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Deadly blessings from Covid curse

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Rishard Bathiudeen must be having some relief, and also some comfort in the detention cell he is held in. It is not due to the huge shouting rivalry in Parliament about him. But because the rapidly twisting police probes into the death of the domestic servant in his home, that dominated most media for weeks, have moved to the Delta variant of Covid-19, striking the country and people with much more impact than the alleged child abuse police probe, which also has signs of slapstick.

President Gotabaya Rajapaksa also needs congratulations for his recent call to officials to ensure that all Sri Lankans are vaccinated. That certainly is national leadership, in a situation of crisis, largely due to the huge blunders of key persons in his own government.

Apart from the daily rising deaths, vaccination is the word of the moment. Those in government are now taking pride, with supportive headlines and loud cheers, about the country reaching a 10 percent vaccination of the population. With much effort to forget that our population is more than 20 million!

Are we to forget Cabinet Ministers of this government, including the Health Minister, stating in Parliament that making arrangements to carry out vaccinations against this pandemic is not important, not urgent, and possibly not necessary, too?

Did such delays not contribute to the Covid Crisis and Tragedies we are now facing?

Should we look at parliamentary privilege when recalling how the Dhammika Paniya, that anti-Covid syrup, was promoted by the Health Minister herself, and the Speaker of Parliament, too. That it was a syrupy promotion of the Covid virus, now the bitter reality of life to a hugely threatened population.

Can we forget how that vadu-vedamahatmaya who produced this syrup got so angry when members of the Sangha prevented him from making an offering of it to the Sri Maha Bodhi?

Do we also not recall how the Health Minister Pavithra Waniarachchi herself, as well as the Minister of Tourism Prasanna Ranatunga and Minister of Energy and Petroleum Udaya Gammanpila, took those mantra-powered pots of liquid and dumped them into rivers, with such fervent hope in their power to defeat the Covid Saapaya or Curse?

The President is certainly making headlines with the rise in vaccinations, and his visits to some of the vaccination centres, especially well managed by the Army. Such cause for pride and joy apart, where are we in reality today?

The government certainly has much hope that it’s Vaccinator Fight against the Covid demon will make it the victor in other battles, too. The big battle of today is that of the teachers and school principles. The Saubhagyaye Dekma of the President and the SLPP certainly do not see any need to ensure any Saubhagya, or even limited prosperity, to the teaching profession. The demands of the teachers may have issues for debate. But they have dragged on for too long, and the size of the current protests certainly calls for a good governmental response, and not to hide it away for yet another government.

The other issue that has raised many alarm bells is that of the Kotelawala Defence University. Providing a good higher education facility for the armed forces, is not a matter at issue. It is a must. But, how much should this affect the wider and larger national policies of Higher Education? The mounting protests have certainly made the government take this issue away from the parliamentary debate, scheduled for this week.

Is this delay the acceptance of reality on key issues affecting higher education, or just another political delay, for it to be taken up once the Covid Crisis has moved away? Let’s hope it is not so.

There are other issues too – such as the call for fertilisers by the agricultural community, and the major threats to the economy with the lack of suitable fertilisers for the tea and other agro-industries. There are some signs of a change in the Gotabhaya Special Fertiliser Policy. Is this a show of the Gota – Basil divergence, that shows a new power play in the Rajavasala Pavula?

As the Delta variant of Covid-19 hits us hard and pushes the people into a disaster that could have been avoided, if good politics and governance prevailed; isn’t it time to look at the need for good thinking on the system of governance in Sri Lanka?

Should we have a system that can carry on for more than two decades on a policy dealing with the income of teachers? Should we have a system where Free Education is far removed from what it was when introduced by the late CWW Kannangara – and the politics of that age? Should we not think of the serious changes certainly needed to the very system of University Education, with genuine service to the people and country?

These are the real calls of the mass protests that are now being threatened by the Covid Curse.

Amidst this curse, there is also the need for urgent action to fight and destroy the forces that encourage the use of child labour, especially of girls, of a largely powerless minority ethnic community in the plantation sector.

