For healthcare systems in the Pacific Northwest, the recent outbreaks of Candida auris (C. auris) serve as a wake-up call. The implications of the arrival of this resilient and drug-resistant fungal pathogen are profound, particularly for our most vulnerable patients who are immunocompromised or critically ill. This new threat also represents a bellwether in health circles due to the clear link between the spread of C. auris and climate change.
C. auris is a potentially deadly fungus that was only first reported in the U.S. in 2016. Its arrival to Washington state is not just a local issue; it is a global concern. The rise in global temperatures, attributed to climate change, is believed to be a key factor behind the alarming surge of C. auris cases. As temperatures increase, fungi can adapt to warmer environments, overpowering the body’s natural defenses. In the U.S., reported clinical cases increased by 95% during 2020–2021, and in 2022 alone, over 2,377 cases were recorded, emphasizing the urgency of understanding and addressing this emerging threat.
Researchers posit that climate change acts as a catalyst for C. auris‘s evolution into a formidable human pathogen, highlighting the intricate connection between environmental shifts and the spread of infectious diseases.
What makes C. auris particularly dangerous is its resistance to multiple antifungal drugs. Strains of the fungus can be resistant to one, two, or even all three main classes of antifungal medications. For immunosuppressed or critically ill patients, these drug-resistant strains pose a significant threat to health, with more than one-third of patients infected with C. auris dying within a month of diagnosis.
C. auris also adds another layer of complexity to our healthcare system. Because C. auris can be so challenging to eradicate, hospitals with known cases must adopt enhanced infection control measures. But despite these efforts, it can still be difficult to control the spread of the fungus, in part because healthy individuals can become colonized with C. auris and transmit it to others.
While the full impact of this pathogen’s arrival in the Seattle area is not yet fully understood, one thing is certain: it will not be the last time we contend with the emergence of a new infectious threat linked to climate change. Each new pathogen will likely have its own unique set of challenges that will need to be addressed in a timely and nuanced manner. Tackling these emerging pathogens head-on will require a team effort that includes close coordination among clinicians, researchers, public health officials, and policymakers.
We propose that funding from the Climate Commitment Act be put toward building a climate resiliency program that addresses these emerging pathogens. Financial backing could allow for rapid expansion of public health measures — such as more diagnostic testing and research on therapeutics — in the event of future outbreaks.
It is time for a paradigm shift, a new way of thinking that recognizes the intricate links between our health and the world we inhabit. Incorporating a One Health perspective is crucial in addressing emerging pathogens. Antimicrobial stewardship reduces resistance, preventing spread of multi-resistant yeasts like C. auris in antibiotic-intensive environments like hospitals. Such measures are ripe for inclusion in county-level adaptation planning, including the resiliency element of the Growth Management Act.
As we grapple with the complexities of C. auris, we must acknowledge the broader implications of climate change on human health. The healthcare community in Washington and beyond must adopt a proactive stance, integrating climate-conscious practices into our healthcare systems. This involves not only enhancing infection control measures but also reevaluating our approach to patient care in the context of a changing climate.
Stefan Wheat, MD, is an assistant professor of emergency medicine at the University of Washington in Seattle. Thomas Kuczmarski, MD, is a hematology/oncology fellow at the Fred Hutchinson Cancer Center and University of Washington.
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