Mucormycosis: The ‘black fungus’ maiming Covid patients in India

On Saturday morning, Dr Akshay Nair, a Mumbai-based eye surgeon, was waiting to operate on a 25-year-old woman who had recovered from a bout of Covid-19 three weeks ago.

Inside the surgery, an ear, nose and throat specialist was already at work on the patient, a diabetic.

He had inserted a tube in her nose and was removing tissues infected with mucormycosis, a rare but dangerous fungal infection. This aggressive infection affects the nose, eye and sometimes the brain.

After his colleague finished, Dr Nair would carry out a three hour procedure to remove the patient’s eye.

“I will be removing her eye to save her life. That’s how this disease works,” Dr Nair told me.

Even as a deadly second wave of Covid-19 ravages India, doctors are now reporting a rash of cases involving a rare infection – also called the “black fungus” – among recovering and recovered Covid-19 patients.

What is mucormycosis?

Mucormycosis is a very rare infection. It is caused by exposure to mucor mould which is commonly found in soil, plants, manure, and decaying fruits and vegetables. “It is ubiquitous and found in soil and air and even in the nose and mucus of healthy people,” says Dr Nair.

It affects the sinuses, the brain and the lungs and can be life-threatening in diabetic or severely immunocompromised individuals, such as cancer patients or people with HIV/AIDS.

Doctor believe mucormycosis, which has an overall mortality rate of 50%, may be being triggered by the use of steroids, a life-saving treatment for severe and critically ill Covid-19 patients.

Steroids reduce inflammation in the lungs for Covid-19 and appear to help stop some of the damage that can happen when the body’s immune system goes into overdrive to fight off coronavirus. But they also reduce immunity and push up blood sugar levels in both diabetics and non-diabetic Covid-19 patients.

It’s thought that this drop in immunity could be triggering these cases of mucormycosis.

IMAGE COPYRIGHTGETTY IMAGES

image captionSteroids are an essential life-saving drug for Covid patients

“Diabetes lowers the body’s immune defences, coronavirus exacerbates it, and then steroids which help fight Covid-19 act like fuel to the fire,” says Dr Nair.

Dr Nair – who works in three hospitals in Mumbai, one of the worst-hit cities in the second wave – says he has already seen some 40 patients suffering from the fungal infection in April. Many of them were diabetics who had recovered from Covid-19 at home. Eleven of them had to have an eye surgically removed.

Between December and February, just six of his colleagues in five cities – Mumbai, Bangalore, Hyderabad, Delhi and Pune – reported 58 cases of the infection. Most of the patients contracted it between 12 to 15 days after recovery from Covid-19.

Mumbai’s busy Sion Hospital has reported 24 cases of the fungal infection in the past two months, up from six cases a year, according to Dr Renuka Bradoo, head of the hospital’s ear, nose and throat wing.

Eleven of them had to lose an eye, and six of them died. Most of her patients are middle-aged diabetics who were struck down by the fungus two weeks after recovering from Covid-19. “We are already seeing two to three cases a week here. It’s a nightmare inside a pandemic,” she told me.

In the southern city of Bengaluru, Dr Raghuraj Hegde, an eye surgeon, tells a similar story. He has seen 19 cases of mucormycosis in the past two weeks, most of them young patients. “Some were so sick that we couldn’t even operate on them.”

Doctors say they are surprised by the severity and the frequency of this fungal infection during the second wave, compared to some cases during the first wave last year.

Dr Nair says he has come across not more than 10 cases in Mumbai in the past two years. “This year is something different,” he says.

In Bengaluru, Dr Hegde had never seen more than one or two cases a year in over a decade of practice.

IMAGE COPYRIGHTEPA

image captionMumbai is one of the worst affected cities in India’s second wave

Patients suffering from the fungal infection typically have symptoms of stuffy and bleeding nose; swelling of and pain in the eye; drooping of eyelids; and blurred and finally, loss of vision. There could be black batches of skin around the nose.

Doctors say most of their patients arrive late, when they are already losing vision, and doctors have to surgically remove the eye to stop the infection from reaching the brain.

In some cases, doctors in India say, patients have lost their vision in both eyes. And in rare cases, doctors have to surgically remove the jaw bone in order to stop the disease from spreading.

An anti-fungal intravenous injection which costs 3,500 rupees ($48) a dose and has to be administered every day up to eight weeks is the only drug effective against the disease.

One way to stall the possibility of the fungal infection was to make sure that Covid-19 patients – both in treatment and after recovery – were being administered the right dose and duration of steroids, says Dr Rahul Baxi, a Mumbai-based diabetologist.

He says he treated some 800 diabetic Covid-19 patients in the past year, and none of them contracted the fungal infection. “Doctors should take care of the sugar levels after the patients are discharged,” Dr Baxi told me.