As much as the President has called for good action to achieve Vaccination Immunity from the Covid pandemic, let’s hope the President and all government leaders, as well as the Opposition, give good thought to these other burning issues before the country.

Such good political thinking could be a blessing to Sri Lanka, from those who suffer and die in hospitals and homes today from the Covid Delta surge.

With three deaths every hour, there will certainly be a hugely deadly blessing to bring this country to modern and scientific thinking and living. The Sad Reality of Today.



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Pandemic and emergence of variants

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By Prof Kirthi Tennakone

The behaviour of the coronavirus bears resemblance to a high-speed magnified video of Darwinian evolution. The virus changes in front of our eyes and variants emerge as the fittest that survive. Genome surveillance has succeeded in reading the genetic changes accurately and sees how the genotype expresses as phenotype. Genotype being the chemical-genetic constitution and phenotype, characters as manifested in the environmental background.

Humans have sinisterly arrested the natural evolution of animals and plants; but despite scientific advancements, find it difficult to deal with a fast-evolving virus, science alone cannot resolve a social calamity. Containment of the pandemic would be difficult if our actions lag in relation to the pace of virus evolution.

Mutations: cause of biological evolution

According to Charles Darwin’s theory of evolution, life on earth continues by descent, inheriting parental characters subject to infrequent variations or mutations. After the discovery of DNA, the mechanism of inheritance and mutations was understood.

The genetic material DNA, present in all living cells, is a double-stranded structure composed of bead-like moieties pairs, known as nucleotide bases, denoted by symbols A, T, G and C. The sequence of these entities in a strand encodes genetic information analogous to a four-letter alphabet. Some viruses contain one strand referred to as RNA and encode information in the same way. When the cell or the virus replicate, most of the time, the sequence of nucleotides is copied exactly giving birth to a genetically identical cell or a virus. Rarely, copying errors creep in during replication. For example, the sequence AAGCT may be miscopied as AAGCG. This is a minor change in comparison to the entire genome, nevertheless a genetic change or a mutation. Most mutations will not lead to overriding alterations in the character of an organism. Mutations are often deleterious. Very infrequently, a change in character, owing to a mutation, turns out to be beneficial for the species to survive and procreate.

Mutants fitting the environment survive and proliferate. Paleontological findings provide ample evidence of the evolutionary process, when noticeable changes in living species manifest during, more or less, millennia. In most cellular organisms a mutation, fit to get established, takes place once in a million generations. For that reason, we do not see sporadic changes in the progenies of animals and plants. In the past there had not been significant alterations in genetically transferred characters of wild animals. The leopards we see today are not different from ones that lived during the Anuradhapura period, their hunting capabilities are similar.

The situation is different if a virus invades a population devoid of immunity. Their intrinsically fast mutation and replication rates and sheer numbers, invariably bring forth more adaptable strains in very short periods. Certainly, the same phenomenon occurred during previous epidemics and pandemics. Today it is happening at an escalated level because of high human population density, mobility and unrestrained interference in the environment.

Viruses live on cellular life, constantly interacting and following their evolution, while they themselves evolve.

Unicellular and multicellular and viruses

The first living cells or unicellular microbes seemed to have originated 3.5 billion years ago. A giant step in the advancement of life on earth has been the appearance of multicellular organisms, living systems made of assemblies of cells. A mutation in a unicellular agent around 1.5 billion years ago is believed to have cleared the way for the development of multicellular life. These individual cells, sharing similar DNA, formed colonies. Later colonies subdivided, each expressing genetic instructions differently to create complex animals, with organs performing varying functions. The above developmental pathways, leading to advanced forms of life existing today, took more than one billion years.

Viruses are distinct from cellular forms of life. The latter possesses the capacity to grow and reproduce, deriving energy and essence of structural materials from non-living substances; whereas the former needs to enter a living cell to reproduce. All cellular creatures and viruses replicate, mutate and interact with each other and the external environment and evolve.

The pandemic is just one episode of this universal phenomenon, progressing fast and tracked by humans, the concern now is the threat posed by variants.

