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COVID How To Survive
COVID How To Survive
Nightmare in the Making
India’s “black fungus” crisis signals a global problem
INTERVIEW BY ANNALIES WINNY | JULY 1, 2021
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But the scale of India’s outbreak is rare. Mucor, which can lodge deep into the
sinuses or lungs, has already killed hundreds in India, and forced others to have
an eye excised to remove the fungus.
Mucor is a particularly nasty fungus—and for those who can’t clear it, it tends to
kill slowly.
If it lands in the sinuses or brain, it can cause facial swelling, nasal congestion,
and headache. In the lungs: fever, cough, and shortness of breath.
The fungus itself is not particularly black, even though it makes melanin, a
pigment that is a secret weapon to almost all fungi, including Mucor.
When Mucor lands in the lung, it begins to grow and kill tissue as it expands into
a fungal mass which kills tissue, which causes scarring that makes the tissue
appear black.
The fungus—in fact most fungi—uses this black melanin pigment as “armor”
which enables it to survive the body’s immune defenses and evade drugs. This is
quite different from how humans use melanin, for protection against sunlight.
What I would like to know is, what is in the air in India, and whether this reflects
local farming conditions and how vegetation is disposed of. Compost piles, for
example, contain enormous amounts of fungal spores. Anywhere you have
decaying vegetation [and] rotting wood are places you tend to get a lot of fungi. It
could be as simple as vegetation rots faster in the tropics, resulting in
more spores.
In weaker health systems, poorly filtered air in hospitals can also encourage
spores to spread.
The common theme is, with the combination of damaged lungs and steroids,
you’re going to get fungal disease. Depending where you are, you’re going to
end up with different ones.
Looking beyond India, the bigger story is that amid this pandemic, fungal
infections are a major calamity because they are so hard to diagnose and treat.
Because the antifungal drugs don’t work well with Mucor, often the only option is
to remove a piece of the lung or an eye, surgically, depending on where the
fungus took hold.
How is mucormycosis diagnosed?
There is not a simple blood test. Sadly, the way it would manifest is that people
don’t get better as expected.
Mucor [mycosis] only gets diagnosed when the symptoms get sufficiently bad,
and once Mucor is causing symptoms, the immune system cannot clear it.
First the lung will show a lesion. At first, you don’t know if this lesion is just scar
tissue from COVID, whether it’s a bacterial pneumonia, or whether it’s a
fungal pneumonia.
Given the extremely limited ability to diagnose, the cases seen so far are
probably the tip of the iceberg, sadly.
India is going to have a big problem going forward with patients who survived
COVID but now have chronic mucor [mycosis]—and that will kill them down
the line.
Annalies Winny is associate editor of Global Health NOW and an editor of the
Expert Insights newsletter from the Johns Hopkins Bloomberg School of Public
Health.