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Candida auris: A fungus hospitals don’t want to talk about (nytimes.com)
218 points by DVassallo on June 13, 2019 | hide | past | favorite | 69 comments

I used to work on antifungal drugs (though not against C Auris) and I don’t remember it being any sort of secret. It’s just not a sexy microbe.

Antifungal drugs tend to be very toxic for humans too, though luckily most healthy people’s immune systems are pretty good at rejecting them.

I think the point of the article is not that they're trying to find info on an unsexy microbe. It's that hospitals and similar organizations don't want to talk about antifungal-resistant C Auris because they don't want to be pegged as "that hospital where people get candidiasis", and that secrecy is harmful to the public's ability to find out about the problem.

To eradicate it after one patient died, a hospital in Brooklyn even “had to rip out some of the ceiling and floor tiles” in his room.

- https://slate.com/technology/2019/04/candida-auris-hospitals...

I wonder what if some developed countries release these viruses in developing country with large population but not advance medical techniques. Would they be able to see evolution making people survive against this deadly fungus?

Then simply understanding the mechanism might lead to development of new drugs.

Like polio, malaria, yellow fever, rotavirus, trachoma, hepatitis? Sadly we have plenty of pathogens of all stripes in common circulation already.

Maybe I'm misreading what you wrote - but it kind of sounds like you are suggesting we knowingly infect some developing country with additional diseases, just to see what happens, in the hope it helps us make better medicine for ourselves? That would be kinda ... twisted

This person's comment from two days ago:

> If Norway wants to strive for sustainability they should be installing power plants in India and offering EVs and free charging ports there. In coming days, India is going to surpass all countries when it comes to net pollution.

> I don't know why these rich countries never do anything to improve quality of life on whole planet.

Hypocrisy at it's finest.

I am not here to take any position, I simply asked this because I suspect some country might have this trick in their playbook.

I am not suggesting that countries should do this but I am expressing that it might already be in someone's list of strategy to save their country from the deadly virus.

What you're suggesting is eugenics.

I'm frankly surprised they should be surprised about this - wanting to talk to a hospital about their issues with resistant germs is like asking a restaurant about the roaches in their kitchen...

The surprise is that hospitals are allowed to act this way. Patient privacy is one thing, but this is attempting to suppress information to the public about deadly infections.

Act in what way? Is there some obligation for hospital staff to talk to journalists?

In England there's several duties here.

1) Nolan Principles of Public Life https://www.gov.uk/government/publications/the-7-principles-...

> 5. Openness

> Holders of public office should act and take decisions in an open and transparent manner. Information should not be withheld from the public unless there are clear and lawful reasons for so doing.

> 6. Honesty

> Holders of public office should be truthful.

2) The Professional Standards Organisation's Standards for members of NHS boards and Clinical Commissioning Group governing bodies in England

> Honesty: I will act with honesty in all my actions, transactions, communications, behaviours and decision-making, and will resolve any conflicts arising from personal, professional or financial interests that could influence or be thought to influence my decisions as a board member

> Openness: I will be open about the reasoning, reasons,and processes underpinning my actions, transactions, communications, behaviours,and decision-making and about any conflicts of interest

We could argue that the principle of "Duty of Candour" applies. https://www.cqc.org.uk/guidance-providers/regulations-enforc...

In England I'd be pushing hard for these hospitals to be more open about what's happening and what they're doing to fix it.

I forgot the link to the PSO document. Here it is, it's just four pages and it's pretty good: https://www.professionalstandards.org.uk/docs/default-source...

The answer is in the post you're replying to... Public health is a reasonable priority to expect from a hospital.

Without a public conversation about resistant bugs, the causes (drug overuse) will never be addressed.

That's a really fascinating thought. We often hear and talk about "public health" in the US - but also have serious issues with approving "public" health organizations and care providers. It's ironic how we want our private businesses to take care of our public health.

There's lots of work and discussion going on regarding drug resistance.

Funny, I've been to plenty of conferences and talks about it and I've never seen a journalist.

They just want to churn out articles like this one: FIND OUT ABOUT THIS ONE DEADLY BUG THAT NOBODY WANTS TO TALK ABOUT. No surprise they get few responses.

