India’s Black Fungus Epidemic

Written by: Aaron Wong Jielun (21-I4), Elizabeth Khoo Yuk Min (21-U1), He Jizhao (21-U5), Katelyn Joshy (21-U1), Lay Kai En, Ashley (21-O1), Tiew Zuo Yuan, Richard (21-I2), Zuo Yuning (21-A1)

Designed by: Lay Kai En, Ashley (21-O1)

Introduction


The sky-rocketing number of “black fungus” infection cases has exacerbated the coronavirus calamity that India is struggling to subsist through, placing further strain on India’s healthcare system. The clinical diagnosis of this bizarre infection can maim patients, scarring them and incapacitating them with disabilities. This extremely virulent pathogen is an epitome for a living nightmare and portends India’s moribund healthcare infrastructure. On 28th May, India’s prime minister Narendra Modi claimed the outbreak as a new adversity that the nation is determined to surmount despite in the midst of fighting of the global’s most severe outbreak of Covid-19. The underlying medical conditions of India’s populace are preyed upon by the “black fungus” and things are looking bleak for India. 

What is Black Fungus? 

Before diving into recent events, it is important to understand what black fungus (formally named mucormycosis) is. 

Black fungus is an infectious disease caused by fungi of the order Mucorales. Mucorales fungi are also called pin molds, and are known to grow rapidly. Most people would have seen them before as moldy patches laying claim to stale food like bread. Black fungus is spread when fungal spores enter and grow within human bodies when breathed in, through open wounds, or through contaminated food that is ingested. In normal circumstances, black fungus is rare. While such spores are commonly breathed in by most people without causing infection, the risk of infection can greatly increase due to factors including diabetes, weak immune systems, low white blood cell counts, cancer, and high bodily iron levels. 

Patients infected by the disease may have symptoms ranging from vomiting and breathing difficulties to fever and blurred vision. The black blisters and lesions that it can afflict is how the name “black fungus” was coined. Fatal complications arise when infection takes root within the nasal cavity, brain tissue or lungs. Antifungal medication is used to combat the disease, as well as drastic surgical removal of infected tissue.

India’s Healthcare System—Ill-equipped for the Poor

India is not known for having quality, affordable healthcare. Instead, its system faces numerous problems: healthcare is unevenly distributed and sometimes too expensive, and its budget is simply too small to hire enough staff or purchase sufficient equipment and facilities.

The quantity of healthcare facilities available to each state varies tremendously. In 2019, 12 states in India which hold around 70% of the country’s population have fewer hospital beds for 1000 people than the national average of 0.55. Evidently, healthcare facilities congregate in a few states, meaning that the majority of its population is unprotected. As a result, many healthcare professionals in India have reported that their hospitals are grossly understaffed and they struggle to take care of all their patients, especially during the recent Covid spike in the country. To make matters worse, India, unlike countries like Canada or the United Kingdom, does not have a national healthcare insurance system. Instead, individuals have to purchase insurance from individual firms, which shrinks the pool of insurers and hence their bargaining power. 

Hospitals also frequently report that they lack the funds necessary to purchase essential equipment such as Personal Protective Equipment (PPE) and ventilators, and have dangerously low supply of surgical masks and oxygen. As such, India’s healthcare system was already crippled before the Black Fungus epidemic. This new disease, along with Covid-19, will result in unprecedented damage to people’s lives.

The Black Fungus Epidemic 

Before the pandemic, mucormycosis was already more common in India than in any other country. It affects about 14 in every 100,000 people in India. To better understand how high this rate is, we take Australia for a comparison—0.06 per 100,000. During the pandemic, as of March 2021, 41 cases of Covid-19-associated mucormycosis had been documented around the world, with 70% in India. 

Unfortunately, coupled with the second wave of Covid-19 and the prevalence of diabetes in India, the number of cases of black fungus in India has skyrocketed to 31,216 as of June 11. COVID-19 patients are especially vulnerable to this due to their impaired respiratory function and their being on medication for health problems which impairs their natural immunity to environmental pathogens. Some cases are so severe that they require immediate surgery.

Additionally, it has been found that COVID-19 makes the immune system vulnerable to Black Fungus. Since the COVID-19 pandemic began, there has been a dramatic rise in black fungus cases. Steroid treatments for COVID-19 may suppress the body’s immune response, contributing to increased mucormycosis infection rates. Moreover, oxygen support for people with severe COVID-19 dries the nasal cavity and further increases the risk of infection, making patients of COVID-19 most vulnerable. Hence, it can be said that one of the contributing factors of the black fungus epidemic is COVID-19 itself.

The black fungus outbreak in India has pushed Indian citizens to fear and panic. This has come with the revelation that the high mortality rate of mucormycetes can lead to blindness without immediate medical attention and once the brain is affected, the mortality rate rises to 80%. In conjunction with the growing fears on mucormycetes, India has been in short supply of the drug Liposomal Amphotericin-B, which is used to treat black fungus cases. States in India are now in for a tight scramble for the shortage of the drug.

Curing Black Fungus 

The development of effective treatment methods is ramping up in order to stem the tide of black fungus cases.

Methylene blue is an antimalarial drug with antifungal activity as it has the mechanism of redox reduction in mitochondria- the bacteria cell’s powerhouse. Thus, it effectively breaks down the Black Fungus- a few drops in a humidifier which filters oxygen can control contamination, including mucormycosis, found in oxygen. It is a viable option for India as it is inexpensive and doctors believe that methylene blue cannot reach the lungs and cause harmful side effects to patients.

On June 10th 2021, Indian pharmaceutical company ‘Mankind Pharma’ launched a Posaconazole Gastro resistance drug- “Posaforce 100”, meant to treat the Black Fungus. This antifungal drug is approved by the Drugs Controller General of India (DCGI) as various studies have found it to be a safer and effective drug to treat mucormycosis. The drug’s recent launch means not much is known of how it treats Black Fungus patients.  

Conclusion 

Overall, the Black Fungus epidemic is a scary development in India, especially taking into consideration its effects and India’s healthcare infrastructure. At this point in time, we can only watch how Modi’s government is dealing with the crisis, considering they basically have their hands tied–already handling political instability from the recent wave of protests regarding sexual violence in the country and just surpassing the highest number of deaths from COVID-19 in a day. Considering all these factors, the Indian government has a lot on its plate. We can only hope that the situation in India improves. 

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