As India begins to recover from a devastating second wave of coronavirus infections, thousands of Covid-19 patients in the country developed the deadly "black fungus" infection.
India has had about 12,000 cases and more than 300 deaths from black fungus in the past few months, with several states affected.
Other countries have reportedly recorded many Covid-linked black fungus cases including Pakistan and Russia.
On May 25, Bangladesh reported its first death caused by black fungus.
A disease as unpleasant as it sounds, black fungus, or mucormycosis, is a fungal disorder that forces surgeons in some cases to remove patients’ eyes and jawbones to stem the infection.
It's a lot more common in developing countries. It's certainly more common in patients with diabetes and in organ transplant patients
Until this year, there had been only a few dozen published mucormycosis cases linked to Covid-19 worldwide, but in India alone recent case numbers run into the thousands.
A recent scientific paper said a combination of a severe Covid-19 outbreak and uncontrolled diabetes – a key risk factor – created “the perfect storm for mucormycosis”.
Here we outline what mucormycosis is and why so many people are being infected and even dying.
What is mucormycosis?
This group of infections is caused by spores of fungi known as mucormycetes. Common in soil and decaying organic matter, including leaves, fruit, vegetables and manure, they are usually harmless, but their airborne spores can cause illness in individuals with weak immune systems.
Symptoms include headache, fever, blocked nose, chest pain, breathing difficulties and, if the infection spreads to them, pain and pressure around the eyes and blurred or double vision.
Patients may cough up blood and develop a blackish discolouration over the bridge of the nose, with a process of tissue death or necrosis occurring. This occurs when too little blood flows to the tissue.
Figures from the US Centres for Disease Control and Prevention indicate that slightly more than half of people with the disease die.
Fortunately, the condition is not thought to spread from person to person.
How common is it?
The condition is rare in developed nations, with the CDC quoting a US study that found an annual rate of 1.7 cases per million people. But it occurs much more frequently in some developing nations.
“In my whole career, I’ve seen probably two or three cases,” said Dr Andrew Freedman, an infectious diseases specialist at Cardiff University in the UK.
“It’s exceedingly rare in the UK but it’s a lot more common in developing countries ... it’s certainly more common in patients with diabetes and in organ transplant patients.”
Figures published in March this year, before the worst of India's second Covid-19 wave, suggested that the country of 1.37 billion accounted for 71 per cent of cases worldwide.
Apart from India, Pakistan and Russia reported cases of the deadly disease.
Russia confirmed reports of black fungus among Covid-19 patients on May 17, but authorities said the situation was under control.
Why did numbers surge during India’s wave of Covid-19 cases?
People with Covid-19 are sometimes given steroids to reduce lung inflammation, but these drugs weaken the immune system and so increase the risk of mucormycete infection.
“Steroids ... are commonly used to treat severe Covid, and they predispose to rare infections, like fungal infections,” Dr Freedman said.
Particularly if steroids are used in excess, the fungus may be able to multiply and cause an infection.
That steroids can increase blood-sugar levels in some people with diabetes, which is common in India, is also thought to be a factor, with more than eight in 10 black fungus cases happening in diabetics. A frequent scenario is for the disease to develop in diabetics recovering from Covid-19 at home.
The disease is more common after a prolonged stay in intensive care, leading to concerns that contaminated oxygen cylinders, pipes and humidifiers in hospitals are causing infections.
Uncertainty persists, however, because there a5re reports from India that mucormycosis has been seen in individuals who have not been treated with steroids or given oxygen.
How is it treated?
Early treatment is important to stem the infection and prevent it from spreading. In advisory notes, the Indian Council of Medical Research and India’s Ministry of Health and Family Welfare tell clinicians to “not lose crucial time to initiate treatment”.
Black fungus is often treated by intravenous injections of anti-fungal medication for at least four weeks.
Surgery may be required to cut away dead tissue and prevent the infection spreading. Drastic measures are often called for, such as removing an eye to stop the fungus reaching the brain, or cutting out part of the jaw or the skull. Some patients now face a life where they will struggle to talk or eat normally because parts of their mouth were cut away.
Doctors are told to reduce and then discontinue steroid treatment in affected patients, and to stop giving other drugs that affect the immune system.
With India's coronavirus case numbers dropping by more than 20 per cent a week, doctors will be hoping that the prevalence of black fungus decreases too.
India's devastating second wave of the coronavirus – in pictures
Rock in a Hard Place: Music and Mayhem in the Middle East
Orlando Crowcroft
Zed Books
Three ways to limit your social media use
Clinical psychologist, Dr Saliha Afridi at The Lighthouse Arabia suggests three easy things you can do every day to cut back on the time you spend online.
