Amid the spread of 'black', 'white' and 'yellow' fungus in COVID-recovered patients, health experts have said that multiple factors are playing a role and the high intake of zinc supplements in the pandemic may also be one of the key factors, but more research is needed on this.

Zinc is thought to accumulate iron in the body which can create a breeding ground for mucormycosis, a serious but rare fungal infection caused by a group of moulds called mucormycetes. Mucor growth in a human body depends on multiple host factors. Last year, doctors had seen mucor patients, but the number was less as the number of COVID patients was less. "This year, the number of COVID patients is high, the virulence of COVID is more and steroids have been used indiscriminately, so several factors are playing a role in the spread of the black fungus", Dr Aparna Mahajan, Consultant-ENT, Fortis Escorts Hospital, Faridabad, stated.

Mucormycosis has been there in India for decades. Rhinoorbitocerebral mucormycosis is the most common and has been managed by ENT surgeons for several decades. "But it used to present itself very rarely and in immunocompromised patients like diabetics or cancer patients or transplant recipients, etc. Due to COVID, it has reached the masses," Mahajan said.

The country has recorded 11,717 cases of black fungus to date with Gujarat, Maharashtra, Andhra Pradesh, Madhya Pradesh, and Telangana reporting highest number of cases. According to Dr Dinesh V. Kamath, Consultant, Internal Medicine, Manipal Hospitals Malleshwaram, there is no direct link between zinc and mucormycosis, a fungal infection seen primarily in people who have uncontrolled diabetes, increased usage of steroids, and situations where they are immunocompromised. "As of now, there was no direct link between zinc and mucormycosis. But mucormycosis has been a very rare disease for about the past year. After this pandemic, especially in the second wave, we are seeing a greater number of mucormycosis cases", Kamath said.

There were some possibilities like increased steam inhalation may cause mucormycosis, or people who are on high supplements of zinc may be one of the factors for the increased incidence. "That is how there is a link now that there may be a cause of high zinc intake for mucormycosis, however, it certainly requires more studies to prove this", Kamath said. Due to the fear of COVID, patients started taking zinc and iron supplements on their own. "My final say would be not to use zinc as the blanket treatment to all the patients and definitely not as prevention. Only patients who are diagnosed with COVID can consider it, and zinc as a supplement can be given for a short period, and then stopped once they recover from the illness", Kamath added.

Mucormycosis has multi-factorial reasons which have seen increased incidence, particularly in the second wave in the past few weeks. "Both the public and the doctors should be more aware to see that they don't use steroids inappropriately and should ensure that diabetes is under good control," experts advised.