Tuesday, April 09, 2019

Should you worry about Candida Auris infections?

In Fall 2012, I realized that the source of numerous health – albeit sometimes cosmetic – issues of mine were yeast, most likely from the Candida family. Before that time, I didn't even know that yeast or fungus could be a health problem for humans (only viruses and bacteria seemed relevant) – maybe a fungus is a problem for an apple but humans?

The Candida genus shares certain traits and the accumulation of symptoms was so clear – along with some diagnosis – that I decided that extra information wasn't really "necessary". I've never known which Candida species was harassing me. The most widespread species is Candida albicans. Every human has it in his or her guts and it's mostly innocent. But it may also get to the bloodstream through a leaky gut (which may be caused by some Crohn's disease; vitamin B12 etc. recommended) and infect organs, skin, and lots of other things.

At some level, it doesn't matter which Candida species one deals with. The cure is similar. Except that in some cases it does matter. In the recent week, Google Trends show, the interest in the Candida auris skyrocketed.



The reason is that three days ago, newspapers led by The New York Times published their story about this new supergerm. It's not really a bacterium, like "true" supergerms, but a yeast. But the dynamics, causes of infections, and the character of the threat seem very similar to superbugs.



Candida auris was only identified in Japan in 2009, just a decade ago – in a woman's ear. The Latin word for an "ear" led to the name "auris". Since that time, it has spread to states and countries like New York, New Jersey, Illinois, London, Venezuela, and a dozen of others.

Like other supergerms, Candida auris apparently evolved as the winner that is resistant to the excessive anti-biotic treatment, especially by fungicides such as azoles. Candida auris is resistant to fluconazole and nystatin, aside from a few other strongest chemicals to fight fungal infections. An extra problem is that a detailed DNA analysis may be needed not to confuse Candida auris with some older well-known Candida species. The New York Times described some horror stories about the viability of these yeast cells:
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.
In another hospital, peroxide was applied everywhere for a few days and all microorganisms died – with the exception of Candida auris. Terrifying.

Now, Slate has argued that you shouldn't worry, it's a global public health problem but it is not your personal problem. Almost all sufferers (Candida auris has a 50% death rate) are people with some heavily dysfunctional immune system and the overall numbers are still small.

Well, using the word you is clearly just a guess because they can't know who is you and who is just reading the article at some place of Earth. It could very well be a Candida auris sufferer. While I agree with Slate that some numbers and "personal relevance" should always be explained by similar popular articles about medicine, I disagree that Candida auris seems like a non-problem.

It's still an infection – and an extremely resilient one. It surely spreads in various ways and it doesn't want to leave the new walls of the houses unless you burn that house completely or do something like that. Could the problem go away? Maybe. But maybe it won't.

The New York Times mentioned that by one estimate, Candida auris will claim 10 million casualties in the year 2050, beating cancer estimated at 8 million deaths. Well, if one particular yeast species is plausible to beat all of cancers by casualties, it may be pretty important, right?

Slate also defends the coverup of the Candida auris outbreaks in the hospitals. It's not the regular people who should deal with it, it's just the physicians, and the regular people's knowledge would just cause some extra panic which would make them avoid hospitals even if they urgently needed them:
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.
Of course at some level I have sympathy for this kind of silence. People react irrationally and if it is guaranteed that their reaction will almost certainly incorrectly compare the different kinds of dangers, it might be better to hide the smaller danger from them.

But there simply comes a point in which the "smaller danger" isn't necessarily smaller anymore. At least for some patients, the decision to avoid a hospital with a Candida auris outbreak could be a damn sensible one. Just imagine we're in 2050 and Candida auris really beats cancer by fatalities. If you need to cure some uncertain or light form of cancer and you're told to do it in a hospital with some big Candida auris outbreak, well, it may really be sensible to avoid the treatment.

At the end, Slate defends a "Big Brother" approach to healthcare. Doctors always know better and the system must be optimized so that they decide, even if it means not to communicate some very important information to the patients. Well, I don't like this "Big Brother" approach to healthcare. The physicians have some expertise but at the end, it's the patient's health or life that is at stake. If it is really just the personal health or life that is at stake, I feel that the patient should always have the power to overwrite the physician's decision. When the patient has an increased expertise close to the doctor, it may become obvious. Maybe the patient really knows some detailed things about a condition better than his or her doctor, especially if it is a doctor who isn't specialized in these matters.

The very fact that many people seem to be driven by this coverup logic or ideology has consequences. People may have good enough reasons not to trust the hospitals – or the government – in many other respects, too. Some people at the top who want to control things may consider this distrust "a bug". But it's really a feature – the distrust has objectively good and sensible reasons! Hospitals seem to be really hiding the outbreaks etc.

Concerning the fatal epidemics, I still find it sort of fascinating that none of these nasty microorganisms has led to the extinction of the mankind. Some really bad infection starts by growing exponentially, at a staggering rate, but this Ansatz is bound to break down at some moment.

An example is representative of many: around 1350 AD, Black Death reduced the population of Europe from 450 to 350 million. Yersinia pestis, a bacteria, was the culprit. People pretty much correctly determined that the death was spread by rats. A more accurate explanation is that it was spread by the bacterium living in fleas living in rats. The infection makes the fleas eat, but never satisfy the hunger because the guts are blocked, and the fleas ultimately vomit their blood to the rats etc.

That wasn't nice. But the nice side effect of all this speedy epidemics is that when a disease is just too deadly, it kills the victims too quickly – and without these supporters, it dies out, too. The only other "good news" I can think of is that some immunity develops, either individually or by spreading a subpopulation whose genes make it immune or more immune.

So no infection could have killed everybody so far. But I still feel that the "happy end" is far from a mathematically guaranteed outcome. Isn't it possible that something like Candida auris will ultimately kill everybody? A germ that can live both on humans and on the walls? Do you understand why Candida auris – which seems so powerful to kill the weak people and get stuck on the walls – seems so easy for healthy people to fight by their immune system? Is that counterintuitive relationship unavoidable?

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