Covid News: India’s ‘Black Fungus’ Crisis Spreads

Credit…Atul Loke for The New York Times

The number of so-called black fungus cases in India shot up to more than 30,000 from negligible levels in just three weeks. The deadly disease has sickened former coronavirus patients across the country, and doctors believe that hospitals desperate to keep Covid-19 patients alive made choices that left them vulnerable.

Indian states have recorded more than 2,100 deaths, according to news reports. The federal health ministry in New Delhi, which is tracking nationwide cases to allot scarce and expensive antifungal medicine, has not released the number of fatalities.

The coronavirus pandemic has drawn stark lines between rich nations and poor, and the mucormycosis epidemic in India stands as the latest manifestation. During the second wave, which struck India in April, its creaky, underfunded medical system lacked beds, oxygen and other necessities as infections and deaths soared.

The mucormycosis epidemic adds even more urgency to the difficult task of protecting India’s 1.4 billion people, only a fraction of whom have been vaccinated against the coronavirus. They remain vulnerable to a third wave and the consequences that could follow.

“Mucormycosis will tail off and go back to baseline as the Covid cases subside,” said Dr. Dileep Mavalankar, an epidemiologist. “But it may come back in the third wave unless we find out why it is happening.”

Many doctors in India think they know why. The bone-and-tissue-eating fungus can attack the gastrointestinal tract, the lungs, the skin and the sinuses, where it often spreads to the eye socket and the brain if untreated. Treatment for the disease involves complex, often disfiguring surgery and an uncommon and expensive drug, contributing to a mortality rate above 50 percent.

Mucormycosis is not passed from person to person. It develops from commonplace spores that sometimes build up in homes and hospitals. Doctors believe India’s crowded hospitals, and their dire lack of medical oxygen, left the fungus an opening.

Without enough oxygen, doctors in many places injected patients with steroids, a standard treatment for doctors battling Covid globally. Steroids can reduce inflammation in the lungs and help Covid patients breathe more easily.

Many doctors prescribed steroids in quantities and for durations that far exceed World Health Organization recommendations, said Arunaloke Chakrabarti, a microbiologist and the co-author of a study examining the causes of India’s mucormycosis outbreak. Those steroids may have compromised patient immune systems and made Covid patients more susceptible to fungal spores.

The steroids may have also dangerously increased blood sugar levels, leaving people with diabetes vulnerable to mucormycosis. It could also increase the chance of blood clots, leading to malnourished tissue, which the “fungus attacks,” said Dr. Bela Prajapati, who oversees treatment for nearly 400 patients with mucormycosis.

Desperate doctors may not have had the chance to ask patients whether they had diabetes or other conditions before resorting to steroids.

“Doctors hardly had any time to do patient management,” Dr. Chakrabarti said. “They were all looking at how to take care of the respiratory tract.”

A woman placed a rose in the sand on Copacabana beach in Rio de Janeiro on Sunday, in memory of Brazil’s 500,000 coronavirus deaths.
Credit…Silvia Izquierdo/Associated Press

The Covid-19 death toll in Brazil has now surpassed 500,000, behind only the United States, which marked 600,000 deaths last week, and India, where deaths may range from 600,000 to as high as 4.2 million.

Nearly 18 million people have been infected so far, and the country is averaging almost 73,000 new cases and some 2,000 deaths a day, according to official data. But many experts believe the numbers understate the true scope of the country’s epidemic, as they do in India.

Brazil’s president, Jair Bolsonaro, has been heavily criticized for dismissing the threat posed by the virus, despite contracting it himself last year. On Saturday, thousands of people protested his response to the pandemic, including his resistance to mask-wearing edicts and the slow rollout of vaccines, according to Reuters. Only 11 percent of residents are believed to be fully vaccinated.

A severe drought has also gripped the country, the worst in at least 91 years, and experts say a terrible fire season may further complicate the country’s struggle to manage the virus. The smoke could even aggravate cases of Covid-19, by increasing the inflammation in the lungs.

“It’s a situation that’s dangerous,” said Dr. Aljerry Rêgo, a professor and director of a Covid facility in the Amazon state of Amapá. “And the biggest risk, of course, is overwhelming the public health system even further, which is already precarious in the Amazon.”

