The fungus among us: the next pandemic

I thought we were friends. You help me make beer, wine, bread and kombucha.

We help you spread your spores by clearing land for crops and housing. We warm the climate to make it comfortable for you to grow. You happily hitchhike around the world on goods and animals.

Every day, every person on the planet inhales at least 1,000 fungal spores.

Sure, you can be irritating at times with your fungal skin infections. You bug us with your athlete’s foot, jock itch, ringworm, and yeast infections.

But now you are turning deadly. What gives?

Up until now, doctors have considered Valley Fever an exotic “desert disease” confined to California, Arizona, the southern tip of Nevada, New Mexico and west Texas.

Now Valley Fever, caused by Coccidioides, is on the move. It regularly infects about 150,000 a year in the desert and it’s now moving north. With soil becoming drier due to climate change, Coccidioides spores are blowing in the wind and infecting people in Washington State (Scientific American, June, 2021).

While no statistics are available for Canada, Coccidioides has likely moved into B.C.’s southern desert interior.

When those spores are inhaled, they can migrate from the lungs into the bloodstream, and from there to the skull and spine. The lungs react by producing scar tissue that stiffen and block the lungs, reducing breathing capacity. Masses can form around organs and the membranes around the brain, causing death.

Because infections have been relatively rare until now, there are few antifungal treatments. Also, they are difficult to design because fungal and humans human cells are so similar. It’s challenging to create a drug that can kill them without killing us, too.

The yeast-like fungus, Candida auris, was virtually unknown until 2009. Since then, there have been outbreaks of infection in hospitals and long-term care facilities in Canada and around the world. Most infections occur in patients with weakened immune systems: those receiving chemotherapy or surgery and who are on large intravenous lines.

Former president of the Canadian Infectious Disease Society, Dr. John Conly, says that we have been ignoring the growing multidrug-resistance of C. Auris for decades.

“The ball was dropped for many years,” says Conly. He likens antimicrobial resistance to climate change as: “a slow-moving tsunami.”

The COVID pandemic brought on new opportunities for C. Auris. In the frantic interventions to save patients from the coronavirus –such as ventilators, immune-damping drugs, broad-spectrum antibiotics- patients are left vulnerable to the fungus.

In the chaos of the pandemic, few statistics of infection were kept. But a report from New Delhi found that two thirds of the patients who contracted C. Auris died after they were admitted to hospital with COVID.

Another so-called friend is revealing its malevolence.  On its good side, Aspergillus fumigatus serves as a clean-up crew. It encourages the decay of vegetation in the composting process.

One its evil side, Aspergillus causes of an opportunistic infection spawned when someone with a compromised immune system cannot sweep away its spores. In people who are already ill, the mortality rate of Aspergillus is near 100 percent.

Aspergillus can invade organs and the blood stream, including the brain. Professor Kieren Marr of Johns Hopkins Medical Center says:“This is bad. Aspergillus is more important in COVID right now than C. auris. Without a doubt.”

Fungi are woven into our lives, our environments and our bodies.  

Can’t we continue to be friends?

When am I dead?

When I’m dead I won’t be writing these columns. But other than that, indication of my demise might not be certain. The problem is that our definitions of death vary according to legal, cultural, religious and philosophical perspectives.

  image: slideserve.com

There was some dispute about whether Taquisha McKitty of Brampton was dead. Doctors said she was but her parents disagreed. She went into cardiac arrest following a drug overdose and was declared neurologically dead. A death certificate was issued.

McKitty’s father said: “My daughter is not dead -she shows that every day.” He maintains that his daughter shows signs of life: squeezing the hands of loved ones and even shedding tears.

Whether she was living was finally decided through a court decision. A judge ruled that McKitty was, in fact, dead.

Keeping someone alive with life support is not an issue. Canadians are kept alive with pacemakers, kidney dialysis, mechanical hearts and lungs while awaiting transplants. The issue is whether we should maintain one’s bodily functions when they are dead.

McKitty’s family might disagree with my last sentence. If they believe that bodily functions define life, then the squeezing of hands indicates that Taquisha was alive.

Others could argue that breath itself is life. If so, breathing is an indication of life. Genesis 2:7 says: “The LORD God formed the man from the dust of the ground and breathed into his nostrils the breath of life, and the man became a living being.”

Still others believe that the soul, the essence of life, resides in the heart. The ancient Egyptians thought that the heart was vital. During mummification, they discarded the brain by removing it through the nose but kept the heart. They likely believed that as long as the heart is pumping, a person is alive.

In Western culture, the brain defines life because it’s the seat of the mind. Some philosophers suggest that it’s the mind that defines life. They argue that since the mind resides in the brain, and because the brain is a (biological) machine, the mind could reside in any machine. If complex computer could be built, the mind could continue to live in a solid state environment without a body.

The Japanese would disagree. They see the body and mind as a single unit so that the mind is not independent of the brain. To be alive is to experience bodily sensations and desires as well as cerebral thoughts.

The judge in McKitty’s case ruled that the brain is central in determining death. If the brain is dead, so is the mind. This opinion coincides with doctors’ assessments. Dr. Sonny Dhanani, a pediatric critical care physician in Ottawa, concludes:

“When brain death occurs, there is no blood and oxygen going to it. The brain ceases all function. There are no functions left to be lost. This means there is the irreversible loss of any ability to have thoughts or feelings or memories (Globe and Mail, July 6, 2018).”

I won’t know when I’m dead and given the definitions of life, maybe no one else will be sure any time soon.