I don't think that's a fair characterization. The linked article is a "Times Insider" article, so an article about the reporting that went into a much longer article. It focuses on the difficulties the reporter had researching the topic, and I don't think that any of it is fear-mongery like your all-caps title.

The article whose reporting this one focuses on [0] is quite long and strikes me as being well-researched, thorough in its explanations, and not over the top in its take on the issue. Sure, there's a little bit of intrigue, but that just makes for interesting reading.

[0] https://www.nytimes.com/2019/04/06/health/drug-resistant-can...

Their obligation is to keep the authorities informed (and these to inform the public).

At least someone is not doing their job, it seems, which is when journalism is most important.

It's also a paradox to their oath. You come to an hospital to get better, not leave worse. Hiding this mislead people coming in. It's sensitive, I'm not advocating for information spreading panic but still.

People don't come into a restaurant pouring out buckets of super-roaches that are immune to all normal methods of extermination.

If a restaurant has roaches it's their own fault. If a hospital has to fight back a resistant germ it doesn't show they did anything wrong.

People do go into restaurants with viruses though, and restaurants get treated very harshly should people get infected from someone or some foodstuff there.

Restaurant's don't create viruses, they just pass them on, usually unwittingly (and sometimes despite good hygiene practices) but one nasty outbreak traced to a restaurant can destroy a reputation (and kill a business).

The classic case being Heston Blumetnthal's 'Fat Duck' restaurant where 240 people suffered gastroenteritis (nausea, vomiting and diarrhoea) due to norovirus, probably carried in Oysters:


Who is to blame here? Maybe the Oyster farmer, but maybe the distributor. It could have been a single employee with norovirus in the restaurant (or anywhere in the distribution chain).

Most likely no-one did anything wrong and this was just "one of those things"

"We also received full support by our insurers who found no fault in our practices following a report from a leading UK independent specialist. There is still no guaranteed safety measure in place today to protect the general public with regards to shellfish and viral contamination. For this reason we still do not serve oysters or razor clams at the Fat Duck."

Fat Duck was criticised for poor food hygiene practices.

> Restaurant's don't create viruses

They can dramatically amplify the viral / bacteria presence though. Norovirus is pretty nasty (potentially fatal). Very small amounts of norovirus will cause illness. This is why excellent hygiene is needed in restaurants.

Fat Duck was slow to respond to the incident; they had staff working who should not have been working due to sickness; they were using the wrong cleaning products.


I think that's a fairly harsh reading of the report.

Saying "Fat Duck was criticised for poor food hygiene practices" is a little different to saying "Several weaknesses in procedures at the restaurant may have contributed to ongoing transmission."

The report simply says that they relied too heavily on using alcohol gels which don't work so well on norovirus.

It also says that they are unsure if it was The Fat Duck's staff that continued to infect customers or if the Oysters they continued to use continued to be infected.

Yes, excellent hygiene is needed in Restaurants but excellent hygiene won't always stop a norovirus.

One thing not mentioned here (that I suspect might be a factor) is that restaurants that serve tasting menus are more at risk of causing an outbreak like this. If everyone eats a large number of identical courses each with a diverse number of ingredients the possibility of one of those ingredients infecting a large number of people is surely greatly increased.

Excellent hygiene won't always prevent norovirus, but it will prevent more than 400 customers from getting it across several weeks.

> one nasty outbreak traced to a restaurant can destroy a reputation (and kill a business).

> The classic case being Heston Blumetnthal's 'Fat Duck' restaurant...

The Fat Duck is still open, has three Michelin stars and is booked out months in advance. Possibly not the best example of a reputation being destroyed or a business being killed.

True, I could have worded that better—I meant it as a high-profile example of a restaurant that could have been destroyed by norovirus.

It lost a Micehelin star for a while which is often portrayed as a disaster for a restaurant but, as you rightly point out, it bounced back.

Indeed. Some hospitals have really bad statistics on treatment-resistant infections. The reason? They are a better hospital, and they specialise in dealing with them, so when someone at another hospital is diagnosed with one, they get shipped there.

That's clear, however the consequences are the same: if word gets out that a certain hospital has these issues, people will avoid it, same as a restaurant with severe hygiene issues. So the tendency to keep this topic on the down low is understandable, even if I personally don't agree with it either...

Well, this isn't true. If you go to hospital, you might catch dangerous infection there. It has been common sense since forever.