Variants of Coronavirus (SARS-CoV-2)

A variant means a mutated version of an organism, distinct from the original in a noticeable deviation of an observable trait. For example, king coconut is a variant of coconut, the distinguishing attribute being the colour of the nut. Apart from the shade of the nut, this particular mutation had turned the tree into a dwarf, very disadvantageous for harvesting sunlight. Unable to compete with other trees, the king coconut would not survive in the wild. Attracted by the colour, humans (in Sri Lanka) have taken care of the variety and propagated it.

In the case of the Coronavirus, the important qualities distinguishing variants are higher infectivity, degree of virulence and resistance to vaccines.

The Coronavirus and other RNA viruses mutate faster than DNA based organisms. Here the probability of a viable mutation per generation (replication) exceeds 10,000 times that of a cellular life form. Furthermore, the generation time of the Coronavirus is a few hours compared to years and months in the case of animals and the total population of viruses in bodies of infected persons, during the time of the pandemics, is many billions times larger than an animal population. Consequently, Coronavirus variants popped up in durations as short as a few months, after the aggravation of the pandemic in late 2020. The longer the pandemic lasts and the greater the intensity, the more variants we encounter.

Since the emergence of COVID-19 in Wuhan, China in December 2019 and its global spread, many variants have appeared in geographically distinct regions and crossed borders. The original version of the virus which triggered the epidemic in Wuhan underwent the mutation D614G altering the spike proteins, making it more contagious. Soon the strain D614G surfaced almost everywhere initiating the pandemic. It is the common ancestor of almost all variants seen today. The World Health Organization and Center for Disease Control, United States, have classified Coronavirus variants into three categories.

Variants of Concern

: They have increased transmissibility, detrimental alteration in epidemiology, enhanced virulence, decrease effectiveness in public health measures or available vaccines and diagnostics. The Alpha variant detected in the United Kingdom, September 2020; Beta in South Africa, May 2020; Gamma in Brazil November 2020; Delta in India October 2020 falls into this category.

Variants of Interest

: These are strains of the Coronavirus genetically distinguished by sequencing with potentialities of higher transmissibility, disease severity, and immunity resistance. They could pose threats in the future and need to be watched. Variants; Eta, Iota, Kappa, Lambda and Mu recently detected in Colombia are classified as variants of interest.

Variants of high consequence

: These are variants that would largely escape known control measures. Fortunately, at the moment, no candidates come under this category.

How Coronavirus variants originate

A variant begins as a mutation of one single virus in an infected person somewhere. It is very unlikely it would enter someone else and cause the disease. The variant requires to breed sufficiently in the individual in whom it was created. Again, in order to procreate and proliferate, it will have to compete with the parent strain, initially dominant in the patient. The variant will succeed in competing if it replicates faster and more effectively invades cells. As expected, all variants of concern possess the above qualities. Similarly, if the mutant had acquired the trait of evading host immunity, it could overshoot the parent strain.

Variants possibly originate and breed in immunosuppressed persons chronically infected with COVID-19. They carry large viral loads for prolonged durations, a pathology conducive to the birth and growth of variants. A wide range of mutants have been detected in such patients.

Characteristics of variants

Variants of concern spread faster in contrast to the parent strain. A pertinent question is, what changes in the virus provide this facility? For the virus to invade the human system, it must attach to a cell in the respiratory tract and transfer genetic material to the interior of the cell. The virus does this with a special protein in the spikes, binding selectively to a receptor in human cells named ACE2. In variants, the chemistry and architecture of the spikes are redesigned to enhance attachment. Thereafter, the migration of the replicating viruses to adjacent cells is also facilitated by the same process. The host antibodies drive the immune response by attacking spikes to suppress their bondage to the receptors. Mutagenic alterations in the spikes also help the variants to escape host immunity.