In recent testimony before a legislative committee, Brazil’s former health ministers described Mr. Bolsonaro’s befuddling belief that an anti-malaria drug was effective against Covid-19, and an executive at Pfizer said that the company offered millions of doses of its Covid-19 vaccine to Brazil last year — but received no response from the government for months.

Mr. Bolsonaro shrugged off the revelations. Last month, his government announced that Brazil would host the Copa America soccer tournament later this year, after Argentina decided it would be irresponsible to do so while the virus continued to spread.

On Friday, officials reported that 82 people connected with the tournament had contracted Covid-19, according to The Associated Press. Brazil’s health ministry said in a statement that 37 players and staffers of the 10 tournament teams infected, along with 45 workers.

Many immigrants, who are suspicious of the coronavirus vaccine and fear government help, have been sold fraudulent Covid therapies at flea markets like the Cherry Avenue Auction in Fresno, Calif.
Credit…Brian L. Frank for The New York Times

FRESNO, Calif. — On a Tuesday afternoon in April, among tables of vegetables, clothes and telephone chargers at Fresno’s biggest outdoor flea market were prescription drugs being sold as treatments for Covid.

Vendors sold $25 injections of the steroid dexamethasone, several kinds of antibiotics and the anti-parasitic drug ivermectin. Chloroquine and hydroxychloroquine — the malaria drugs pushed by President Donald J. Trump last year — make regular appearances at the market as well, as do sham herbal supplements.

Such unproven remedies, often promoted by doctors and companies on social media, have appealed to many people in low-income immigrant communities in places across the country where Covid-19 rates have been high but access to health care is low. About 20 percent of Hispanic people in the United States lack health insurance, and the proportion is far higher among undocumented immigrants.

What’s more, some immigrants mistrust doctors who don’t speak their language or who treat them curtly — and those concerns have been amplified by harsh political rhetoric directed at Mexicans and Central Americans.

“My community fears that the government might be trying to get rid of us,” said Oralia Maceda Méndez, an advocate at a Fresno-based community group for Indigenous people from Oaxaca, Mexico.

A woman in Fresno recently described how her husband, a farmworker, had fallen so sick from Covid-19 that he couldn’t breathe or walk, but he refused to go to the hospital because he had heard rumors that undocumented immigrants had checked in and never left.

She took him to a wellness clinic, where a doctor gave him injectable peptide treatments, recalled the woman, who requested anonymity because of her immigration status.

She wasn’t prepared, she said, for the $1,400 bill, which included the cost of syringes and vials labeled thymosin-alpha 1, BPC-157 and LL-37. Pulling them out of a cabinet in the kitchen of her mobile home, she said she didn’t know exactly what they were, and she still feels the sting of the price.

“I was shocked, but I was trying to act like it was OK because I had to be strong for my husband and my kids,” she said. He grew sicker despite the injections, but the family had no funds left for care. More than a month passed before he was well enough to return to the fields.

Some unregulated drugs can be dangerous. And even if they aren’t a health risk by themselves, they can lead people to postpone seeking help from doctors, which can be deadly. Delayed treatment is one reason Black and Hispanic people have died from Covid at twice the rate as white people in the United States.

Alternative therapies can also limit a patient’s treatment options because doctors worry about toxic drug interactions, said Dr. Kathleen Page, an infectious-disease specialist at Johns Hopkins University School of Medicine in Baltimore.

“I’m not upset at patients when they tell me what they’ve taken,” Dr. Page said. “I’m upset about the system that makes it easier for them to get help from nontraditional places than from regular health care.”

Sandy Sirias contributed reporting. This story was supported by the Pulitzer Center.

David Lat, a legal writer in Manhattan, had Covid-19 last year and received the vaccine. An antibody test in April showed he was barely positive, but Mr. Lat did more research and found that the test didn’t measure antibodies from the vaccine.
Credit…Gabby Jones for The New York Times

Now that tens of millions of Americans are vaccinated against the coronavirus, many are wondering: Do I have enough antibodies to keep me safe?

For a vast majority of people, the answer is yes. That hasn’t stopped hordes from stampeding to the local doc-in-a-box for antibody testing. But to get a reliable answer from testing, vaccinated people have to get a specific kind of test, and at the right time.

