COVID-19, steroids and diabetes—why mucormycosis is now a deadly epidemic in India

19 June 2021
Doctors perform endoscopic surgery on a mucormycosis patient at Harsh ENT hospital in Ghaziabad, Uttar Pradesh on 3 June 2021.
Rajat Gupta / EPA
Doctors perform endoscopic surgery on a mucormycosis patient at Harsh ENT hospital in Ghaziabad, Uttar Pradesh on 3 June 2021.
Rajat Gupta / EPA

In mid April, 59-year-old Dilip Menon, his wife and son were just about recovering from COVID-19, when he started developing new symptoms. “His eye was swollen and he complained of pain in his face,” Dilind, his son, told me. “We thought it was just an insect bite.” However, it turned out that Menon had mucormycosis, a fungal infection that quickly spread across his facial tissues, causing him to lose vision in his right eye and have it removed. “We have brought him back to the house now, but still worried about infection, he is still on medication,” Dilind said. “This was a horrifying experience. Everything has gone downhill.”

Dilip Menon was one of thousands of people who have developed mucormycosis along with COVID-19 during the second nationwide wave. It is an opportunistic infection, in which spores of the fungus take hold of tissues in immunocompromised patients, such as those who have contracted COVID-19 or are on immunosuppressants such as steroids. The fungus damages cells and nerves and cuts off blood supply as it spreads. The lack of blood supply turns tissue black, earning the disease the misnomer “black fungus.” “But there is nothing black about the fungus,” Jagdish Chander, the former head of the department of microbiology at Chandigarh’s Government Medical College and Hospital, said. Mucormycosis is often deadly and pre-pandemic reviews of literature on mucormycosis suggested that mortalitycould be as much as 54 percent. 

The union health ministry recently declared mucormycosis an epidemic in India. On 7 June, Harsh Vardhan, the health minister, said that 28,252 cases of mucormycosis had been identified in the country since the disease was notified in early May 2021. Eighty-six percent of these cases had a history of COVID-19 infection and 62.3 percent had a history of diabetes. At least 900 of these patients had died as of 28 May, according to an affidavit filed by the union government in the Delhi High Court.

Doctors corroborated this data with cases they had seen in emergency rooms. “Before the pandemic, our hospital received five to ten such cases per year, and now at least five patients are referred to our hospital daily,” Abdul Ghafur, an infectious-disease physician at Apollo Hospital in Chennai, said.

Mucormycosis was considered rare in India until this year. Atul Patel, an infectious-disease expert in Ahmedabad, estimated that around 300 cases were diagnosed annually before the pandemic. Patel was the lead author of a multi-centre study conducted between January 2016 and September 2017, according to which 465 mucormycosis patients were diagnosed in India’s foremost tertiary care hospitals. However, the disease was endemic in India, and there was a 70-percent prevalence of the disease globally. 

Chahat Rana is a reporting fellow at The Caravan. 

Keywords: coronavirus COVID-19 mucormycosis SARS-CoV2 Harsh Vardhan Ministry of Health and Family Welfare Black Fungus