Most contagious Delta variant

The delta variant first identified in India, October 2020, resulted in an aggressive epidemic there and rapidly diffused. Several mutations in the spike proteins facilitated its fast spread. While retaining the common ancestral mutation D614G, the Delta carries three other mutations named P681R, L452R and D950N. The mutation D614G increases the number of spikes on the viral envelope. Production of higher viral loads in Delta-infected patients is believed to be a character manifested by the P681R mutation. Their respiratory tracts carry 1000 times more virus particles. The L452R mutation seems to protect spikes from antibodies helping immunity evasion. An ability of the Delta variant to attack a wider group of cells probably originates from a trait induced by D950N mutation. Mainly because of the changes in the spike proteins, the Delta variant reproduces faster by cell-to-cell invasion. Consequently, once this brand of Coronavirus enters a susceptible person, the symptoms appear in a shorter period of four to five days, compared to about a week for the alpha variant.

The Delta variant is 60 percent more transmissible than the alpha which stands 50 percent higher than the ancestral strain. A parameter defining the transmissibility of an infectious disease is the average number of cases reproduced by one carrier of the pathogen, the basic reproduction number (R0). An infection reaches epidemic proportions if R0 exceeds unity. When the pandemic originated in China, the value of R0 was about 2.5. The estimated value of R0 for the delta variant is somewhere between six and nine, an enormous increase in transmissibility relative to the previous strains.

Virus variants compete, whenever the Delta entered new territory, it out-competed other strains.

Vaccinations and Delta Variant

Except for a partial immunity evasion of the Delta variant, vaccines are effective against both variants. Vaccines lower the probability of catching the infection, more importantly greatly reduce serious complications and death. Some statistical assessments conclude that breakthrough infections (re-infections) are higher for the Delta variant compared to Alpha.

The discrepancies reported could also be indications of the fact that the Delta variant is far more contagious than previous strains. Here, the statistically meaningful epidemiological parameters are the number of different categories of infected persons (vaccinated, the severity of infection as determined by hospitalizations and mortality) as a percentage of the total number of infected individuals, recorded temporally. It is extremely difficult to keep track of these quantities when the disease spreads fast. Even the total number of people infected cannot be ascertained reliably. Under such circumstances, the anomalies reported as lesser effectiveness of vaccines in the case of the Delta variant, could also entail errors in data interpretation, arising from the fact that the Delta variant spreads fast.

There are also reports to the effect that more unvaccinated younger adults and children are hospitalized after the arrival of the Delta variant, reflecting the severity of symptoms. Theories have been put forward to explain the apparent anomaly. However, because of faster transmission of the Delta variant, proportionately younger patients may seek hospitalization.

As the dominant strain infecting a large proportion of people; the Delta variant will continue to mutate and evolve. Few mutational changes have already been noticed and named Delta pluses, but there is no evidence to conclude they are more dangerous.

Doomsday variant

News spreads like viruses. Just as mutations, inadvertent or deliberate distortions and exaggerations happen in reproducing news. Versions with more sensational twists disseminate faster.

In May 2021 a new variant carrying mutations suggestive of fast transmission and immunity resistance was identified in South Africa. Months later a reputed epidemiologist tweeted that the variant could be an imminent danger, prompting media to name it a doomsday variant. The ensuing panic was the result of premature unconfirmed assertion. The World Health Organization announced that this variant is not propagating as fast as the Delta.

Stories of pathogens spreading exceedingly fast, evading immunity, are common in science fiction. There is no evidence for such, even at times when preventive measures were completely unknown. Attributes encoded in different mutations do not add arithmetically. If one virus has a trait that allows it to spread fast and another to evade immunity, these two qualities will not necessarily be pronounced, to the same extent, in a third virus endowed with both mutations. Fear-mongering concerning doomsday viruses is most unlikely to persist.