Scientists would prefer that the average vaccinated person not get antibody testing at all, on the grounds that it’s unnecessary. In clinical trials, the vaccines authorized in the United States provoked a strong antibody response in virtually all of the participants.

“Most people shouldn’t even be worrying about this,” said Akiko Iwasaki, an immunologist at Yale University.

But antibody tests can be crucial for people with weak immune systems or those who take certain medications — a broad category encompassing millions of people who are recipients of organ donations, have certain blood cancers, or who take steroids or other drugs that suppress the immune system. Mounting evidence suggests that a significant proportion of these people do not produce a sufficient antibody response after vaccination.

If you must get tested, or just want to, it’s essential to get the right kind of test. Early in the pandemic, many commercial tests were designed to look for antibodies to a coronavirus protein called the nucleocapsid, or just N, because after infection, those antibodies were plentiful in the blood.

But these antibodies are not as powerful as those required to prevent virus infection, nor do they last as long. More important, antibodies to the N protein are not produced by the vaccines authorized in the United States; instead, those vaccines provoke antibodies to another protein sitting on the surface of the virus, called the spike.

Rapid tests that are commonly available deliver a yes-no result, and may miss low levels of antibodies. A certain type of lab tests, called Elisa, may offer a semi-quantitative estimate of antibodies to the spike protein.

Many doctors are still unaware of the differences between antibody tests, or the fact that the tests measure just one form of immunity to the virus. In May, the Food and Drug Administration recommended against the use of antibody tests for assessing immunity — a decision that has drawn criticism from some scientists — and provided only bare-bones information about testing to health care providers.

It’s also important to wait to be tested at least two weeks after the second shot of the Pfizer-BioNTech or Moderna vaccines, when antibody levels will have risen enough to be detectable. For some people receiving the Johnson and Johnson vaccine, that period may be as long as four weeks.

But antibodies are just one aspect of the immune system. The body also maintains so-called cellular immunity, a complex network of defenders that also responds to invaders.

“There’s a lot happening under the surface that antibody tests are not directly measuring,” said Dr. Dorry Segev, a transplant surgeon at Johns Hopkins University.

The Wuhan Institute of Virology, in China, is central to unproven speculation that researchers were experimenting with so-called gain-of-function research on the coronavirus. 
Credit…Ng Han Guan/Associated Press

At a Senate hearing on efforts to combat Covid-19 last month, Senator Rand Paul, Republican of Kentucky, asked Dr. Anthony S. Fauci whether the National Institutes of Health had funded “gain-of-function” research on coronaviruses in China.

“Gain-of-function research, as you know, is juicing up naturally occurring animal viruses to infect humans,” the senator said.

Dr. Fauci, the nation’s top infectious disease expert, flatly rejected the claim: “Senator Paul, with all due respect, you are entirely and completely incorrect.”

This exchange, and the bit of scientific jargon at the heart of it, has gained traction in recent weeks — usually among people suggesting that the coronavirus was engineered, rather than having jumped from animals to humans, the explanation favored by most experts on coronaviruses.

The uproar has also drawn attention back to a decade-long debate among scientists over whether certain gain-of-function research is too risky to allow. The stakes of the debate could not be higher.

Too little research on emerging viruses will leave us unprepared for future pandemics. But too little attention to the safety risks will increase the chances that an experimental pathogen may escape a lab through an accident and cause an outbreak of its own.

Sorting out the balance of risks and benefits of the research has proved over the years to be immensely challenging. And now, the intensity of the politics and rhetoric over the lab leak theory — the unproven idea that the coronavirus escaped from a lab in Wuhan, China — threatens to push detailed science policy discussions to the sidelines.

“It’s just going to make it harder to get back to a serious debate,” said Marc Lipsitch, an epidemiologist at the Harvard T.H. Chan School of Public Health who has urged the government to be more transparent about its support of gain-of-function research.

There’s no question the new coronavirus will influence the shape of the debate. Jesse Bloom, a virologist at the Fred Hutchinson Cancer Research Center, said that before the pandemic, the idea of a new virus sweeping the world and causing millions of deaths felt hypothetically plausible. Now he has seen what such a virus can do.

“You have to think really carefully about any kind of research that could lead to that sort of mishap in the future,” Dr. Bloom said.

