Thought of the Day - May 18 2021 - Just When You Thought It Could Not Get Any Worse

Last week India has recorded its highest weekly COVID-19 death toll, reporting an average 4,029 deaths a day in the seven days leading up to 13 May. Anecdotal reports suggest that deaths are rising unnoticed in the countryside even as they level off in India’s cities, a fear reinforced by the discovery of more than 130 bodies in the Ganges over the past three days; their relatives probably unable to procure wood for cremation, police speculated ( Thought of the Day - April 23 2021 - India ).

Ashish Jha, dean of the Brown University School of Public Health, tweeted, “There’s an old saying in global health. You can ignore, fail to test for, or undercount whatever disease you want. But you can’t ignore the dead. In India, the dead are telling us the disease is much worse than the official statistics.” He continued, “India can’t be experiencing four thousand deaths a day. [That] would barely be a blip in the background” in a country that sees about 30,000 deaths on a normal day. Instead, India is “seeing crematoriums running 24 7 and running out of firewood.” As mentioned a few weeks ago the daily number of deaths from COVID in India is more likely to be 20,000 a day and now maybe more ( Thought of the Day - May 2 2021 - By the Numbers ).

Rajkot’s daily newspaper Sandesh now carries a nine-page obituary section instead of the usual one or two pages.

But now, the Indian public has another problem to contend with: "black fungus,” (mucormycosis) in patients recently treated for COVID-19. This fungal infection, while rare and difficult to treat, has a mortality rate higher than 50%.

If the infection grows in the sinuses and brain, symptoms include fever, one-sided facial swelling, headache, and nasal or sinus congestion. If your lungs are affected by the fungus, you can experience cough, chest pain, and shortness of breath. When mucormycosis attacks the digestive system, you may experience abdominal pain, nausea and vomiting, and gastrointestinal bleeding.

Eye surgeons, who often have to remove an eye to contain mucormycosis, reported a dramatic rise in cases. Over the last 10 years, doctors have only seen a handful of mucormycosis cases in India. This past month, however, tens of thousands of cases have been reported. Surat, a city of 6 million, reported 40 cases and eight lost eyes in 15 days. The health minister of Maharashtra, Rajesh Tope, said on 11 May that “there could be over 2,000 mucormycosis patients in the state as of now.” Most cases occur in diabetic patients with poorly controlled blood sugar, about two weeks after recovering from COVID-19. Some doctors blame the overuse of steroids to treat COVID-19, while others suggest the virus itself is the immunosuppressive factor helping the fungus to spread.

You can contract the fungus by inhaling the spores or when you come into contact with them in things like soil, rotting produce or bread, or compost piles. One theory is that with the health system stretched to breaking point and vaccines in short supply, some are turning to traditional medicine. The Indian Medical Association (IMA), earlier this month, warned people against smearing cow dung and urine over the body, a practice that some believe protects against the virus.

These fungi can be found in countries throughout the world, including Canada. In fact, they’re so widespread they can even be found in the nose and lungs of healthy individuals, according to Leah Cowen, a professor and Associate Vice President, Research of the University of Toronto. Although one of the few treatments we use for COVID here in Canada are steroids, dexamethasone and hydrocortisone ( Thought of the Day - January 26 - Therapeutics ), to my knowledge there has not been a COVID-related case of "black fungus" here in Canada.

Cheers

Cliff