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The hospital was\u00a0<\/span>doing everything it could<\/span><\/a>. It set up a separate unit to house COVID-19 patients. It imposed exhaustive hygiene\u00a0measures to\u00a0keep\u00a0the virus\u00a0from\u00a0spreading. It even\u00a0used\u00a0ultraviolet light for sanitization, which at that time\u00a0\u2013\u00a0July 2020 \u2013\u00a0was being marketed with great enthusiasm as a way to zap COVID particles out of thin air.<\/span><\/p>\n Still, patients at this Florida medical unit remained gravely ill. Ventilators, feeding tubes, catheters pumping medicines straight into patients\u2019 hearts \u2013\u00a0none of it seemed to be enough.<\/span><\/p>\n The battle against the virus raged on.<\/span><\/p>\n That\u2019s when a blood test came back with a peculiar result. Then another. Then another.<\/span><\/p>\n COVID, it turned out, wasn\u2019t the only enemy. The patients were positive for a fungus:\u00a0<\/span>Candida auris<\/span><\/i>, or <\/span>C. auris<\/span><\/i> for short. This wasn\u2019t just any old yeast. <\/span>C. auris<\/span><\/i>\u2014a \u201csuperfungus\u201d\u00a0associated with that scientists think may be linked\u00a0climate change\u2014\u00a0is capable of\u00a0can cause\u00a0invasive, sometimes life-threatening infections, according to the\u00a0<\/span>CDC<\/span><\/a>. Florida\u2019s first reported case was in 2017, and since then, the organism has cropped up across the state. In the COVID unit that was set up in the summer of 2020,\u00a0about\u00a0some\u00a035 patients tested positive for the fungus in just\u00a02\u00a0weeks. Within 30 days, eight\u00a0<\/span>had died<\/span><\/a>.<\/span><\/p>\n<\/section>\n Today, the threat of superfungi is still on the rise, and it\u2019s hardly limited to the Sunshine State. As heat and drought ravage many parts of the country, drug-resistant fungi are spreading. Floods cause the deadly strains to mingle with more benign ones, enabling antimicrobial-resistant genes to jump between species. Hurricanes are pulling entombed fungi from beneath the earth, showering the air with potentially deadly mold.<\/span><\/p>\n Meanwhile, the arsenal against superfungi is sparser than ever, as decades-old medicines\u00a0aren\u2019t as\u00a0effective\u00a0and new drug legislation is stalled in Congress. \u201cWe\u2019re sort of where we were 30 years ago,\u201d says John Rex,\u00a0MD,\u00a0chief medical officer at the\u00a0drug\u00a0company F2G and a former member of the FDA \u2019s Anti-Infective Drugs Advisory Committee. \u201cThere remain very few options.\u201d<\/span><\/p>\n<\/section>\n<\/div>\n By the standards of nature, <\/span>C. auris<\/span><\/i> is a baby. It was first identified at the Teikyo University Institute of Medical Mycology, after doctors in a Tokyo hospital had a hard time\u00a0treating a 70-year-old woman whose symptoms suggested a\u00a0basic\u00a0ear infection. What researchers found was anything but\u00a0basic: small, pill-shaped cells that indicated a distinct species. Their case study\u00a0<\/span>was published<\/span><\/a> in 2009, but <\/span>C. auris<\/span><\/i> wasn\u2019t discovered in the United States\u00a0<\/span>until 2016<\/span><\/a>.<\/span><\/p>\n<\/section>\n A baby, perhaps, but far from harmless. Almost 20% of patients in the first series of U.S. cases died within 30 days of\u00a0getting\u00a0the fungus. The number doubled within\u00a03\u00a0months.<\/span><\/p>\n It\u2019s essential not to confuse <\/span>C. auris<\/span><\/i> with its less virulent cousins like <\/span>C. albicans,<\/span><\/i> which is easily treatable, notes Tina Tan,\u00a0MD,\u00a0an infectious disease specialist at Lurie Children\u2019s Hospital and vice president of the Infectious Diseases Society of America. \u201cYou really have to be vigilant,\u201d Tan says, \u201cand understand what you’re dealing with.\u201d<\/span><\/p>\n Now <\/span>C. auris<\/span><\/i> is at the top of the CDC\u2019s most-wanted list. Earlier this year, the agency called the fungus\u00a0<\/span>an \u201curgent\u201d threat<\/span><\/a> \u201cbecause it is often resistant to multiple antifungal drugs, spreads easily in healthcare facilities, and can cause severe infections with high death rates.