1. Put the social media app in a folder on the second or third screen of your phone so it has to remain a conscious decision to open, rather than something your fingers gravitate towards without consideration.
2. Schedule a time to use social media instead of consistently throughout the day. I recommend setting aside certain times of the day or week when you upload pictures or share information.
3. Take a mental snapshot rather than a photo on your phone. Instead of sharing it with your social world, try to absorb the moment, connect with your feeling, experience the moment with all five of your senses. You will have a memory of that moment more vividly and for far longer than if you take a picture of it.
ENGLAND SQUAD
Goalkeepers Pickford (Everton), Pope (Burnley), Henderson (Manchester United)
Defenders Alexander-Arnold (Liverpool), Chilwell (Chelsea), Coady (Wolves), Dier (Tottenham), Gomez (Liverpool), James (Chelsea), Keane (Everton), Maguire (Manchester United), Maitland-Niles (Arsenal), Mings (Aston Villa), Saka (Arsenal), Trippier (Atletico Madrid), Walker (Manchester City)
Midfielders: Foden (Manchester City), Henderson (Liverpool), Grealish (Aston Villa), Mount (Chelsea), Rice (West Ham), Ward-Prowse (Southampton), Winks (Tottenham)
Forwards: Abraham (Chelsea), Calvert-Lewin (Everton), Kane (Tottenham), Rashford (Manchester United), Sancho (Borussia Dortmund), Sterling (Manchester City)
'Top Gun: Maverick'
Rating: 4/5
Directed by: Joseph Kosinski
Starring: Tom Cruise, Val Kilmer, Jennifer Connelly, Jon Hamm, Miles Teller, Glen Powell, Ed Harris
Skoda Superb Specs
Engine: 2-litre TSI petrol
Power: 190hp
Torque: 320Nm
Price: From Dh147,000
Available: Now
RESULTS
Bantamweight
Victor Nunes (BRA) beat Siyovush Gulmamadov (TJK)
(Split decision)
Featherweight
Hussein Salim (IRQ) beat Shakhriyor Juraev (UZB)
(Round 1 submission, armbar)
Catchweight 80kg
Rashed Dawood (UAE) beat Otabek Kadirov (UZB)
(Round-1 submission, rear naked choke)
Lightweight
Ho Taek-oh (KOR) beat Ronald Girones (CUB)
(Round 3 submission, triangle choke)
Lightweight
Arthur Zaynukov (RUS) beat Damien Lapilus (FRA)
(Unanimous points)
Bantamweight
Vinicius de Oliveira (BRA) beat Furkatbek Yokubov (RUS)
(Round 1 TKO)
Featherweight
Movlid Khaybulaev (RUS) v Zaka Fatullazade (AZE)
(Round 1 rear naked choke)
Flyweight
Shannon Ross (TUR) beat Donovon Freelow (USA)
(Unanimous decision)
Lightweight
Dan Collins (GBR) beat Mohammad Yahya (UAE)
(Round 2 submission D’arce choke)
Catchweight 73kg
Martun Mezhulmyan (ARM) beat Islam Mamedov (RUS)
(Round 3 submission, kneebar)
Bantamweight world title
Xavier Alaoui (MAR) beat Jaures Dea (CAM)
(Unanimous points 48-46, 49-45, 49-45)
Flyweight world title
Manon Fiorot (FRA) v Gabriela Campo (ARG)
(Round 1 RSC)
School counsellors on mental well-being
Schools counsellors in Abu Dhabi have put a number of provisions in place to help support pupils returning to the classroom next week.
Many children will resume in-person lessons for the first time in 10 months and parents previously raised concerns about the long-term effects of distance learning.
Schools leaders and counsellors said extra support will be offered to anyone that needs it. Additionally, heads of years will be on hand to offer advice or coping mechanisms to ease any concerns.
“Anxiety this time round has really spiralled, more so than from the first lockdown at the beginning of the pandemic,” said Priya Mitchell, counsellor at The British School Al Khubairat in Abu Dhabi.
“Some have got used to being at home don’t want to go back, while others are desperate to get back.
“We have seen an increase in depressive symptoms, especially with older pupils, and self-harm is starting younger.
“It is worrying and has taught us how important it is that we prioritise mental well-being.”
Ms Mitchell said she was liaising more with heads of year so they can support and offer advice to pupils if the demand is there.
The school will also carry out mental well-being checks so they can pick up on any behavioural patterns and put interventions in place to help pupils.
At Raha International School, the well-being team has provided parents with assessment surveys to see how they can support students at home to transition back to school.
“They have created a Well-being Resource Bank that parents have access to on information on various domains of mental health for students and families,” a team member said.
“Our pastoral team have been working with students to help ease the transition and reduce anxiety that [pupils] may experience after some have been nearly a year off campus.
