What causes black fungus?

Several factors are behind the rise of black fungus in patients after India’s second Covid wave, according to doctors — including the drugs used to treat it.

Senior health officials from India’s Covid taskforce and the All India Institute of Medical Sciences said the overuse of steroids to treat Covid-19 had suppressed patients’ immune systems and made them more susceptible to black fungus.

Under India’s Covid management protocols, steroids can be prescribed in moderate and severe cases of Covid, though the latest guidelines issued in May advise “judicious use” to prevent and manage conditions like mucormycosis.

Some doctors also suspect a shortage of medical-grade oxygen may have played a role, arguing that prolonged low levels of oxygen can make patients more vulnerable to infection.

Some doctors believe there may be a link between the rise in black fungus infection and the Delta variant, a more transmissible Covid strain first detected in India in December.

Since then, the Delta variant has spread to 96 countries, and World Health Organization expects it to soon become the world’s most dominant strain.

While several studies have confirmed that patients with Covid are more vulnerable to black fungus, researchers have not determined if the Delta variant creates greater risk factors than other strains.

The spread worldwide

India’s second Covid wave has passed, but there are fears of a third wave and what could mean for black fungus outbreaks in India. The infection is not contagious between people, but clearly the environment is suitable for its spread.

So far, no other country has reported a sharp rise in cases — even as the Delta variant spreads worldwide. For example, by mid-June, the Delta variant accounted for 99% of Covid-19 cases in the UK but no cases of mucormycosis had been reported.

Srinivas is a Covid survivor, but it will be some time before he’s able to return to work. He was unable to speak for weeks after his surgery to remove traces of black fungus, initially due to pain and swelling, then because a feeding tube had been inserted due to the loss of part of his jaw.

“I can see … I feel good, I’ll try to get back to work as soon as possible. I have two small kids. I have been in the hospital for a very long time and I haven’t even seen them,” Srinivas said in early July.

Srinivas was discharged last Saturday after two months in the hospital, though his left eye remains swollen shut, and he must visit the hospital each week to monitor his progress.

“I don’t think he can go back to work before a year, said his sister Shyamala. “But it will be difficult to make him stay home.”

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