Medical Examiner

Why You Don’t Need to Worry About That New Drug-Resistant Super Fungus

Stock image of a person wearing medical scrubs mopping the floor.
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Is fungus something that you should spend significant brain space worrying about? After the New York Times published an excellent and meticulously researched and reported story about the growing threat of a drug-resistant yeast called Candida auris this past weekend, a lot more people might be considering adding it to the list. The story is full of scary examples of people who’ve been infected and scary stats about how deadly the fungus is—basically, half of the people who get it seem to die, though it’s not clear if that’s from the fungus itself or from other factors. Seems worrisome! The reality, though, is that you don’t have to freak out about the fungus. As the Times story makes enormously clear, there are plenty of people who are currently freaking out about it for you.

The piece painted a vivid picture of just how vexing this drug-resistant fungus has been to medical professionals across the globe: They don’t understand what has caused its rise, they don’t have a terribly effective treatment for it, and they don’t even really know how to scrub it out of hospital rooms once it’s gotten in. Reporters Matt Richtel and Andrew Jacobs start their tale with the story of a C. auris case discovered in an elderly man at Mount Sinai Hospital in Brooklyn that makes that last problem unnervingly clear:

The man at Mount Sinai died after 90 days in the hospital, but C. auris did not. Tests showed it was everywhere in his room, so invasive that the hospital needed special cleaning equipment and had to rip out some of the ceiling and floor tiles to eradicate it.

“Everything was positive — the walls, the bed, the doors, the curtains, the phones, the sink, the whiteboard, the poles, the pump,” said Dr. Scott Lorin, the hospital’s president. “The mattress, the bed rails, the canister holes, the window shades, the ceiling, everything in the room was positive.”

The fact that the only way to eradicate a deadly pathogen from this hospital room was via ripping out ceiling and floor tiles sure sounds alarming. And then, perhaps even more alarmingly, about a third of the way through the piece, we get to a subheadline that reads: “ ‘No need’ to tell the public.“ Here, Richtel and Jacobs explain the complicated situations in which many hospitals have found themselves as they’ve tried to navigate C. auris outbreaks. As the subhed implies, hospitals have largely decided not to issue public-facing statements about what’s happening. “It’s hard enough with these organisms for health care providers to wrap their heads around it,” said Dr. Anna Yaffee, a former outbreak investigator for the Centers for Disease Control and Prevention. “It’s really impossible to message to the public.”

And yet, here we are, in the middle of a Times story, where the threat of Candida auris is most certainly being messaged to the public via the paper of record. Again, that piece is great journalism—the portrait it draws is thorough and complex. But as a means of risk communication, the piece has a murkier takeaway—it’s tough for readers to understand just what, exactly, the news means for them. And that’s even before taking into account that the story itself became news, getting picked up and reblogged with great alarm: “We Should All Probably Freak Out About this Deadly, Drug-Resistant Fungus,” wrote Jezebel. “Candida auris: These alarming CDC maps show where the mysterious fungus is spreading,” wrote Fast Company. You’d probably be an outlier not to feel a least a bit alarmed after reading through all of this.

This is a perpetual problem in health reporting. It’s very hard to bridge the divide between the personal and the global (and maybe not even journalists’ jobs!). Indeed, the problem we the media face when we write headlines about stuff like this new fungus is closely related to the problem hospitals face as they decide whether or not to release a public-facing statement about experiencing an outbreak: The fungus is a very legitimate public health issue, but for almost everyone in the world, it will not be a personal health issue. That is to say, your own actual risk of being harmed by this fungus is extremely, extremely, extremely low. (Being immunocompromised increases one’s risk, but the absolute numbers on infection rates are still very low.) And yet, the disease is a big deal, because in comparison to other outbreaks, it’s growing relatively quickly and doctors don’t know what to do about it yet.

Which means that it’s extremely worthy of news coverage. Stories like this can help public health advocates in making their case for increasing research attention and funding. As Maryn McKenna wrote in a good Wired story on the fungus in the summer of 2018—and as the researchers who spoke with the Times clearly also feel—such support is likely to provide our best path toward triumphing over C. auris. That more research and money is the solution underscores exactly why public health officials likely decided not to put out public notices about which hospitals were dealing with infection. It’s not because they’re trying to hide reality from anyone (they’re diligently reporting cases to the CDC), but because it simply wouldn’t do much good. The action items when it comes to C. auris are on the public health side, not so much on the individual consumer side, which helps explain why numerous hospitals have all landed on the side of not releasing statements about outbreaks and have instead opted to deal with it internally.

A patient advocate that the Times quotes and a Forbes contributor writing in reaction to the Times’ story both deployed the same analogy in arguing that the lack of disclosure is a bad thing: Each likened the decision not to announce the disease to a restaurant not saying publicly that it’s had a food poisoning outbreak. But hospitals aren’t restaurants in that most people end up there out of necessity, not because they’re hungry for a pizza. The danger of hospitals broadcasting these outbreaks might be to make people who need immediate medical attention—and who face relatively little risk of infection—fearful to get that help. The public benefit for the smaller number of people going in for elective surgery who might have canceled their procedures, meanwhile, is relatively minuscule, if it exists at all.

Again, this hits up against the same problem—the problem of personal health risk versus population-level health risk, and how we calculate and communicate those things. It’s extremely difficult to be clear about both at once because they often seem to contradict each other. It’s also true, in my opinion, that journalism has a higher obligation to population-level risks than individual ones. Individual risk should be conveyed by your doctor or by a member of the actual medical establishment (again, it’s worth considering that in the case of the fungus, medical professionals decided that the individual risk wasn’t worth conveying at all). The population-level concerns should be rigorously covered by the media—this is what allows us to engage in a discussion about what’s important on a policy level, what kind of science and research we should be investing in, and how our world should operate. (The Times story makes perfectly clear that the fungus problem reaches into questions of food production, pesticide use, and more.) With a threat as slow-building as drug resistance, incremental reporting is key.

We all want to feel as protected as possible against bad outcomes. No one wants the deadly fungus. But worrying about the fungus won’t help you avoid it. The lesson of this Times story isn’t to panic about your potential fungal infection, it’s to help the people who are worrying about it for everyone get the funding and attention they need.