UPDATED: May 26, 2021 14:03 IST
At a time when several secondary fungal infections are being reported among those recovering or recovered from Covid-19, especially black fungus, there’s a debate on whether unhygienic delivery of oxygen to patients could be a potential cause behind such cases.
While uncontrolled diabetes and the use of high dose steroids, which suppress immunity, have been identified as the primary factors behind the cases of black fungus or mucormycosis, experts told IndiaToday that contaminated water used in humidifiers, unsterilised equipment and non-medical grade oxygen cylinders could also play a possible role.
“In the second wave, industrial oxygen has been diverted for medical use. We have seen these industrial oxygen cylinders, which are not medical grade and prone to leaks, being transported in trucks and vans. Thus, the hygiene of cylinders could have been compromised. Secondly, the water used in humidifier bottles through which oxygen is given needs to be sterile and clean. If not, the risk of contamination increases by breathing in fungal spores,” infectious diseases specialist Dr Ishwar Gilada told IndiaToday.
In a similar vein, Dr Kapil Salgia, a pulmonologist at the Bombay Hospital, who has been treating black fungus patients, said cannulas and oxygen masks for every Covid-19 patient should be discarded and new ones should be used for the next patient.
“Due to shortage of oxygen, we have seen two patients using the same cylinder and even the same non-rebreather mask. This could have also led to fungal infections,” Dr Kapil Salgia said.
Earlier this week, Karnataka deputy chief minister CN Ashwath Narayan stated that a team of microbiologists would study whether the rise in black fungus cases in the state was linked to the use of industrial oxygen and its possible contamination.
‘No direct link between industrial oxygen and black fungus cases’
However, opinion is divided on this point.
Dr Kapil Salgia also highlighted that unhygienic practices in hospitals are not a new phenomenon and similarly, steroids were administered to Covid-19 patients in the first wave as well, but not many black fungus cases were witnessed.
Padmashree awardee Dr JM Hans told IndiaToday.in there was no direct link between industrial oxygen and sanitation of cylinders to the sudden surge in mucormycosis cases.
“When it comes to oxygen — whether industrial or not — it passes through water which traps the fungal spores. The oxygen which is passed then is without fungal spores. The sanitation of ICU pipes and other equipment could cause any virus, why just mucor? [sic]” Dr JM Hans said.
“The humidity in the nose due to the use of oxygen passing through water, poor and constant use of masks and people doing steam inhalation 10 to 12 times a day may be the causes for colonisation of the fungus in the nose. When the body is in an immunocompromised state, this non-invasive fungus becomes invasive,” Dr JM Hans explained.
Dr Anup Sabarwal, ENT specialist, Rosewalk Hospitals, said theories linking oxygen cylinders and industrial oxygen to black fungus cases were a bit far-fetched. “Use of industrial oxygen per se cannot be a reason because that is 100 per cent pure oxygen and would kill off everything — it could only be more sterilising,” Dr Sabarwal said.
An audit of cases in Rajasthan by Dainik Bhaskar found that 57 per cent of black fungus patients were not on oxygen support and 27 per cent of them did not even take steroids. Rajasthan has reported over 100 black fungus cases.
Climatic conditions behind the spurt in black fungus cases?
Experts also said it should be studied whether certain climatic conditions were linked to rising in mucormycosis and other fungal infections.
“The fungus is found more in areas where there is humidity like Mumbai than interior places of Maharashtra. Mumbai is seeing a lot of black fungus cases,” Dr Ishwar Gilada said.
Echoing him, Dr Kapil Salgia said warm and moist areas were breeding grounds for fungus. “It needs to be studied if the black fungus cases are from Mumbai itself or are they being transferred from a smaller setup. Since Mumbai has tertiary care facilities, patients from mofussil are coming here for better healthcare,” he said.
Maharashtra has reported the highest number of black fungus cases at over 2,000 and more than 90 deaths, according to the state health department.
For Covid-19 patients recovering at home, Dr Gilada, who is also the general secretary of the Organised Medicine Academic Guild (OMAG), said certain precautions should be taken to prevent fungal infections.
“Mucor fungus is everywhere…it is in the air, near AC ducts, in the soil, decaying organic matter. Rooms where Covid-19 patients are kept should be clean, have proper cross-ventilation, fans should be at full speed and minimise use of AC. Ensure sterile water is used for humidification in oxygen tube. Tubes should be cleaned with betadine two-three times a day,” Dr Gilada said.