Herd immunity and Delta variant

When the percentage of subjects acquiring immunity (either by vaccination or contracting the illness) exceeds a threshold, epidemics wane and disappear. The point at which this transpires depends on the value of the basic reproduction number R0; determined on the assumption there were no immune individuals, at the time the pathogen initiated the epidemic. As the immunity of the community increases, the reproduction number decreases proportionate to the fraction of people remaining susceptible and the rate of transmission is determined by an effective reproduction number RE. If N is the total population and M the number among them immune, the fraction susceptible is 1- M/N. Therefore the reproduction number reduces to the effective value RE = R0 (1 – M/N). Once RE reaches a value less than unity, the epidemic ceases to continue and the threshold corresponding to RE = 1, occurs when M/N = 1 -1/R0. At the beginning of the pandemic, the value of R0 was approximately 2.5 and the above formula yields M/N = 0.6, so that herd immunity threshold is 60 percent. For the highly transmissible Delta variant, a mean value of R0 is 7.5 and the same formula gives a herd immunity threshold of 87 percent. As vaccinated persons sometimes get re-infected, the actual threshold may exceed the above number, suggesting herd immunity is virtually beyond reach. Fortunately, R0 can be reduced by preventive measures such as social distancing, wearing masks and hand sanitization, thereby lowering the threshold.

Are we sufficiently disciplined to follow preventive measures stringently? The virus will continue to evolve via random mutations and their selection may be influenced by our behaviour. Will it turn more deadly or less deadly? These questions are too complex and unpredictable.

Fortunately, vaccines answer satisfactorily and redesigning and improvements are within reach. Preventive measures dampen transmission significantly. Every individual needs to follow these two strategies confidently, without resorting to unproven practices and myth.

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Right to Life – Right to drink clean water

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‘We don’t want the right to vote, just the right to live,’ the villager said, holding his dying child in his arms.

By Dr. Ranil Senanayake

This is the simple truth that seems to elude most development work. The right to life is more fundamental to humanity than any political or religious goal and certainly, more than the right to profit. The more we look to science to validate modern society, the more evident becomes the conclusion that we humans share the same evolutionary heritage as all other life on this planet and like all living things, we have limits. All living things stressed beyond their limits die. It is as simple as that.

Heat or cool a bacterium, algae or elephant beyond a certain threshold and they die. The same holds true for all elements of the environment, whether they be as innocuous as salt or as toxic as strychnine. But we are facilitated to cross these thresholds in the quest for profit, justified by claims of ‘development’. The fossil energy industry has endangered our right to life, by profiting in selling a planetary eco-toxin, unchallenged by the so-called guardians of our well-being, our elected leaders.

A healthy living environment is the most fundamental right that can be recognised for any human or any other living thing. Freedom from conditions hostile to life must become a basic right. A right to life!

The three basic substances of our biosphere, air, water and earth, share the characteristic that they are all dynamic and vary in quality and quantity from place to place on this planet. They form what can be termed the ‘Global Commons’ a place we all have equal access to in the pursuit of living. However, there is what is generally recognized as the ‘optimal range’ of values for each one of these substances, to render the environment hospitable to life. While my comments today are focused on water, it should be kept in mind that they apply equally to the other two.

Water is a critical element of all living things and it is the medium through which much of life is expressed, all animals and plants including humans are made mostly of water. Water is an essential material for the maintenance of global ecosystems; it is required in the right quality and quantity for each purpose that it is used for.  Water enters a landscape as rain or fog and moves across a landscape, responding to gravity and heat. It flows both above and below the soil level in every terrestrial ecosystem increasing its load of suspended and dissolved solids, organic and inorganic compounds as it flows. The ability to clean groundwater is demonstrated by active soils, wetlands and by evapotranspiration, this critical consideration is important, not only for human sustainability but also for the sustainability of our life support systems.

For Sri Lanka, where 90 percent of household water came from wells or springs, the condition of the surface and shallow aquifer is of critical importance. Internal renewable groundwater resources are estimated at 7.8 km3, most (estimated at 7 km3/year) returning to river systems and being included in the surface water resources estimate. The current trend of polluting surface water, if not checked, would place us in a situation similar to Honduras where almost all surface and shallow aquifer water is polluted and people have to depend on bottled water for drinking.

To protect this critical national resource there should be a National Water Resources policy, but it should emerge from the broadest public discussion possible. In that spirit the framework summarising the work of many authors is submitted below:

Framework National Water Resources Policy

All citizens of Sri Lanka are entitled to have access to clean water, free from pollution, for the preservation of life as a basic human right.

All water resources, excluding rainwater, belong to the people and subsequent to consultation and agreement may be held and managed in trust for them by local and national bodies, elected by the people.