A senior government official says there is “no big outbreak”. Yet it is difficult to say why a growing number of cases of mucormycosis are being reported from all over the country. “The strain of the virus appears to be virulent, sending blood sugars soaring to very high levels. And strangely, the fungal infection is affecting a lot of young people,” says Dr Hegde.

His youngest patient last month was a 27-year-old man, who was not even a diabetic. “We had to operate on him during his second week of Covid-19 and remove his eye. It’s pretty devastating.”

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Vaccine deserts: Some countries have no COVID-19 jabs at all jabs at all

N’DJAMENA, Chad (AP) — At the small hospital where Dr. Oumaima Djarma works in Chad’s capital, there are no debates over which coronavirus vaccine is the best.

There are simply no vaccines at all.

Not even for the doctors and nurses like her, who care for COVID-19 patients in Chad, one of the least-developed nations in the world where about one third of the country is engulfed by the Sahara desert.

“I find it unfair and unjust, and it is something that saddens me,” the 33-year-old infectious diseases doctor says. “I don’t even have that choice. The first vaccine that comes along that has authorization, I will take it.”

While wealthier nations have stockpiled vaccines for their citizens, many poorer countries are still scrambling to secure doses. A few, like Chad, have yet to receive any.

The World Health Organization says nearly a dozen countries — many of them in Africa — are still waiting to get vaccines. Those last in line on the continent along with Chad are Burkina Faso, Burundi, Eritrea and Tanzania.

“Delays and shortages of vaccine supplies are driving African countries to slip further behind the rest of the world in the COVID-19 vaccine rollout and the continent now accounts for only 1% of the vaccines administered worldwide,” WHO warned Thursday.

And in places where there are no vaccines, there’s also the chance that new and concerning variants could emerge, said Gian Gandhi, UNICEF’s COVAX coordinator for Supply Division.

“So we should all be concerned about any lack of coverage anywhere in the world,” Gandhi said, urging higher-income countries to donate doses to the nations that are still waiting.

While the total of confirmed COVID-19 cases among them is relatively low compared with the world’s hot spots, health officials say that figure is likely a vast undercount: The countries in Africa still waiting for vaccines are among those least equipped to track infections because of their fragile health care systems.

Chad has confirmed only 170 deaths since the pandemic began, but efforts to stop the virus entirely here have been elusive. Although the capital’s international airport was closed briefly last year, its first case came via someone who crossed one of Chad’s porous land borders illegally.

Regular flights from Paris and elsewhere have resumed, heightening the chance of increasing the 4,835 already confirmed cases.

The Farcha provincial hospital in N’Djamena is a gleaming new campus in an outlying neighborhood, where camels nibble from acacia trees nearby. Doctors Without Borders has helped supply oxygen for COVID-19 patients, and the hospital has 13 ventilators. The physicians also have plenty of Chinese-made KN95 masks and hand sanitizer. Still, not a single employee has been vaccinated and none has been told when that might be possible.

That was easier to accept at the beginning of the pandemic, Djarma said, because doctors all around the world lacked vaccines. That has changed dramatically after the development of shots in the West and by China and Russia that have gone to other poor African countries.

“When I hear, for example, in some countries that they’ve finished with medical staff and the elderly and are now moving on to other categories, honestly, it saddens me,” Djarma said. “I ask them if they can provide us with these vaccines to at least protect the health workers.

“Everyone dies from this disease, rich or poor,” she says. “Everyone must have the opportunity, the chance to be vaccinated, especially those who are most exposed.”

COVAX, the U.N.-backed program to ship COVID-19 vaccines worldwide, is aimed at helping low- and middle-income countries get access. A few of the countries, though, including Chad, have expressed concerns about receiving the AstraZeneca vaccine through COVAX for fear it might not protect as well against a variant first seen in South Africa.

Chad is expected to get some Pfizer doses next month if it can put in place the cold storage facilities needed to keep that vaccine safe in a country where temperatures soar each day to 43.5 degrees Celsius (110 degrees Fahrenheit).

Some of the last countries also took more time to meet the requirements for receiving doses, including signing indemnity waivers with manufacturers and having distribution plans in place.

Those delays, though, now mean an even longer wait for places like Burkina Faso, since a key vaccine manufacturer in India scaled back its global supply because of the catastrophic virus surge there.

“Now with global vaccine supply shortages, stemming in particular from the surge of cases in India and subsequently the Indian government’s sequestration of doses from manufacturers there, Burkina Faso risks even longer delays in receiving the doses it was slated to get,” said Donald Brooks, CEO of a U.S. aid group engaged in the COVID-19 response there known as Initiative: Eau.

Front-line health workers in Burkina Faso say they’re not sure why the government hasn’t secured vaccines.

“We would have liked to have had it like other colleagues around the world,” says Chivanot Afavi, a supervising nurse who worked on the front lines of the response until recently. “No one really knows what this disease will do to us in the future.”