The CDC has a web page where it keeps track of the number of cases, as well as the geographical locations where they occurred [0]. Not currently there, but Costa Rica appears to report a new case just recently.

[0] https://www.cdc.gov/fungal/candida-auris/tracking-c-auris.ht...

Luckily a couple biotech companies like Scynexis and Cidara Therapeutics are working on some novel anti-fungals (currently in stage 3 trials). Hopefully one or both make it through successfully and are approved by the FDA as cases rise.

A related article, published around the same time as this one, was posted and got significant attention on HN about 2 months ago:


(Probably doesn't count as a dupe as this article is more about the secrecy than the infection itself).

The lack of transparency here is criminal.

By the hospitals or by the government unwilling to regulate disclosure?


As eeZah7Ux noted, both.

Not trying to be cynical or arch or snarky here. But considering what hospitals charge for things, isn’t it relatively affordable to do drywall work, tile replacement, etc.?

Copper and silver are good for stopping bacterial growth : https://www.ncbi.nlm.nih.gov/m/pubmed/28407716/

Are there any materials can slow or stop fungal growth?

Baby powder works wonders for fungus. It destroyed jock itch when the azole anti fungals couldnt. Just dry out the fungus if its external. Internal fungals are an entirely different beast..

Exactly. Fungus are usually quite straightforward to eradicate on the surface of the body or on non-porous material. The issue with Candida auris is that it gets in the patient's blood and inside the porous ceiling tiles and walls.

A workplace has to have Material Safety Sheets for hazardous chemicals that people can review for safety precautions and dangerous effects (per OSHA). Why wouldn't a hospital have something similar for communicable diseases?

They likely do. My hospital has patient handouts that cover common antibiotic resistant organisms such as MRSA, VRE, CPO etc.

We live in a world, where almost all skin care products contain anti-fungals. People treat minor skin conditions with essential oils and teatree oil. Fungicides are sprayed on the fields so the crop doesn't get infected and the same is done with factory farmed animals. No wonder these things get resistant...

It should be illegal to use fungicides or bactericides with medicinal value in non-human applications, especially on crops. I'm feeling hopeless regarding what our future chances are in fighting super-bugs. Could you elaborate more on why using tea tree oil contributes to drug-resistant Candida?

> It should be illegal to use fungicides or bactericides with medicinal value in non-human applications, especially on crops.

Fungi are one of the big crop killers. Potato blight, black pod disease, panama disease, mildews, … are all fungi.

I can't tell where you're going with this. Are you saying that there aren't enough non-medicinal-value fungicides to use on crops? Did you misread the sentence you replied to?

> Are you saying that there aren't enough non-medicinal-value fungicides to use on crops?

There's going to be a significant overlap between fungicides which don't kill crops and fungicide with medicinal value.

Edit: Let me try rewriting this comment.

Sure, there's overlap. That doesn't answer the question.

Are you making that claim? Or saying that it's likely?

Your comment had a stance for a brief moment, but then you backed up to "overlap exists" which isn't really evidence in any particular direction.

You appear to be really contrarian about this issue (which can be valuable) for reasons unclear to me and from the looks of it the person you are responding to, who you keep trying to peg as being just as contrarian when in fact they really haven't said much that should be surprising.

Perhaps you can explain what exactly your stance on the subject is, and what you think the person you are responding to is saying. Then you can explain why that bothers you, perhaps then this person and the casual reader can take something away from this discussion.

What bothers me is that masklinn is saying statements that sort of imply there should be a debate, but are not actually advancing the conversation at all. They are neither stating a position nor introducing evidence toward a possible position.

Maybe it helps if I go through the conversation:

Neodypsis says we shouldn't use medicinal-value fungicides on crops. A clear position, based on obvious evidence.

Masklinn replies saying that fungi kill a lot of crops. Okay, well taken literally that's already a part of the comment they reply to. Is the implication that we need medicinal-value fungicides for crops? So I ask if that's what they're saying.

Their reply back... refuses to answer. They just say there's "significant overlap", but "significant overlap" is almost nothing in terms of answering that question. There could be tons and tons of usable crop fungicides outside the overlap. Or none. So it's a fact that's useless by itself but deniably implies a position.

And unless I'm going crazy they initially posted with a real position, but immediately edited it out.