\u201d\u00a0<\/span>A paper<\/span><\/a> based on CDC data noted a \u201cdramatic increase\u201d in the spread of the fungus, with 17 states reporting their first-ever cases between 2019 and 2021. Since then, 18 more states have seen first cases of their own.<\/span><\/p>\n<\/section>\n The outbreaks<\/span><\/a> \u201cdemonstrate how easily something can spread,\u201d\u00a0says\u00a0Meghan Lyman,\u00a0MD,\u00a0medical officer in the CDC\u2019s Mycotic Diseases Branch.<\/span><\/p>\n C. auris<\/span><\/i> is distinctive in ways that make controlling outbreaks a tall task,\u00a0she says. The fungus is hardy: It can survive for weeks on surfaces ranging from toilets to telephones. It\u2019s tenacious: Products like Purell, Lysol, and Virex may not keep it from spreading. It\u2019s evasive: Traditional biochemical tests often misdiagnose it or fail to detect it at all. And it\u2019s a shape-shifter, appearing sometimes as lines, other times as ovals; sometimes in isolation, other times in clusters.<\/span><\/p>\n Given\u00a0how easily it spreads, health professionals face a tough challenge. Jeffrey Rybak,\u00a0PharmD, PhD,\u00a0a pharmacist and antifungal resistance researcher at St. Jude Children\u2019s Research Hospital, has received calls from a colleague across the country seeking advice on how to quell the outbreak. \u201cYou have to have concern for the patient in front of you\u2013and equal concern for the other patients in the facility,\u201d he says. Often, Rybak\u00a0says, \u201cyou\u2019re fighting a losing battle from the infectious control standpoint.\u201d<\/span><\/p>\n<\/section>\n<\/div>\n C. auris<\/span><\/i> didn\u2019t come out of nowhere. Researchers\u00a0say it\u2019s here because of\u00a0climate change, which makes it one of the first infectious diseases\u2013some say\u00a0<\/span>the<\/span><\/i>first<\/span><\/i><\/a>\u2013directly linked to the climate crisis.<\/span><\/p>\n A group from Johns Hopkins, MD Anderson Cancer Center, and the Netherlands cites several reasons:\u00a0warmer environments that\u00a0are about the\u00a0same\u00a0temperature as the human body, droughts that lead to saltier wetlands akin to the bloodstream, and intense ultraviolet light exposure that fosters mutations. Although the authors concede that global warming is \u201cunlikely to explain the whole story,\u201d they say\u00a0the emergence of <\/span>C. auris<\/span><\/i> \u201cstokes worries that humanity may face new diseases from fungal adaptation to hotter climates.\u201d<\/span><\/p>\n It\u2019s telling that states severely affected by climate change report the most cases of <\/span>C. auris.<\/span><\/i> Nevada, for example, has had prolonged heat waves in recent years, as well as\u00a0an\u00a0intense drought that\u00a0<\/span>threatens<\/span><\/a> the Colorado River Basin, according to the National Oceanic and Atmospheric Administration. Not coincidentally, the state has seen an extraordinary number of <\/span>C. auris<\/span><\/i> patients relative to its population\u2013more than 1,600, according to the Nevada Department of Health and Human Services. As of July 2023,\u00a0about\u00a0140 of them had died.<\/span><\/p>\n<\/section>\n Mark Pandori,\u00a0PhD,\u00a0director of the Nevada State Public Health Laboratory, has been tracking the outbreaks since the beginning. He notes that there are only three types of antifungal drugs, and since superfungi may be resistant to one or more of them, treatment alternatives are limited. Adding to the problem, these options are often\u00a0toxic. One of the drugs is amphotericin, which can cause reversible kidney injury.<\/span><\/p>\n Given how hard it is to\u00a0identify <\/span>C. auris<\/span><\/i> in the first place, cases have likely been underreported, according to Pandori. With uncertain data, doctors don\u2019t always know when and how to intervene. \u201cIt\u2019s like any other challenge, military or otherwise,\u201d he says. \u201cYou don\u2019t have information, you can\u2019t act.\u201d<\/span><\/p>\n<\/section>\n Of course, <\/span>C. auris<\/span><\/i> isn\u2019t the only medical challenge linked to\u00a0global warming. Consider, for example, the 2010 case of a boy in Washington state who went to the pediatrician complaining of chest pain. At first, doctors didn\u2019t see a need to hospitalize him, but that changed when, within\u00a03 days,\u00a0he\u00a0began to have trouble breathing. Tests later showed that his lungs contained coccidioides, the bug that causes valley fever, a fungus\u00a0usually found about 1,000 miles to the south. It was Washington\u2019s first documented case.