"Special secondary tutorial classes have also focused on preparing students for their return; going over new guidelines, expectations and daily schedules.”
UPI facts
More than 2.2 million Indian tourists arrived in UAE in 2023
More than 3.5 million Indians reside in UAE
Indian tourists can make purchases in UAE using rupee accounts in India through QR-code-based UPI real-time payment systems
Indian residents in UAE can use their non-resident NRO and NRE accounts held in Indian banks linked to a UAE mobile number for UPI transactions
LOS ANGELES GALAXY 2 MANCHESTER UNITED 5
Galaxy: Dos Santos (79', 88')
United: Rashford (2', 20'), Fellaini (26'), Mkhitaryan (67'), Martial (72')
England v South Africa Test series:
First Test: at Lord's, England won by 211 runs
Second Test: at Trent Bridge, South Africa won by 340 runs
Third Test: at The Oval, July 27-31
Fourth Test: at Old Trafford, August 4-8
Our family matters legal consultant
Name: Hassan Mohsen Elhais
Position: legal consultant with Al Rowaad Advocates and Legal Consultants.
Super Rugby play-offs
Quarter-finals
- Hurricanes 35, ACT 16
- Crusaders 17, Highlanders 0
- Lions 23, Sharks 21
- Chiefs 17, Stormers 11
Semi-finals
Saturday, July 29
- Crusaders v Chiefs, 12.35pm (UAE)
- Lions v Hurricanes, 4.30pm
The National Archives, Abu Dhabi
Founded over 50 years ago, the National Archives collects valuable historical material relating to the UAE, and is the oldest and richest archive relating to the Arabian Gulf.
Much of the material can be viewed on line at the Arabian Gulf Digital Archive - https://www.agda.ae/en
Indoor cricket in a nutshell
Indoor Cricket World Cup – Sep 16-20, Insportz, Dubai
16 Indoor cricket matches are 16 overs per side
8 There are eight players per team
9 There have been nine Indoor Cricket World Cups for men. Australia have won every one.
5 Five runs are deducted from the score when a wickets falls
4 Batsmen bat in pairs, facing four overs per partnership
Scoring In indoor cricket, runs are scored by way of both physical and bonus runs. Physical runs are scored by both batsmen completing a run from one crease to the other. Bonus runs are scored when the ball hits a net in different zones, but only when at least one physical run is score.
Zones
A Front net, behind the striker and wicketkeeper: 0 runs
B Side nets, between the striker and halfway down the pitch: 1 run
C Side nets between halfway and the bowlers end: 2 runs
D Back net: 4 runs on the bounce, 6 runs on the full
Sri Lanka-India Test series schedule
- 1st Test India won by 304 runs at Galle
- 2nd Test Thursday-Monday at Colombo
- 3rd Test August 12-16 at Pallekele
Our legal consultant
Name: Hassan Mohsen Elhais
Position: legal consultant with Al Rowaad Advocates and Legal Consultants.
Results
International 4, United States 1
Justin Thomas and Tiger Woods (US) beat Marc Leishman and Joaquin Niemann (International) 4 and 3.
Adam Hadwin and Sungjae Im (International) beat Xander Schauffele and Patrick Cantlay (US) 2 up.
Adam Scott and Byeong Hun An (International) beat Bryson DeChambeau and Tony Finau (US) 2 and 1.
Hideki Matsuyama and C.T. Pan (International) beat Webb Simpson and Patrick Reed (US) 1 up.
Abraham Ancer and Louis Oosthuizen (International) beat Dustin Johnson and Gary Woodland (US) 4 and 3.
US PGA Championship in numbers
1 Joost Luiten produced a memorable hole in one at the par-three fourth in the first round.
2 To date, the only two players to win the PGA Championship after winning the week before are Rory McIlroy (2014 WGC-Bridgestone Invitational) and Tiger Woods (2007, WGC-Bridgestone Invitational). Hideki Matsuyama or Chris Stroud could have made it three.
3 Number of seasons without a major for McIlroy, who finished in a tie for 22nd.
4 Louis Oosthuizen has now finished second in all four of the game's major championships.
5 In the fifth hole of the final round, McIlroy holed his longest putt of the week - from 16ft 8in - for birdie.
6 For the sixth successive year, play was disrupted by bad weather with a delay of one hour and 43 minutes on Friday.
7 Seven under par (64) was the best round of the week, shot by Matsuyama and Francesco Molinari on Day 2.
8 Number of shots taken by Jason Day on the 18th hole in round three after a risky recovery shot backfired.
9 Jon Rahm's age in months the last time Phil Mickelson missed the cut in the US PGA, in 1995.
10 Jimmy Walker's opening round as defending champion was a 10-over-par 81.
11 The par-four 11th coincidentally ranked as the 11th hardest hole overall with a scoring average of 4.192.
12 Paul Casey was a combined 12 under par for his first round in this year's majors.
13 The average world ranking of the last 13 PGA winners before this week was 25. Kevin Kisner began the week ranked 25th.
