Millions of people around the world have battled COVID-19 over the last year, but for some, the struggle is not over after overcoming the viral infection itself. Numerous cases of post-covid infection complications have been reported and COVID infections have also made people prone to getting certain diseases. Of these diseases gaining traction during the pandemic, three are being talked about the most: black fungus, MIS-C, and POTS. To better understand the true toll of this pandemic and the costs of it, we must go beyond understanding COVID and also take the time to learn about these diseases that we may become prone to during the pandemic
Black fungus (mucormycosis)
Mucormycosis is a rare fungal infection in humans caused by exposure to mucor mold. Mucor mold is found almost everywhere, including in soil, plants, manure, air, and even the nose and mucus of healthy individuals. Despite mucor mold’s presence on virtually every type of surface and even the air, being infected by it is quite rare and the body’s immune defenses are usually capable of battling any exposure to the mold.
For those who do end up getting infected, though, the black fungus affects their nose, eyes, and sometimes even spreads to the brain. Symptoms of the infection include a “stuffy and bleeding nose; swelling of and pain in the eye; drooping of eyelids; and blurred and finally, loss of vision” as reported by the BBC. This infection has a 50% mortality rate, much higher than that of COVID itself, which makes it extremely deadly. It is especially dangerous to diabetics and those who are immunocompromised, such as those with HIV/AIDs or cancer.
The only way to treat this fungal infection is with an antifungal intravenous injection administered daily for up to 8 weeks. Additionally, a shocking 60% of hospitalized patients with this infection end up getting at least one eye removed to prevent the infection from reaching their brain. In some extreme cases, patients even have to get their jaws removed to prevent the spread of the fungal infection.
The connection between COVID and mucormycosis is rather obvious as we observe the current wave of the pandemic occurring in India. Cases of mucormycosis are popping up all over the country as it battles high levels of the coronavirus, and in Delhi itself, there have been 750 reported cases and 50 deaths. The NY Post reports that “medics in India are now seeing around five or six cases a day, but would usually see three or four a year”.
The reasons why this is occurring is not because of COVID itself but rather the steroids used to treat COVID patients. When a person has COVID their immune system is actively fighting the virus, which can cause side effects such as inflammation that can be treated with steroids. However, steroids also boost blood sugar levels and reduce immunity when introduced into the body. This then makes steroid-treated patients prone to fungal infections such as mucormycosis. Most patients test negative for COVID after being infected and then are hospitalized for mucormycosis a few weeks later upon exposure to the fungus in an already weakened state.
The current spread of mucormycosis across India can be attributed to both the high levels of COVID infections there and the lack of drugs to treat mucormycosis in India. A few cases in concentrated groups have also been detected outside of India last week for the first time. As COVID infections still remain at high rates in some parts of the world, we must also be wary of the spread of mucormycosis. Doctors and patients should be careful regarding the amount of steroid use in COVID treatments (limiting it when possible) to protect individuals from this disease.
MIS-C (Multi Inflammatory Syndrome in Children)
MIS-C is a rare pediatric condition that has become increasingly prevalent during the COVID-19 pandemic. It is caused by viral particles - such as those of the coronavirus- remaining in the intestines even after the infection has subdued and then traveling into the bloodstream to cause a subsequent MIS-C infection, typically 2 to 6 weeks after a COVID-19 infection. This infection then causes an inflammatory immune response in the “heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs” (VeryWellHealth).
MIS-C has been closely associated with COVID-19 during the pandemic, a pandemic study published in the Journal of Clinical Investigation finding that 95% of the stool samples of children with MIS-C also had COVID-19 viral particles. A total of 4018 MIS-C cases have been reported in America and 36 deaths, most after the pandemic started.
MIS-C infections cause stomach pains, diarrhea, vomiting, stomach pain, fatigue, and swelling in children. The median age of these children affected by it is 9 years, with most falling between the age of 5 to 13 years of age. This disease also happens to disproportionately affect Latino and black children with 62% of children who get MIS-C being black or Latino. This may be attributed to the higher incidences of COVID-19 in black and Latino communities.
There is no treatment for an MIS-C infection as of now, but steroid medications for inflammation, IV hemoglobin, and fluids are currently being used to help the patients fight off this infection. Some children even end up requiring ICU care for extended periods of time when they get MIS-C.
The development of drugs to treat MIS-C directly is currently occurring but needs to be sped up if cases of MIS-C and COVID continue to increase in certain parts of the world. Addressing the spread of COVID in minority communities can also help lower rates of MIS-C infections. Children under the age of 12 are still not eligible for the COVID vaccine and may not be eligible till the end of 2021, putting them at higher risk for MIS-C if community COVID infection rates are high. Vaccinating children needs to be made a priority and children should continue to wear masks in order to protect themselves from both COVID and MIS-C.
POTS (postural orthostatic tachycardia syndrome)
POTS is a syndrome in which one’s autonomic nervous system (the part of your nervous system that controls actions that happen without your control to maintain homeostasis) fails to control heart rate and blood pressure. There are two parts to the autonomic nervous system, the sympathetic nervous system that creates a stress response and the parasympathetic nervous system that returns your body to a calm state after a stress response is completed. In this syndrome, antibodies are made by your immune system that attacks your own sympathetic nervous system which leads to dysfunctional blood circulation (limited blood flow to the heart), dizziness, and faintness.
This syndrome is triggered by surgery, concussions, pregnancy, and viral infections such as COVID. It is considered a “long haul” symptom of a COVID infection that has seen a huge surge during the pandemic, but even before the pandemic, there were around 3 million reported cases of it in America. Additionally, this syndrome disproportionately affects women ages 15 to 50 the most. Those with a history of dizziness, lightheadedness, and a racing heartbeat are at higher risk for this disease after a COVID infection. These are frequent menstrual symptoms, which probably explain why women of menstruating age have higher instances of POTS.
This disorder can be treated by controlling blood flow with increased salt and water intake as well as physical exercise. Medications including midodrine, fludrocortisone, and beta-blockers can also be used to treat the symptoms of POTS but not the syndrome itself. Staying hydrated, taking COVID precautions, and maintaining physical fitness are all ways to prevent POTS and a potential hospital stay associated with it.
As COVID still remains prevalent in many parts of the world, we need to continue practicing social distancing and mask-wearing to some extent especially if we are not vaccinated. It is the best way to protect ourselves and especially children (who are not eligible for vaccines yet) from not only COVID but also some of these potentially life-threatening conditions that can stem from a COVID infection!
I've been seeing a fair bit in the news about the black fungus, that's so incredibly unfortunate
I've been reading more and more about the long haul effects of Covid. I hope that as the scientific and medical communities learn more that more help can be given. Thanks for sharing.