\u00a0<\/span>A case report<\/span><\/a> notes \u201cclimate changes conducive to colonization, allowing expansion into new regions.\u201d<\/span><\/p>\n<\/section>\n<\/div>\n In other words, climate change isn\u2019t just giving rise to new superfungi; it\u2019s also allowing old fungi to flourish. \u201cSmall temperature changes for fungi cause them to adapt, or go away, and for other organisms to move in,\u201d\u00a0says\u00a0Tom Chiller,\u00a0MD,\u00a0chief of the CDC\u2019s Mycotic Diseases Branch.<\/span><\/p>\n Since coccidioides first appeared in Washington, fungi once limited to certain regions have been <\/span>found\u00a0far from their original homes<\/span><\/a>. Valley fever is\u00a0more common well outside the Southwest valleys for which it is named. Histoplasmosis, triggered by a fungus usually found in Ohio, is now in Michigan and Minnesota. Blastomycosis, normally linked to\u00a0caves in the Southeast, has turned up in states as far-flung as Texas and Vermont.<\/span><\/p>\n For most people, common fungal infections\u2013\u00a0thrush, athlete\u2019s foot, diaper rash\u2013\u00a0are easily treatable with wipes, drops, or ointments. These conditions can be more serious for more vulnerable patients like newborns, the elderly, and the estimated 9 million Americans with compromised immune systems.<\/span><\/p>\n<\/section>\n And as old fungi spread to new regions, some become more deadly. Case in point: <\/span>Aspergillus fumigatus.<\/span><\/i> Hospitalizations from this ubiquitous mold have jumped 40% in recent years. It now tops the CDC\u2019s Watch List of resistant organisms that can \u201cspread across borders and cause significant morbidity and mortality,\u201d but whose \u201cfull burden\u00a0\u2026\u00a0is not yet understood.\u201d<\/span><\/p>\n That has been Tan\u2019s experience in Chicago, too. In the past decade, she\u2019s seen\u00a0more severe cases of blastomycosis. Where once kids came in just with lung disease, they now have fungal abscesses in their bones and skin. In hotter, more humid conditions, Tan says, fungi tend to be \u201cdriven into overdrive.\u201d<\/span><\/p>\n<\/section>\n To curb the spread and combat antimicrobial resistance, policymakers and industry leaders worldwide have stepped up.<\/span><\/p>\n On the one hand, they\u2019re naming the issue. In 2013,\u00a0U.S.\u00a0Rep. Kevin McCarthy, R-CA, founded the\u00a0<\/span>Valley Fever Task Force,<\/span><\/a> which set out to\u00a0help develop new antifungal medicines through the FDA.\u00a0But progress has been sluggish. Almost a decade after the task force was established, McCarthy continued to emphasize \u201cthe critical need to find effective treatments.\u201d<\/span><\/p>\n<\/section>\n<\/div>\n On the other hand, they\u2019re proposing legislation. In 2021, <\/span>McCarthy introduced<\/span><\/a> the Finding Orphan-disease Remedies With Antifungal Research and Development (FORWARD) Act, with the hope that the National Institutes of Health would target coccidioidomycosis, among other fungal infections, and the FDA would\u00a0make development of antifungal drugs a priority. But the FORWARD Act remained stuck in the House. In 2022, Rep. Anna Eshoo, D-CA, reintroduced a pared-down version as part of a larger law. That bill, with further refinements, was passed in the House in June 2022 and adopted by Congress in December 2022.<\/span><\/p>\n Don\u2019t count on a breakthrough right away. The bill gave the FDA almost\u00a05\u00a0years to enact guidance that would lead to new drugs. No such guidance had\u00a0been issued as of August 2023, according to Beth Fritsch, an FDA external affairs officer.<\/span><\/p>\n Money is being poured into drug development. For example, there\u2019s the\u00a0<\/span>Antimicrobial\u00a0Resistance\u00a0(AMR) Action Fund<\/span><\/a>, a joint investment involving the International Federation of Pharmaceutical Manufacturers and Associations, the World Health Organization, the European Investment Bank, and Wellcome Trust. But antifungals aren\u2019t a top priority. The fund hasn\u2019t yet targeted yeast like\u00a0<\/span>C. auris<\/span><\/i> or molds like aspergillus.<\/span><\/p>\n<\/section>\n