14 The world ranking of Justin Thomas before his victory.
15 Of the top 15 players after 54 holes, only Oosthuizen had previously won a major.
16 The par-four 16th marks the start of Quail Hollow's so-called "Green Mile" of finishing holes, some of the toughest in golf.
17 The first round scoring average of the last 17 major champions was 67.2. Kisner and Thorbjorn Olesen shot 67 on day one at Quail Hollow.
18 For the first time in 18 majors, the eventual winner was over par after round one (Thomas shot 73).
Match statistics
Abu Dhabi Harlequins 36 Bahrain 32
Harlequins
Tries: Penalty 2, Stevenson, Teasdale, Semple
Cons: Stevenson 2
Pens: Stevenson
Bahrain
Tries: Wallace 2, Heath, Evans, Behan
Cons: Radley 2
Pen: Radley
Man of the match: Craig Nutt (Harlequins)
Fifa Club World Cup:
When: December 6-16
Where: Games to take place at Zayed Sports City in Abu Dhabi and Hazza bin Zayed Stadium in Al Ain
Defending champions: Real Madrid
PREMIER LEAGUE FIXTURES
All times UAE ( 4 GMT)
Saturday
West Ham United v Tottenham Hotspur (3.30pm)
Burnley v Huddersfield Town (7pm)
Everton v Bournemouth (7pm)
Manchester City v Crystal Palace (7pm)
Southampton v Manchester United (7pm)
Stoke City v Chelsea (7pm)
Swansea City v Watford (7pm)
Leicester City v Liverpool (8.30pm)
Sunday
Brighton and Hove Albion v Newcastle United (7pm)
Monday
Arsenal v West Bromwich Albion (11pm)
Mercer, the investment consulting arm of US services company Marsh & McLennan, expects its wealth division to at least double its assets under management (AUM) in the Middle East as wealth in the region continues to grow despite economic headwinds, a company official said.
Mercer Wealth, which globally has $160 billion in AUM, plans to boost its AUM in the region to $2-$3bn in the next 2-3 years from the present $1bn, said Yasir AbuShaban, a Dubai-based principal with Mercer Wealth.
“Within the next two to three years, we are looking at reaching $2 to $3 billion as a conservative estimate and we do see an opportunity to do so,” said Mr AbuShaban.
Mercer does not directly make investments, but allocates clients’ money they have discretion to, to professional asset managers. They also provide advice to clients.
“We have buying power. We can negotiate on their (client’s) behalf with asset managers to provide them lower fees than they otherwise would have to get on their own,” he added.
Mercer Wealth’s clients include sovereign wealth funds, family offices, and insurance companies among others.
From its office in Dubai, Mercer also looks after Africa, India and Turkey, where they also see opportunity for growth.
Wealth creation in Middle East and Africa (MEA) grew 8.5 per cent to $8.1 trillion last year from $7.5tn in 2015, higher than last year’s global average of 6 per cent and the second-highest growth in a region after Asia-Pacific which grew 9.9 per cent, according to consultancy Boston Consulting Group (BCG). In the region, where wealth grew just 1.9 per cent in 2015 compared with 2014, a pickup in oil prices has helped in wealth generation.
BCG is forecasting MEA wealth will rise to $12tn by 2021, growing at an annual average of 8 per cent.
Drivers of wealth generation in the region will be split evenly between new wealth creation and growth of performance of existing assets, according to BCG.
Another general trend in the region is clients’ looking for a comprehensive approach to investing, according to Mr AbuShaban.
“Institutional investors or some of the families are seeing a slowdown in the available capital they have to invest and in that sense they are looking at optimizing the way they manage their portfolios and making sure they are not investing haphazardly and different parts of their investment are working together,” said Mr AbuShaban.
Some clients also have a higher appetite for risk, given the low interest-rate environment that does not provide enough yield for some institutional investors. These clients are keen to invest in illiquid assets, such as private equity and infrastructure.
“What we have seen is a desire for higher returns in what has been a low-return environment specifically in various fixed income or bonds,” he said.
“In this environment, we have seen a de facto increase in the risk that clients are taking in things like illiquid investments, private equity investments, infrastructure and private debt, those kind of investments were higher illiquidity results in incrementally higher returns.”
The Abu Dhabi Investment Authority, one of the largest sovereign wealth funds, said in its 2016 report that has gradually increased its exposure in direct private equity and private credit transactions, mainly in Asian markets and especially in China and India. The authority’s private equity department focused on structured equities owing to “their defensive characteristics.”
