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OUTBREAK ALERT: BLACK FUNGUS IN INDIA

Richard Catherina, Jade Patel, Ariana Epstein, Aman Barekzai, Emergency Management, Health, and Hazards (EMH2) Team

Week of Monday, May 24, 2021


Black Fungus[1]


India is experiencing an unexpected surge of black fungus amidst an ongoing surge of COVID-19. The mortality rate from black fungus combined with the COVID-19 makes it extremely likely that mass fatality could occur throughout India. As vaccinations and treatments are being administered throughout India, a secondary epidemic is enough to buckle the health system once more. It is crucial that further preventative measures are taken to protect from the high transmissibility of infections. As of May 23, 2021, 9000 cases have been detected and are extremely likely to increase over this week, with 212 people dead due to black fungus.[2] This will have the biggest impact on those with or recovering from COVID-19 likely due to weakened and compromised immune systems due to their bodies trying to fight another severe virus. Those on steroid treatments, which are being used as a treatment for COVID-19, are equally as likely to contract black fungus as their immune system is susceptible to secondary disease. With two highly contagious and deadly illnesses, India is likely to face grave consequences over the coming weeks.


Description of Pathogen

Black fungus is a form of mold that is commonly found in soils, plants and rotting vegetation, causing living organisms to decay. Sometimes spores can transmit into the human body from exposure and ingestion causing a very rare infection known as “mucormycosis.” Mucormycosis infections can also develop through adhesions on the skin such as a cut, burn, and/or scratch.[3] To contract the disease, an individual must come into contact with a spore, which is likely to have grave consequences. Black fungus spores spread through air transmission and have the ability to infect all those in contact or within the environment. The mortality rate linked to black fungus is 50%, likely to increase when infected by those with or recovering from COVID-19. There is no evidence to suggest the disease is seasonal but it is probable that warmer months are primal for food decay due to the excessive heat and drought conditions.


Black Fungus spores enter into the body or skin and attach onto fibres and cells, predominantly within the lungs. Contracting black fungus disease makes individuals immunocompromised and is likely to cause severe illness. Individuals with underlying health issues, such as those with poorly controlled diabetes or who receive steroid treatments, are extremely likely to face health complications that could be fatal. Epidemic concerns are growing as healthy children are starting to become infected.[4] This indicates that the black fungus epidemic targets anyone, regardless of age.


It is unpredictable how long an outbreak of black fungus can last as it is dependent on the control methods used to contain, reduce and protect against the spread of black fungus. One known treatment is the use of the medication Ampho B, an antifungal drug, that fights against the black fungus pathogen internally. Due to the spike in cases over the past week, there has been a sudden rise in demand for antifungal drug Ampho B, likely causing shortages and pharmaceutical delays as the numbers of infected continue to increase.[5]


The duration of the outbreak is unknown but is expected to last over the coming month as more cases are being identified throughout India. It is likely that without COVID-19 the timespan of a black fungus outbreak would have been shorter. The high transmissibility and severity of the fungus, alongside COVID-19, makes it increasingly likely to cause immediate risks to health and has the potential to be fatal. So far black fungus has led to multiple deaths since the outbreak.


Longer-term consequences of contracting mold infections are dependent on the type of mold.[6] Dangerous molds, including black fungus, share the same pathogen and can differ depending on the individual underlying health, duration of exposure, the type and how quickly treatment is received. Notably, mold infections have led to allergies, asthma, depression, headaches, fatigue, memory loss, lung problems, and death in the worst cases. This is likely to differ between each individual, outbreak and type of mold.[7] With a vulnerable healthcare system, this makes it more challenging to efficiently diagnose patients due to shortages of beds and resources such as oxygen.


Location

Black fungus cases are being discovered throughout different regions of India: Tamil Nadu, Gujarat, Odisha, Bihar, Uttarakhand, Rajasthan, Telangana and Chandigarh.[8] With multiple regions reporting cases, it is extremely likely to become widespread throughout India if control measures are not implemented. Regions of India are already imposing tighter restrictions in attempts to decrease active COVID-19 cases, which is likely to have secondary effects on controlling the black fungus outbreak.


Black fungus is most common in terrains with lots of vegetation such as forests, farming lands and rural areas. The diverse climates within India are likely a key component to the creation of black fungus; monsoons followed by periods of drought, creating an environment perfect for the creation of mold. Vegetation that is unusable and left can also create an ideal environment for mold, specifically black mold.


Response Challenges

COVID-19 is a key driver that is overwhelming the Indian health system, resulting in medical treatments being in high demand. Without a stable health system, it is extremely likely that many people have no or limited access to healthcare, increasing the number of people with untreated and/or unidentified underlying health conditions. Last month the country's health system hit a breaking point and sparked an international health crisis. Doctors are using steroid treatments to treat COVID-19, which increases susceptibility to secondary infections which is likely a reason why those actively taking steroid medications may be more likely to contract black fungus.[9] Whether steroids will help prevent black fungus is currently unknown and likely under investigation. The influx of hospital admissions has led to the creation of designated wards within Indian hospitals to deal with COVID-19 and black fungus, but they are becoming rapidly overwhelmed and working to capacity already, likely exhausting health workers and services, leaving more people without access to treatment.


