Freak out over fungus is better used as fuel for investigative reporting

You may have recently found yourself trying to find a fungus.

Calling up hospitals. Driving to nursing homes. Emailing that guy at the county whose name you can never remember who you last emailed when people were talking about “bird flu” on Facebook.

This time, your boss asked you to track down a fungus because of a story in The New York Times with this dramatic headline: “A Mysterious Infection, Spanning the Globe in a Climate of Secrecy.”

More dramatic coverage followed.

WDTN in Dayton, Ohio, wrote:

“Centerville assisted living facility keeping close tabs on 'superbug'”

Several time zones away in Delhi, the Times of India wrote:

“Kolkata hospitals sound alarm over drug-resistant fungus”

And the Deseret News in Salt Lake City blared at its readers:

“CDC calls superbug Candida auris a ‘global health threat.’ And you can totally catch it.”

That last headline is especially unfortunate because anyone can “totally catch” any of thousands of diseases. What would be more truthful — and much less fearmongering — would be to say, “Most people reading this story totally won’t catch this superbug.” Bad for clicks, good for truth.

Instead of leaping onto the fearwagon when a bug seems to appear out of nowhere, check the science. It’s been easy to do for years, but so many people still fail to do basic background research. A good first stop is PubMed, the National Library of Medicine’s archive of scientific publications.

A search for Candida auris shows that the fungus is not new. Scientific articles about the patients suffering illnesses related to the fungus date back to January 2009 in Japan.

It is, however, global. As are the various strains of the influenza virus, the virus that causes shingles, and many, many, many other bacteria, viruses and fungi. The Centers for Disease Control and Prevention wrote in March:

Single cases of C. auris have been reported from Austria, Belgium, Iran, Malaysia, the Netherlands, Norway, Switzerland, Taiwan, and the United Arab Emirates. Multiple cases of C. auris have been reported from Australia, Canada, China, Colombia, France, Germany, India, Israel, Japan, Kenya, Kuwait, Oman, Pakistan, Panama, Russia, Saudi Arabia, Singapore, South Africa, South Korea, Spain, the United Kingdom, the United States (primarily from the New York City area, New Jersey, and the Chicago area) and Venezuela; in some of these countries, extensive transmission of C. auris has been documented in more than one hospital.

So should everyone from Kolkata to Salt Lake City be worried?

No.

A thorough reading of the literature makes two things clear. First, the number of infections is still quite small. There have been fewer than 100 reported every year on average in the U.S. since 2013. In just one state in the U.S., by comparison, there were 7,500 cases of valley fever in 2017.

Second, it is clear that the people who are becoming ill from the fungus — and especially those who are dying — are from populations already deemed vulnerable by health care workers and health systems. There needs to be an extra level of precaution in protecting them from the fungus. Just as there should be extra precaution protecting them from influenza and pneumonia. As the Times put it:

“Resistant germs are often called ‘superbugs,’ but this is simplistic because they don’t typically kill everyone. Instead, they are most lethal to people with immature or compromised immune systems, including newborns and the elderly, smokers, diabetics and people with autoimmune disorders who take steroids that suppress the body’s defenses.”

And that’s where the potential for a good investigative story opens up.

Hospitals are where you need to go to be treated for a drug-resistant infection, and they also are the places where people typically contract the infections in the first place. Yet, decade after decade passes without any national reporting system put in place to allow the public to see for themselves infection hotspots. Dozens of outlets followed the Times’ lead in writing about the possibility of a Candida auris infection showing up in their town. Time would be better spent to take a cue from the Times and track down the hospitals that have had a series of outbreaks of drug-resistant infections – not just Candida auris — and are keeping it secret.

Hospitals and nursing homes should be reporting these infections to the CDC. The agency has been asking them to do so since 2016. There is a long list of other reportable infections, including Staphylococcus aureus, Enterobacteriaceae, and others that have drug-resistant strains.

To start tracking down which hospitals have had outbreaks in your area, you can start with two initial sources and go from there.

First, start with Medicare’s Hospital Compare and Nursing Home Compare. You can plug in the name of your facility and see how they are graded on a number of process measures. The information won’t show you whether there has been an outbreak of a specific pathogen, but it will give you clues as to whether there is a problem with the infrastructure or culture — no pun intended — in that facility. There are links on the site to recent inspection reports by state or federal agencies.

Second, go to Hospitalinspections.org, the site created and maintained by the Association of Health Care Journalists. (I compared the two hospital search sites previously.) One of the ways AHCJ has created a better search experience for reporting on drug-resistant bugs is that you can search by specific phrases. I did a search for “Candida auris” and “C. auris” and was given three reports. (Not as many as I had hoped for, of course, but there is no way to do this kind of search on Hospital Compare.)

In addition, you should look to social media for clues. One of the people who has made bird dogging drug-resistant bugs his passion is Dr. Kevin Kaganagh at Health Watch USA. I asked him for ideas for where reporters could turn, and he said:

“There has been some research on using Facebook and Twitter searches to identify outbreaks in a more timely fashion. This obviously has validity concerns but when faced with a data desert what else can one do?”

(If you are interested in that research, you can read more about it in the journal Antimicrobial Resistance and Infection Control.)

One last thought. When writing about drug-resistant pathogens, don’t shout at your audience. When a pathogen is poorly understood, that fear can lead to bad decisions about health and health care.