The coronavirus pandemic is, we are told, a once-in-a-century plague that is the worst outbreak of its kind in living memory.
But that doesn’t mean we can stop worrying about deadly diseases with the potential to rapidly spread across borders. Epidemiologists have already identified several contenders for the next global medical emergency.
One fungal infection, Candida auris , has been described as “almost the perfect pathogen” by Johanna Rhodes, a genomic epidemiologist at Imperial College London.
First identified in 2009, where it was seen infecting the ear canal of a Japanese woman, the drug-resistant organism was spotted in patients across the globe.
The first case in Europe was diagnosed at London’s Royal Brompton Hospital in June 2016. Dr Rhodes, who was one of the specialists called in to help eradicate the Royal Brompton outbreak, says the fungus is almost impossible to kill off with currently-available antifungal drugs.
“One of the things that makes Candida auris so scary is the fact it can linger on inanimate surfaces for long periods and withstand whatever you throw at it,” she told New Scientist. Outbreaks in hospitals are very hard to contain once the fungus has taken a hold.
An outbreak in 2018 at a Spanish hospital was even more severe. A total of 372 people were infected and 85 developed the deadly blood-borne fungal infection. Of those, 41% died within a month.
After one patient died of the infection in the Brooklyn branch of Mount Sinai Hospital, administrators had to virtually demolish his room to wipe out the fungus.
“Everything was positive — the walls, the bed, the doors, the curtains, the phones, the sink, the whiteboard, the poles, the pump,” Dr. Scott Lorin, the hospital’s president told the New York Times, adding: “The mattress, the bed rails, the canister holes, the window shades, the ceiling, everything in the room was positive.”
Candida auris is not the only threat. Just like antibiotic-resistant “superbugs,” fungi are evolving strains that none of our available weapons can beat.
“We’re now seeing strains that are resistant to all classes of antifungals,” warns Mahmoud Ghannoum, a specialist in fungal diseases at Case Western Reserve University in Ohio. “We’ve always had multidrug-resistant bacteria, but we didn’t have the situation with fungus until now.”
The reasons for the change in the way these ancient life forms behave are not known for certain.
Changes to new, “greener” farming practices using a lot more compost and green waste may have provided ideal environments for the fungus to breed.
Arturo Casadevall at the Johns Hopkins Bloomberg School of Public Health in Maryland has suggested that climate change has driven the evolution of Candida auris towards a more heat-resistant form that can thrive within the comparatively warm human body.
Its exact origins may never be known. “It is a creature from the black lagoon,” said Dr. Tom Chiller, who runs the US Centre for Disease Control and Prevention's anti-fungal division. “It bubbled up and now it is everywhere.”
Wherever this new threat came from, we need to develop a defence against it. Once Candida auris gets into its victims’ bloodstream, it can be deadly.
Although its exact fatality rate is hard to determine, because the fungus most commonly takes hold in people who are already in hospital with other conditions, figures from the Centre for Disease Control and Prevention suggest that almost half of the people infected with the fungus will die within 90 days.
Dr. Lynn Sosa, Connecticut’s deputy state epidemiologist, says she now sees Candida auris as “the top” threat among resistant infections. “It’s pretty much unbeatable and difficult to identify,” she says.
The 2016 London outbreak infected over 70 people before Johanna Rhodes and her team were able to contain it. By the beginning of 2019, more than 260 cases had been confirmed in the UK.
Thousands more cases have been identified around the world. Mahmoud Ghannoum says that we need to be ready to fight the next pandemic before it begins.
“Covid-19 teaches us how a pandemic can emerge unexpectedly to have far-reaching impacts on our health, economy and social structure,” he says.
“We need to invest more in research and development, and prepare our defences – against all types of infectious pathogens.”
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