Distinguishing Between Fungal Fact and Fiction in “The Last of Us”
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On a recent episode of the Transmission Interrupted podcast, NETEC hosts Lauren Sauer and Rachel Lookadoo interviewed Dr. Arturo Casadevall, an expert in molecular microbiology and fungal infections, about the popular HBO series “The Last of Us.”
The TV show depicts a fungal pathogen that infects much of humanity, turning people into bloodthirsty zombies. This podcast episode investigates the science behind the zombie fungus in “The Last of Us” and the real threat of fungal pathogens. Listen to the podcast.
Priority Pathogens
In 2022, the World Health Organization released a list of fungal “priority pathogens”—19 fungi that represent the greatest threat to public health. The fungal priority pathogens list (FPPL) underscores the need to prioritize fungal pathogens research to strengthen the global response to fungal infections and antifungal resistance.
Fungal Fact or Fiction in “The Last of Us”
Drawing from the podcast episode, here are four scenarios from “The Last of Us” that Dr. Casadevall decodes as fact or fiction.
#1: In “The Last of Us,” cordyceps fungus (specifically Ophiocordyceps unilateralis) causes a widespread fungal pandemic.
Fact and Fiction: Cordyceps is a real fungus. However, the species of cordyceps Ophiocordyceps unilateralis is pathogenic only in insects. Commonly known as zombie-ant fungus, it takes over their bodies, paralyzes them, grows in them, and reproduces. The fungus then releases spores into the environment and infects other insects. Luckily, humans’ advanced immune systems and higher internal temperatures would protect them from infection with this fungal parasite.
#2: The first people infected with cordyceps are exposed to spores in the environment via infected crops that enter the global food chain. As the show progresses, transmission occurs through contact with infected bodily fluids, for instance, when an infected individual bites someone.
Fact: Fungi tend to spread in two ways: vertical transmission from mothers to their offspring and horizontal transmission through spores in the environment. Fungal spores can be inhaled or land on surfaces of the body, infecting only one area of the body, such as the skin or mouth, or multiple organs, including the lungs, eyes, and brain. In theory, fungal pathogens can be spread through bodily fluids, but spread through blood transfusions is extremely rare as people who are very sick do not donate blood. There have been some fungi that have been transmitted in donated organs, but these, too, are rare. There is some evidence that Candida albicans can be spread sexually.
#3: The initial response to the cordyceps outbreak was to bomb the locations of the outbreaks to eliminate the fungus.
Fiction: It is very hard to get rid of fungi spores, and if you bombed a site full of fungal spores, it is more likely that you would just spread the spores.
#4: In the show, there is no cure for infection with cordyceps.
Fact: Fungi are relatively new pathogens in the history of humanity. It was only when modern medicine developed new therapies in corticosteroids, immunosuppressive therapies, and anti-cancer therapies that we began to see many invasive fungal diseases. The other thing that we saw in the late 20th Century was HIV. Modern medicine and the HIV pandemic both undermined immunity, one of the great pillars that prevent fungal infections. Currently, we only have four classes of antifungal drugs.
Weighing the Threat of Fungal Pathogens
At the end of the day, we just wanted to know whether science fiction could become a reality—could “The Last of Us” be a foretelling of what’s to come? Dr. Casadevall has answered this question a lot since the show first propelled him and other mycologists into the spotlight. And while he says it’s improbable, “you never, ever say ‘impossible’ in science, particularly when you’re dealing with biology.”
This is the first in a three-episode series about pathogens in pop culture. Follow Transmission Interrupted on your favorite podcast platform to be notified when a new episode is released.
About the Experts
Arturo Casadevall, MD, PhD, is the chair of Molecular and Microbiology and Immunology at Johns Hopkins Bloomberg School of Public Health and focuses on host defense mechanisms, how fungi cause disease, and in the development of antibody-based therapies for infectious diseases. Read Dr. Casadevall’s interview in the Hopkins Bloomberg Public Health magazine, “Why Fungal Diseases Are an Increasing Threat.”
Lauren Sauer, MSc, is an Associate Professor in the College of Public Health, Department of Environmental, Agricultural, and Occupational Health, at the University of Nebraska Medical Center and Core Faculty of the UNMC Global Center for Health Security. She is an Adjunct Associate Professor of Emergency Medicine in the Johns Hopkins School of Medicine, and the director of the Special Pathogens Research Network.
She previously served as Director of Operations for the Johns Hopkins Office of Critical Event Preparedness. Lauren’s research focuses on human-subjects research in bio-emergencies and disasters, in particular, ethical implementation of research and navigating the regulatory environment. The goal of her research is to provide health care facilities with the tools needed to conduct a clinical and operational research response in emergencies.
Rachel Lookadoo, JD, is an Assistant Professor in the Epidemiology department of the College of Public Health at the University of Nebraska Medical Center and serves as the Deputy Director of the Center for Biosecurity, Biopreparedness, and Emerging Infectious Diseases. She also acts as the Director of Public Health Policy for the Water, Climate, and Health program at the University of Nebraska Medical Center.
Ms. Lookadoo’s background is as an attorney, and she focuses on the various legal and regulatory issues that can arise in emergency preparedness and response. She specializes in public health impacts of climate change, healthcare surge events, isolation/quarantine law, crisis standards of care, infectious disease response, and general legal preparedness. Ms. Lookadoo also conducts emergency preparedness trainings and assessments for public health departments and healthcare facilities nationally. Ms. Lookadoo received her Juris Doctor degree from American University Washington College of Law, and her bachelor’s degree from Baylor University.