Travel Warnings

The black fungus epidemic has become active at the same time India is dealing with a COVID-19 surge. The high transmissibility of the Indian Variant has caused the Indian health system to collapse, leading to international travel bans to and from India for the foreseeable future. Due to travel bans, access to India is restricted, making it less likely that black fungus will spread internationally, lowering the threat of a worldwide outbreak. There is no vaccination to prevent black fungus, and when travel resumes, travellers will need to have both doses of the COVID-19 vaccination as a condition of entry. No foods are directly linked with the transmission of black fungus, therefore consumption is advised to continue as normal. There is no evidence to suggest transportation systems play a role in spreading the disease, but advice should be given to those who are infected, as close contact and aerosol transmission can lead to the creation of black fungus spores, making it likely more people will become infected. Domestic travel is also not advised to contain the spread of the diseases. Many regions of India are impacted by the epidemic, so decreasing intercity travel is likely to decrease the spread, and control the transmission of the disease.


Political Effects/Effects on Terrorism

The outbreak causes greater concern for India's health care stability and intensifies the recovery phase. With multiple outbreaks, this increases India’s vulnerability towards cyber attacks as cybercriminals may attempt to take advantage by using ransomware and hacking tactics. Physical attacks are also increased, creating opportunities for terror groups to offer aid to recruit and advance within the country. It is likely that during an infectious disease outbreak, terrorist organizations may attempt to recruit individuals by employing direct and personal appeals. During these scenarios, bonds between the recruiter and vulnerable individuals may be strengthened by appealing to frustrations such as loss of family, insufficient funds and a lack of access to basic necessities.


Recommendations for Agencies, Organizations and Companies

Health agencies should work to implement mass production of Ampho B to increase supply and to ensure all those who need healthcare are receiving it. COVID-19 vaccinations should continue, with the potential to find an alternative to steroids as these do not help reduce black fungus. Organizations could provide aid, whether this be hospital equipment and/or financial gifts to enable more scope for treatments. Companies are advised to advocate about the rising concern of black fungus within their local area, and take precautionary measures to reduce transmissibility. Another recommendation is to implement an alternative way of working to avoid high spore active areas, specifically for companies who have staff in the vegetation/agriculture industry.


The Counterterrorism Group (CTG) looks to detect, deter, defeat issues that compromise and are concerning to health, such as disease outbreaks. The Emergency Management, Health, and Hazards (EMH2) Team specifically focuses on analyzing the importance of positive and negative health and hazards impacts, crucially how this can create vulnerabilities for terror advantage. The outbreak of black fungus throughout India will be monitored by the EMH2 team over the coming weeks to assess and highlight any prominent trends to transmission rates, medical developments and fatalities.

________________________________________________________________________ The Counterterrorism Group (CTG)

[1]Black Fungus“ by Cyndy Sims Parr, licensed under Creative Commons Attribution-ShareAlike 2.0 Generic

[2] Probe link between Black Fungus, use of zinc in treatment of Covid patients: Experts, India Today, May 2021, https://www.indiatoday.in/coronavirus-outbreak/story/black-fungus-mucormycosis-cases-epidemic-zinc-treatment-covid-experts-1805824-2021-05-22

[3] Black Fungus: Govt shares do's and don'ts amid rise in Mucormycosis cases in Covid patients, Mint, May 2021, https://www.livemint.com/science/health/black-fungus-govt-shares-do-s-and-don-ts-amid-rise-in-mucormycosis-cases-in-covid-patients-11621002697776.html

[4] Probe link between Black Fungus, use of zinc in treatment of Covid patients: Experts, India Today, May 2021, https://www.indiatoday.in/coronavirus-outbreak/story/black-fungus-mucormycosis-cases-epidemic-zinc-treatment-covid-experts-1805824-2021-05-22

[5] High demand leads to shortage of anti-fungal drug Ampho B to treat Black Fungus, The Economic Times, May 2021, https://economictimes.indiatimes.com/industry/healthcare/biotech/pharmaceuticals/high-demand-leads-to-shortage-of-anti-fungal-drug-ampho-b-to-treat-black-fungus/videoshow/82732236.cms

[6] Consequences Of Long-Term Exposure To Mold,Green Works, May 2021, https://greenworksllc.com/consequences-long-term-exposure-mold/

[7] Ibid.

[8] Probe link between Black Fungus, use of zinc in treatment of Covid patients: Experts, India Today, May 2021, https://www.indiatoday.in/coronavirus-outbreak/story/black-fungus-mucormycosis-cases-epidemic-zinc-treatment-covid-experts-1805824-2021-05-22

[9] Why Deadly ‘Black Fungus’ Is Ravaging COVID Patients in India, Scientific American, May 2021, https://www.scientificamerican.com/article/why-deadly-black-fungus-is-ravaging-covid-patients-in-india/


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