Rainwater is considered part of the land on which it falls and will belong to the person or institution owning or having legal rights to use of the land.

In situations of limited supply, traditionally accepted water use rights for drinking and sanitation will take precedence over all other claims on the resource. Maintenance of livelihoods will be next in the order of precedence.

The unit for planning the development and management of water resources will be the stream or river basin watershed.

Where basins or watersheds are spread across local government boundaries, their utilization and management would be the responsibility of the next higher-level government concerned. Trans-basin and multi-basin development and utilisation of water resources would be managed by authorities set up for the purpose.

Government or Community organisations would be responsible for the distribution of water to users. This responsibility may be contracted out to private organisations where the government or community organisation concerned deems it appropriate.

Water rights will be recognised, with regulations governing allocations in line with local needs and national priorities.

In order to ensure the sustainability of publicly funded water development projects, whether for domestic use, irrigation or commercial purposes, responsibility for the maintenance of the systems would ultimately be handed over to the water users. In the case of large water development projects, the government would support the formation of user organizations for this purpose.

The development of water resources would take economic, social and environmental sustainability into account.

The responsibility for maintaining the quality of a water resource, according to the uses to which it is put, should rest with the users either individually or collectively as the case may be. External polluters of water sources shall be liable, under the law, to appropriate penalties.

Groundwater extraction and pollution will be monitored and appropriately regulated through the relevant institutions in groundwater sensitive areas.

Management of water resources will be devolved or decentralised as provided in prevailing Constitutional provisions.

Water resources should be shared among the demands of major competing uses, including domestic use, irrigation and drainage for agriculture, animal husbandry, fishery, aquaculture, biodiversity maintenance, power generation, industry, tourism and construction in a balanced and integrated manner.

Where there are competing demands for limited water resources, the quantity of water available, after satisfying the demand for domestic supplies and livelihood maintenance, would be allocated based on national and economic priorities rather than financial returns.

In situations of water scarcity, fiscal, and if necessary legal, punitive measures would be taken to prevent wastage, pollution and luxury consumption of water.

All developers of water resources including state agencies, will need to obtain the approval of the National Water Resources Council (NWRC), which should be set up to regulate the development and use of water resources. There will be incentive schemes for the improvement of water quality and quantity increase and disincentive schemes for the reduction of water quality and quantity.

The State will actively promote the integration of gender and public health concerns in policies, plans and programmes in water sector activities

All citizens have an obligation to conserve water, use it judiciously, avoid deliberate contamination and purify it at own cost if inadvertently contaminated.

Deep well groundwater extraction is a non-sustainable activity, although the deep aquifers are slowly charged with deep infiltration of rainwater, it can never be replaced at the rates that deep well extraction demands. This has led to land collapse over certain wells and intrusion of salt into others. Research conducted by the University of Tokyo suggests that it has also contributed to the rising of salt levels.

Living on a densely populated island requires us to be extremely vigilant about our water, its quality, quantity and ownership. How we use and manage our land, air and water resources today will determine the degree of comfort or hardship that the population of tomorrow will inherit. This is too important a topic to be distanced from public discussions or political platforms. Policy needs to be set in respect of how we interact with the global commons, transboundary effects is an obvious one. The smoke from Indonesia affecting Singapore or the haze from India affecting Sri Lanka provides clear examples as to why policy regarding a national position on the Global Commons needs urgent clarification.

Next: Right to Life – Right to breathe clean air

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What is this ‘black fungus’ infection?

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By Dr. Kavindya Marapana

Sri Lanka is in the process of recovering from the most severe COVID-19 wave, dominated by the Delta strain. At the time of writing, 513,278 cases of COVID-19 had been confirmed from all parts of the country with 12,600 deaths. It has affected physical and mental health, the economy, education and the overall wellbeing of people across the globe.

The government and relevant authorities are fighting the pandemic effectively, utilising the relevant healthcare services and facilities to manage patients, aided by lockdowns and the ongoing COVID-19 vaccination programme. More than 50 percent of the population have received both doses of vaccines.

