‘The Last of Us’ is fiction: Deadly fungi outbreaks are, unfortunately, reality

In the wake of COVID, media attention flits from one potential scourge to another, and we the public must remain aware of both the risks and the limitations. 

Recent Ebola and Marburg outbreaks in Africa gain our attention but are limited (despite a high mortality rate) by the difficulty of transmission (not airborne) as well as the advent of a new Ebola vaccine with Marburg soon to follow. 

Public health officials are also keeping their eyes on H5N1 bird flu as they have for several years, but what about other pathogens besides viruses? Certain bacteria including strep and resistant staph and even Yersinia (Plague) remain on the radar. 

But what about a fungal outbreak?

The National Science Advisory Board for Biosecurity has expressed concern about certain fungi on their radar, both in terms of natural occurrence as well as the inherent risks of manipulating them in the laboratory. And then there’s “The Last of Us,” the HBO series about a fungus (based on the Ant Zombie Fungi Cordyceps) that mutates to pass human-to-human and infects the world. 

But there are two major reasons to think that “The Last of Us” will never happen, at least the way it is presented. First, fungi propagate mostly in cold-blooded creatures. Frogs are currently dealing with outbreaks from lily pads in infested water sources, while bats, though warm-blooded, are enduring a fungal outbreak when they hibernate and their blood cools called White Nose Syndrome. 

And though Candida Auris, a yeast, is a growing concern because it spreads on surfaces and can colonize healthy people, the amount of damage it can do to people with intact immune systems is limited. Still, its spread is growing. According to a Centers for Disease Control and Prevention study published in the Annals of Internal Medicine, the number of C. Auris cases nearly doubled in 2021.

Shawn Lockhart, Ph.D., director of the Fungal Reference Library at the CDC and a clinical microbiologist, told me on Doctor Radio on SiriusXM that Candida Auris can cover a room through patients who may not even know they have it. He feels that we need to do a better job of testing high-risk patients. 

Dr. Meghan Lyman, an epidemiologist in the Mycotic Diseases Branch at the CDC and lead author of the latest study told me on Doctor Radio that, “the people who we have observed, that are becoming infected or even colonized with Candida Auris are very sick at baseline.” 

She continued: “Most of them have had multiple exposures to antibiotics or antifungals and they’ve had long or frequent stays in health care facilities. So generally speaking, healthy people are considered low risk for getting Candida Auris, and there’s no evidence that transmission in the community is a big concern. Transmission is occurring mainly in health care settings. So it is definitely this very vulnerable population that’s at risk, and not only the immune-compromised conditions that we typically think of, like chemo, transplant, HIV/AIDS, high dose immune-suppressive medication. These [infected] may not be patients who fit into that category but they still have a lot going on, other aspects that are making them at risk for this.”

So we still have a lot to learn about Candida Auris and fungi in general; plant-like organisms that don’t make chlorophyll, feed on organic matter and, in some species, produce spores that can survive extreme conditions. There are over 140,000 known species, and there are many reasons to think that none of them will spawn the next pandemic: Though it is possible, especially with laboratory manipulations routinely taking place.

Marc Siegel MD is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent and author of the new book, “COVID; the Politics of Fear and the Power of Science.”