In Haiti, not a single vaccine has been administered to the more than 11 million people who live in the most impoverished country of the Western hemisphere.

Haiti was slated to receive 756,000 doses of the AstraZeneca vaccine via COVAX, but government officials said they didn’t have the infrastructure needed to conserve them and worried about having to throw them away. Haitian officials also expressed concerns over potential side effects and said they preferred a single-dose vaccine.

Several small island nations in the Pacific also have yet to receive any vaccine, although the lack of outbreaks in some of those places has meant there is less urgency with inoculation campaigns. Vanuatu, with a population of 300,000, is waiting to receive its first doses of the AstraZeneca vaccine later this month, but it has recorded only three cases of coronavirus, all of them in quarantine.

At the Farcha hospital in Chad, nine health care workers have gotten the virus, including Dr. Mahamat Yaya Kichine, a cardiologist. The hospital now has set up pods of health care worker teams to minimize the risk of exposure for the entire staff.

“It took almost 14 days for me to be cured,” Kichine says. “There were a lot of caregivers that were infected, so I think that if there is a possibility to make a vaccine available, it will really ease us in our work.”

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China says most rocket debris burned up during reentry

BEIJING (AP) — China’s space agency said a core segment of its biggest rocket reentered Earth’s atmosphere above the Maldives in the Indian Ocean and most of it burned up early Sunday.

Harvard astrophysicist Jonathan McDowell, who tracked the tumbling rocket part, said on Twitter, “An ocean reentry was always statistically the most likely. It appears China won its gamble… But it was still reckless.”

China’s official Xinhua News Agency said reentry occurred at 7:24 p.m. local time Saturday. “The vast majority of items were burned beyond recognition during the reentry process,” the report said.

Despite that, NASA Administrator Sen. Bill Nelson issued a statement saying: “It is clear that China is failing to meet responsible standards regarding their space debris.”

Usually, discarded rocket stages reenter the atmosphere soon after liftoff, normally over water, and don’t go into orbit.

The Long March 5B rocket carried the main module of Tianhe, or Heavenly Harmony, into orbit on April 29. China plans 10 more launches to carry additional parts of the space station into orbit.

The roughly 30-meter (100-foot) -long stage would be among the biggest space debris to fall to Earth.

The 18-ton rocket that fell last May was the heaviest debris to fall uncontrolled since the former Soviet space station Salyut 7 in 1991.

China’s first space station, Tiangong-1, crashed into the Pacific Ocean in 2016 after Beijing confirmed it had lost control. In 2019, the space agency controlled the demolition of its second station, Tiangong-2, in the atmosphere.

In March, debris from a Falcon 9 rocket launched by U.S. aeronautics company SpaceX fell to Earth in Washington and on the Oregon coast.

China was heavily criticized after sending a missile to destroyed a defunct weather satellite in January 2007, creating a large field of hazardous debris imperiling satellites and other spacecraft.

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Jerusalem: Many injured on second night of clashes

Fresh clashes between Palestinians and Israeli police broke out in Jerusalem on Saturday, injuring dozens.

Protesters hurled stones at the police at Damascus Gate in the Old City, and officers responded with stun grenades, rubber bullets and water cannon.

Palestinian medics said 90 Palestinians were wounded. Israeli police said at least one officer was hurt.

It follows days of simmering unrest over possible evictions of Palestinians from land claimed by Jewish settlers.

On Friday, more than 200 Palestinians and at least 17 Israeli police were wounded in skirmishes near Al-Aqsa mosque, emergency workers and police said.

Jerusalem’s Al-Aqsa mosque complex is one of Islam’s most revered sites, but its location is also the holiest site in Judaism, known as the Temple Mount. The complex is a frequent flashpoint for violence, but Friday’s was among the worst in years.

The Quartet of Middle East negotiators – the US, the EU, Russia and the UN – on Saturday expressed “deep concern” over the spiralling violence.

In a separate development on Saturday, Israel’s military said a rocket was fired by Palestinian militants from the Hamas-run Gaza Strip into Israel.

“In response, our aircraft just struck a Hamas military post in southern Gaza,” the Israel Defense Forces (IDF) tweeted.

The IDF did not provide any more details, but Israeli media reported that the rocket landed in an open field causing no injuries or damage.

IMAGE COPYRIGHTREUTERS

image captionA number of injured people were taken to hospital, the Palestinian Red Crescent emergency service said

Saturday’s clashes broke out at Damascus Gate after tens of thousands of worshippers had prayed at Al-Aqsa mosque for Laylat al-Qadr, the most holy night in the Muslim month of Ramadan.

The Palestinian Red Crescent said at least 90 Palestinians were hurt, and 14 were taken to hospital.