Meanwhile, several cases of ‘black fungus’ infections have been reported among COVID-19 patients in hospitals in Colombo, Kurunegala and Ratnapura. With the experience of our neighbouring country India, reporting more than 45,000 cases of black fungus infection among COVID-19 patients, causing more than 4,300 deaths, it is of utmost importance for us to be aware of this condition and to adopt preventive measures to avoid such a deleterious situation.

Consultant Mycologist of Medical Research Institute, Colombo, Dr. Primali Jayasekera, in a brief interview with The Island, answers some frequently asked questions about the black fungus infection.

Q: What is ‘black fungus’ infection?

It is a rare but life-threatening fungal infection, known as mucormycosis and colloquially as ‘black fungus’, caused by fungi belonging to the Mucorales group.

Q: Is this infection new to Sri Lanka?

Mucormycosis has been diagnosed among immunocompromised patients (patients with weakened immune systems) in Sri Lanka, over the years, and it is not an uncommon infection among Sri Lankans. It has a worldwide distribution. Found ubiquitous in soil and decomposing organic matter. It can be found indoors and outdoors, in rotten food and dust. In addition, being a temperate country, Sri Lanka has the optimum temperature for the fungi to grow.

Q: How would someone get infected by it?

Most infections occur following inhalation of fungal spores in the air. As a result, nasal sinuses and lungs are the commonest initial sites of infection. Skin infections have also been reported following traumatic inoculation and following injections. Cases have been reported following ingestion of contaminated food as well.

Q. Who is at risk of getting infected?

Patients with prolonged or profound neutropenia (low neutrophils in blood), diabetes mellitus (type I and II), metabolic acidosis, malnutrition, steroid users, bone-marrow transplant recipients, solid organ transplant recipients, patients with haematological malignancies (blood cancers), patients with burn injuries and injection drug users are at risk of developing this infection. It has also been detected among some patients with no apparent immunological defects.

Q. Are COVID-19 patients at a higher risk of getting infected?

Some COVID-19 patients are being treated for cytokine storm, and this is essential. But if such a patient has a weakened immune system, due to some other cause, he or she is more susceptible to mucormycosis infection, compared to a non-COVID-19 infected person with a weak immune system.

Q. What are the symptoms suggestive of the infection?

It depends on the site of infection. The commonest sites of infection are the nasal and adjacent sinuses (rhino cerebral mucormycosis) and lungs. Patients can present with fever, facial swelling (affecting one side of the face), unilateral headache, nasal or sinus congestion or pain and a blood-tinged nasal discharge.

Characteristic diagnostic signs include necrotic black ulceration on the hard palate or nasal turbinates, drooping eyelids, proptosis (protrusion of eyes), ophthalmoplegia (eye muscles not working properly), loss of vision and oozing of black pus from eyes.

Q. How is it treated? What complications can one develop?

Surgical excision and antifungal drugs are mandatory in treatment. Complications include infection spreading to the eye socket, swelling around the nose and eyes with progressive destruction of facial tissues. Infection can spread to the brain affecting the frontal lobe and form abscesses within the brain.

Q. How can one prevent infection?

It can be prevented by

• Adequate control of diabetes mellitus.

• In immunocompromised individuals, reducing the sources of environmental exposure (refraining from gardening, consumption of old and contaminated food, use of contaminated surgical dressing, syringes and such) and avoiding inhalation of spores during critical periods.

• Avoiding contact with COVID-19 patients or suspected individuals.

• Taking both doses of COVID-19 vaccine.

• Always using a clean face mask.

• If diagnosed with COVID-19, receiving treatment from a qualified doctor, as self-medicating with western medicine is very dangerous due to side effects which can make you more susceptible to mucormycosis.

Consequently, it is observed that some individuals are at higher risk of developing conditions such as black fungus infection during COVID-19 infection, and this can lead to severe disability and even death due to already existing comorbidities, as opposed to healthy individuals.

Therefore, it is our duty as responsible citizens to adhere to health guidelines, get fully vaccinated and help control and eventually eliminate this pandemic.

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