People sat in a plaza on 42nd Street in Manhattan on Thursday, in front of a vacant storefront.
Credit…Gabriela Bhaskar/The New York Times

As the national economy recovers from the pandemic and begins to take off, New York City is lagging, with changing patterns of work and travel threatening the engines that have long powered its jobs and prosperity.

New York has suffered deeper job losses as a share of its work force than any other big American city. And while the country has regained two-thirds of the positions it lost after the coronavirus arrived, New York has recouped fewer than half, leaving a deficit of more than 500,000 jobs.

Restaurants and bars are filling up again with New Yorkers eager for a return to normal, but scars are everywhere. Boarded-up storefronts and for-lease signs dot many neighborhoods. Empty sidewalks in Midtown Manhattan make it feel like a weekend in midweek. Subway ridership on weekdays is less than half the level of two years ago.

The city’s economic plight stems largely from its heavy reliance on office workers, business travelers, tourists and the service businesses catering to all of them. All eyes are on September, when many companies aim to bring their workers back to the office and Broadway fully reopens, attracting more visitors and their dollars. But even then, the rebound will be only partial.

The shift toward remote work endangers thousands of businesses that serve commuters who are likely to come into the office less frequently than before the pandemic, if at all. The Partnership for New York City, a business advocacy group, predicts that by the end of September, only 62 percent of office workers will return, mostly three days a week.

Restoring the city to economic health will be an imposing challenge for its next mayor, who is likely to emerge from the Democratic primary on Tuesday. The candidates have offered different visions of how to help struggling small businesses and create jobs.

“We are bouncing back, but we are nowhere near where we were in 2019,” said Barbara Byrne Denham, senior economist at Oxford Economics. “We suffered more than everyone else, so it will take a little longer to recover.”

The city’s unemployment rate in May, 10.9 percent, was nearly twice the national average of 5.8 percent. In the Bronx, the city’s poorest borough, the rate is 15 percent. Workers in face-to-face sectors like restaurants and hospitality, many of whom are people of color, are still struggling.

Raisa Smirnova seen in her home in Yekaterinburg, Russia, earlier this month. She was poisoned in April 1979 at the ceramics factory where she worked, near the military lab.
Credit…Sergey Ponomarev for The New York Times

YEKATERINBURG, Russia — Patients with unexplained pneumonias started showing up at hospitals; within days, dozens were dead. The secret police seized doctors’ records and ordered them to keep silent. American spies picked up clues about a lab leak, but the local authorities had a more mundane explanation: contaminated meat.

It took more than a decade for the truth to come out.

In April and May 1979, at least 66 people died after airborne anthrax bacteria emerged from a military lab in the Soviet Union. But leading American scientists voiced confidence in the Soviets’ claim that the pathogen had jumped from animals to humans. Only after a full-fledged investigation in the 1990s did one of those scientists confirm the earlier suspicions: The accident in what is now the Russian Urals city of Yekaterinburg was a lab leak, one of the deadliest ever documented.

Nowadays, some of the victims’ graves appear abandoned, their names worn off their metal plates in the back of a cemetery on the outskirts of town, where they were buried in coffins with an agricultural disinfectant. But the story of the accident that took their lives, and the cover-up that hid it, has renewed relevance as scientists search for the origins of Covid-19.

It shows how an authoritarian government can successfully shape the narrative of a disease outbreak and how it can take years — and, perhaps, regime change — to get to the truth.

Many scientists believe that the virus that caused the Covid-19 pandemic evolved in animals and jumped at some point to humans. But scientists are also calling for deeper investigation of the possibility of an accident at the Wuhan Institute of Virology.

There is also widespread concern that the Chinese government — which, like the Soviet government decades before it, dismisses the possibility of a lab leak — is not providing international investigators with access and data that could shed light on the pandemic’s origins.

The Hulhumalé Medical Facility, shown in a photo provided by the Maldives government, was built for the treatment of Covid-19 but is facing a shortage of medical workers.  
Credit…Health Emergency Operations Center

The largest Covid-19 treatment facility in the Maldives has nearly 300 beds and a steady supply of oxygen. But as the country reported some of the world’s highest caseloads per capita last month, Covid wards ran low on another essential resource: employees.

The health care system in the Indian Ocean archipelago depends largely on doctors and nurses from India, a country that is facing its own crushing outbreak. With foreign health professionals unavailable, the Maldives’ only medical school — which opened in 2019 and has a total of 115 students — sent dozens of medical and nursing students to work in Covid wards in the capital, Malé. The government also called nurses out of retirement and drafted volunteers with no medical experience.

