Experts working in Covid wards in top government hospitals specialising in infectious diseases have made some startling revelations to Outlook -- the reason for the spread of Mucormycosis or black fungus among many Covid-19 recovered patients could be contaminated nasal swab used during testing.
Mucormycosis is a fungus that floats in the environment or rests on many objects. It can infect only those whose immunity is weak due to illnesses. It can enter the body through several means. For instance, through inhalation or consuming fungal-infected food or coming in contact with any such object etc. It can cause substantive harm to the organ and cause death too. Experts say that about 60 percent of patients admitted to the hospital for the treatment of this black fungal disease neither took steroid or were on oxygen support during Covid-19 treatment.
After observing several such patients, they are of the view that the insertion of a swab (a cotton ball) in the nose during the RT-PCR test could be one of the main reasons for the outbreak of this fungal disease.
They say that on questioning, these patients said that they underwent RT-PCR tests multiple times to find out if they are Covid positive or not. This has made the doctors believe that it could be due to swabs. In western countries like the UK and the USA, these swabs are sterilised before use, through gamma radiation, however, in India, there is no quality control on their production and handling.
That’s why even when steroids and oxygen were extensively used in Western countries like the UK and the USA, patients never contracted the fungal infection because they used sterilised swab. Doctors say that of late, the prices of RT-PCR tests have been reduced, many new players have come into the market and the number of tests has also gone up manifold.
“We don’t know the hygiene status of the workers who are making these swabs or places where it is made and packed,” said a doctor who specialises in infectious diseases and is working at a reputed government hospital in Delhi. “We have admitted several such patients for Mucormycosis infection who were treated for Covid-19 at home. They had a mild and moderate infection and they never took steroid or were ever on oxygen support," he added.
He also said that the only common element among all these patients is that all of them are immunocompromised. “It means they have a weak immune system due to some sort of illness for which they take medicines which reduces the immunity of the body,” another doctor from a top Covid hospital said.
The experts have provided adequate medical reasons to support their observation and negate the widely circulated hypothesis in the media that steroid or industrial oxygen could be the reason for Mucormycosis. Mucormycosis is of many types. Rhino-orbito-cerebral Mucormycosis starts from the nose and proceeds towards the eye and skull. Pulmonary Mucormycosis infects the lungs and chest. Gastrointestinal Mucormycosis infects the digestive tracks.
“Almost all the cases prevalent in India are of Rhino-orbito-cerebral Mucormycosis which means the infection starts from the nose and proceeds towards the eyes and brain,” said the doctor quoted above. In rare cases, black fungal infections are found in the lungs and digestive tract. “Had infected oxygen been the reason, then the cases of Pulmonary Mucormycosis would have also been in reasonable numbers," he added.
Last year, during the first wave, a global study titled “The emergence of Covid-19 associated Mucormycosis: Analysis of cases from 18 countries” was done on 80 patients, 42 of them were from India. One of the noted microbiologists, Arunaloke Chakarabatri, MD, Professor, Department of Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh was part of this study team. The study had established that 41 out of 42 patients from India had a fungal infection in the sinuses, nasal passage, oral cavity, and brain. Only one patient had it in the lungs. Such infections were not found so widely among patients in developed countries.
This study supports the observation of government doctors that during the first wave, the number of RT-PCR tests was far less than during the second wave. They dismiss the hypothesis that oxygen could be one of the reasons. “Even the industrial oxygen supplied to hospital for medical purposes maintains the 99.5% purity. Besides, the high pressure and extremely low temperature (below -183 degree) at which it is stored and transported it is impossible for the fungus to remain present there,” the doctor said.