So what I see is someone who could contribute to the debate, almost did for a brief flash, but would rather make posts that have no opinion and no relevant facts. Noise instead of signal.

I don't think they're contrarian, I think those posts are some kind of terrible opposite of being contrarian. And I'm not trying to be contrarian, I just want them to clarify. As for fungicides I have no idea, I need more evidence...

I think it's credible to say that they assumed that the reader would understand that if there were only a few antifungals that could be used on crops, they would start working very poorly in short order. That's not exceptional, because we've seen it happen before with other compounds we spray on crops.

Seen through this lens, I don't necessarily follow with your thinking - but I can try now! Thank you for explaining it so well.

The problem with large scale agricultural (ab)use of antimicrobial agents - no matter if against fungi, bacteria or viruses - is that the sheer scale combined with sub-100%-efficiency means that there is a huge evolutionary selection pressure and this breeds superbugs that then get into the food chain... which then cause issues in people with weak immune systems and spread.

IMO, it is preferable to try growing GMOs or alternative crops than putting at risk the effectiveness of medicinal-value fungicides.

What if using them on crops saved more lives, especially right now, by avoiding starvation scenarios in prone areas, farmers from going bankrupt (and upping risk of suicide), etc. It's not a simple problem, you have to do the cost-benefit analysis.

In the short-term, my opinion is we should look for growing different crops, more resistant to fungi or bacteria naturally. In the long-term, we should look into how to destroy these pathogens without putting at risk the limited cures we already have. It is easier to test new, different, fungicides on crops than on humans.

Why would you add an anti fungal to a skincare product? In case the buyer has an infection?

Fungal infections are the cause of most peoples dandruff issues, and the same fungi can result in skin issues in the rest of the face. So probably to kill that off.

It's mostly so the product doesn't mold over. Skincare products are excellent mold cultivation medium: they're stored at ambient temperature (or more), they provide moisture (and are stored in moisture-rich environments) and they're full of interesting nutrients.

Plus most people would ‘double dip’ when using jars so there will be a transfer from the skin into the cream in the pot. If you have a pot which lasts a couple of months that is potentially quite a lot of material transferred from your skin into the dish.

> Plus most people would ‘double dip’ when using jars so there will be a transfer from the skin into the cream in the pot.

As long as the packaging is not single-use or a bottle / tube they're multi-dipping anyway.

And most containers are either completely open or will get filled back with unfiltered air.

That's a good point.

> We live in a world, where

The comma should not be used there.

Where the Candida albicans central crew at?

As compared to Kambucha, the fungus everyone wants to talk about.

I think as journalists write more and more articles that are catastrophising, clickbait-laden rubbish, they will find fewer and fewer people willing to talk to them. This is a hole they dug for themselves.

As far as I can see, there are no financial interests behind this article (in fact, all the financial interests are against it because it's criticising the lucrative medical system). Maybe it's slightly over dramatic but at least it seems pure in its intentions and it's good to see that the writer feels strongly about the topic.

This is real journalism and we need more of these articles. What we need fewer of are articles which promote financial interests and drive wealth centralization. These are abundant and nobody seems to be pointing those out.

Sad to say, this is not clickbait. Microbes that are becoming resistant due to overuse of antibiotics is a serious problem, especially in countries that repress such information, or where the use of antibiotics is less firmly regulated.

I'm sure most people are aware that Eastern Europe, and especially Romania and Bulgaria has a rampant problem with resistent microbæ, but I was surprised to see that for instance Italy is almost equally as bad.

I am not sure about talking to them. But I do feel a “it’s the end of the world” fatigue. I understand the economic need to generate traffic, but we are told pretty much daily that we are at risk of some sort of deadly peril that will kill us all, whether it is ebola, this fungus, the swine flu, the bird flu, pollution poisoning, global warming, mad cow disease, etc etc.

I find myself in the position to dismiss automatically all these claims as bullshit, but it may be that one day they may get one right. There is a cost to crying wolf.

> I understand the economic need to generate traffic, but we are told pretty much daily that we are at risk of some sort of deadly peril that will kill us all, whether it is ebola, this fungus, the swine flu, the bird flu, pollution poisoning, global warming, mad cow disease, etc etc.

The problem is that we as societies haven't been doing much over the last decades and shit is culminating in the next maybe 10-30 years.

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