Earlier on Saturday, Israeli police had stopped dozens of buses carrying worshippers to the mosque, and a number of Palestinians were arrested after Friday’s violence.

“They do not want us to pray. There is a fight every day, every day there are clashes. Every day there are troubles,” Mahmoud al-Marbua, 27, told Reuters news agency.

Israel’s Prime Minister Benjamin Netanyahu said his country was acting responsibly to ensure law and order while maintaining freedom of worship.

Palestinian leader Mahmoud Abbas condemned what he said were Israel’s “sinful attacks”.

What’s the background to this?

Israel has occupied East Jerusalem since the 1967 Middle East war and considers the entire city its capital, though this is not recognised by the vast majority of the international community.

Palestinians claim East Jerusalem as the future capital of a hoped-for independent state.

Tensions have been rising over the threatened eviction of Palestinian families in East Jerusalem’s Shaikh Jarrah district.

The UN says Israel should call off any evictions and employ “maximum restraint in the use of force” against protesters.

The League of Arab States has called on the international community to intervene to prevent any forced evictions.

Israel’s Supreme Court is expected to hold a hearing on the long-running legal case on Monday.

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Death toll soars to 50 in school bombing in Afghan capital

KABUL, Afghanistan (AP) — The death toll in a horrific bombing at a girls’ school in the Afghan capital has soared to 50, many of them pupils between 11 and 15 years old, the Interior Ministry said Sunday.

The number of wounded in Saturday’s attack has also climbed to more than 100, said Interior Ministry spokesman Tariq Arian.

Three explosions outside the school entrance struck as students were leaving for the day, he said. The blasts occurred in a mostly Shiite neighborhood in the west of the capital. The Taliban denied responsibility, condemning the attack.

The first explosion came from a vehicle packed with explosives, followed by two others, said Arian, adding that the casualty figures could still rise.

In the capital rattled by relentless bombings, Saturday’s attack was among the worst. Criticism has mounted over lack of security and growing fears of even more violence as the U.S. and NATO complete their final military withdrawal from Afghanistan.

The attack targeted Afghanistan’s ethnic Hazaras who dominate the western Dasht-e-Barchi neighborhood, where the bombings occurred. Most Hazaras are Shiite Muslims

The area has been hit by violence against minority Shiites and most often claimed by the Islamic State affiliate operating in the country. No one has yet claimed Saturday’s bombings.

The radical Sunni Muslim group has declared war on Afghanistan’s Shiites. Washington blamed IS for a vicious attack last year in a maternity hospital in the same area that killed pregnant women and newborn babies.

Soon after the bombing, angry crowds attacked ambulances and even beat health workers as they tried to evacuate the wounded, Health Ministry spokesman Ghulam Dastigar Nazari said. He had implored residents to cooperate and allow ambulances free access to the site.

Bloodied backpacks and schools books lay strewn outside the Syed Al-Shahda school. In the morning, boys attend classes in the sprawling school compound and in the afternoon, it’s girls’ turn.

Residents in the area said the explosion was deafening. Naser Rahimi told The Associated Press he heard three separate explosions, and immediately thought that the sheer power of the blasts meant the death toll would almost certainly climb.

One of the students fleeing the school recalled the attack, the girls’ screams of the girls, the blood.

“I was with my classmate, we were leaving the school, when suddenly an explosion happened, “ said 15-year-old Zahra, whose arm had been broken by a piece of shrapnel.

“Ten minutes later there was another explosion and just a couple of minutes later another explosion,” she said. “Everyone was yelling and there was blood everywhere, and I couldn’t see anything clearly.” Her friend died.

Outside the Muhammad Ali Jinnah Hospital, in the Dasht-e-Barchi neighborhood dozens of people lined up to donate blood, while family members checked casualty posted lists on the walls.

Most of the dozens of injured brought to the EMERGENCY Hospital for war wounded in the Afghan capital, “almost all girls and young women between 12 and 20 years old,” said Marco Puntin, the hospital’s programme coordinator in Afghanistan.

In a statement following the attack, the EMERGENCY Hospital said the first three months of this year has seen a 21 per cent increase in war-wounded.

IS has previously claimed attacks against minority Shiites in the same area, last year claiming two brutal attacks on education facilities that killed 50 people, most of them students.

Even as the IS has been degraded in Afghanistan, according to government and US officials, it has stepped-up its attacks particularly against Shiite Muslims and women workers.

Earlier the group took responsibility for the targeted killing of three women media personnel in eastern Afghanistan.

The attack comes days after the remaining 2,500 to 3,500 American troops officially began leaving the country. They will be out by Sept. 11 at the latest. The pullout comes amid a resurgent Taliban, who control or hold sway over half of Afghanistan.

The top U.S. military officer said Sunday that Afghan government forces face an uncertain future and possibly some “bad possible outcomes” against Taliban insurgents as the withdrawal accelerates in the coming weeks.

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