“We were always prepared for a possible surge, but a wave this sudden and massive was just unexpected,” said Nazla Musthafa, a health adviser to the government.

Though 59 percent of the Maldives’ approximately 540,000 people have received at least one dose of a Covid-19 vaccine, the recent surge took a heavy toll. Nearly half of the country’s 200 Covid deaths during the entire pandemic were reported in May.

Many people in Malé now have someone in their extended families who has died, said Marjan Montazemi, the UNICEF representative to the Maldives. “Because the numbers are not the same as in other countries, it doesn’t attract that much attention,” she said. “But for the country, it has been quite difficult.”

Canadian boxer Mandy Bujold training in Kitchener, Ontario, last month. Ms. Bujold, a 33-year-old flyweight, is one of Canada’s most decorated female boxers. But her bid to fight in Tokyo hit a roadblock after the qualifying tournament in Buenos Aires for boxers from the Americas was canceled.
Credit…Ian Willms for The New York Times

The Tokyo Olympics, already upended because of the coronavirus pandemic, which prompted a yearlong delay and heavy restrictions, is preparing for events in some sports to take place without the best athletes possible.

Numerous qualifying events have been canceled because of safety concerns, raising competitive questions similar to those seen when major sporting events are shortened by strikes and other unusual circumstances.

Few sports have been as disrupted as much as boxing, which was in disarray before the pandemic. In 2019, the International Olympic Committee suspended the International Boxing Association, or AIBA, because of judging scandals, ethics violations and allegations of corruption in the organization’s top ranks.

The I.O.C. formed a boxing task force to run the Olympic qualifying events instead of AIBA, but the pandemic threw some of those competitions into flux as well.

The European event was halted on its third day in March 2020 and was eventually completed this month. The tournament for boxers in the Americas was also postponed in 2020, but was fully canceled this year. A final qualifying competition for boxers who failed to earn spots in their continental tournaments was also canceled.

To make up for the canceled events, the task force decided to use the rankings at tournaments that took place as far back as 2017, from events that were originally designed to determine seedings, to fill these open slots.

Unintentionally or not, the I.O.C. created an uneven playing field, with some boxers fighting their way in last year, others qualifying based on their success a few years ago, and hundreds more unable to earn a spot in Tokyo because they did not participate in tournaments that retroactively became qualifying events.

“A fundamental premise about selection procedures is that they are published in advance and followed, so athletes have a chance to qualify,” said Jeffrey Benz, the former general counsel of the United States Olympic Committee. “It sounds like here they have taken away chances for boxers by looking backward at other events out of administrative convenience.”

Thus far, 173 boxers have filled the 286 slots at the Tokyo Games by winning bouts at qualifying events. Another 102 have earned a trip because of their rankings based on past tournaments. The remaining spots will be given to Japan as the host nation or awarded with wild cards.

A 35-day manhunt in Belgium that involved helicopters, armored vehicles, 400 soldiers and police officers, as well as reinforcements from Germany and the Netherlands, culminated on Sunday in the discovery of a body believed to be that of a missing soldier with links to the far right.

The body was found in a forest where the soldier, Jürgen Conings, 46, disappeared more than a month ago after threatening the government and virologists responsible for the country’s response to the coronavirus, the federal prosecutor said. At the time, the soldier was armed with four rocket launchers, a submachine gun and a semiautomatic pistol that he had taken from an army depot.

The prosecutor said an initial investigation indicated the body belonged to Mr. Conings, a shooting instructor who in February was classified as a high-level threat to national security. He appears to have shot himself, the authorities said.

In a letter to his girlfriend around the time he disappeared on May 17, Mr. Conings wrote that he would not give up without a fight.

The soldier’s disappearance came at a time of frustration in Belgium over pandemic restrictions and the economic damage from them. The country has had a relatively large number of Covid-19 deaths per capita and has imposed one of the longest lockdowns in Europe.

The far-right camp in Belgium has used the pandemic to inflame public anger at the government. Reports from state security agencies warned as early as last spring of “the emergence of various right-wing extremist individuals and groups spreading conspiracy theories” about Covid-19.

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