1.617.2 variant of the virus.
Diabetes causes elevated blood sugar levels — perfect conditions for a fungus that feeds on sugar. In India, at least 77 million people had diabetes as of 2019, second only to China which had 116 million (the United States had 31 million) according to the International Diabetes Federation — which partly explains why Indian black fungus cases are comparatively high.
The World Health Organization says the prevalence of diabetes is rising more rapidly in low- and middle-income countries than high-income countries. Coupled with a rise in Covid cases, doctors predict black fungus will become more common worldwide.
Srinivas, who only uses one name, thought he was over the worst of Covid-19, but his left eye soon started swelling so much he could barely open it. The pain was excruciating.
He had never heard of black fungus but became concerned when his eye and nose started bleeding in May. “A lot of blood was coming out, so I thought, what is happening?” Srinivas told reported from his hospital bed before his third operation to remove infected tissue.
Srinivas said he went to four hospitals before doctors diagnosed him with black fungus and referred him to a fifth hospital where he finally received treatment.
Before the pandemic, India had about 3,000 to 4,000 cases of mucormycosis each year, according to figures provided to the Indian Parliament by Health Minister Mansukh Mandaviya.
Back then, the illness wasn’t notifiable, meaning states weren’t obliged to report cases to the central government. That changed in May as case numbers grew. By the end of June, more than 40,845 cases had been reported nationwide.
Two weeks later, that number had risen by around 9% to 45,374. Of those patients, around half are still receiving treatment, the Health Ministry said on Tuesday.