Excess body weight linked with COVID-19 mortality

 Links between obesity and mortality have become increasingly evident, since the earliest pandemic of the 21st century, leading researchers from The University of Texas at San Antonio and the University of Wisconsin-Milwaukee to investigate if excess body weight may have been associated with high rates of COVID-19 mortalities around the globe.

Lead principal investigator Hamid Beladi, UTSA's Janey S. Briscoe Endowed Chair in Business, and his colleagues recently published a novel study in Public Health in Practice analyzing plausible associations of COVID-19 mortality and excess weight in nearly 5.5 billion adults from 154 countries around the world.

To identify potential patterns in data, the researchers employed cutting-edge techniques of statistical analyses.

"The main finding from the analysis is a statistically significant positive association between COVID-19 mortality and the proportion of the overweight in adult populations spanning 154 countries," Beladi said. "This association holds across countries belonging to different income groups and is not sensitive to a population's median age, proportion of the elderly, and/or proportion of females."

Beladi added that when the proportion of the overweight people in a country's adult population is one percentage point higher than the proportion of the overweight in a second country's adult population, based on this study, it is reasonable to predict that COVID-19 mortality would be 3.5 percentage points higher in the first country than it would be in the second.

"The average individual is less likely to die from COVID-19 in a country with a relatively low proportion of the overweight in the adult population, all other things being equal, than she or he would be in a country with a relatively high proportion of the overweight in the adult population," Beladi said.

The study's authors say that, clinically, excess body weight is related to several comorbidities that can lead to an increasingly severe course of and consequent death from COVID-19. Metabolic disorders, for example, can predispose individuals to a poorer COVID-19 outcome. Since excess body weight can result in a greater volume and longer duration of contagion, it can also lead to a higher level of exposure to COVID-19.

They added that on average, the COVID-19 pandemic has been more fatal for adult populations residing in parts of the world characterized by excess body weight.

The researchers believe their findings can be used to uphold public policy regulations on the food industry, to the extent that it profits off the sales of processed foods, foods high in salt, sugar and saturated fats.

With the death toll from the current pandemic exceeding 4.5 million, the group's main findings call for immediate and effective regulations that are long overdue, Beladi said.

"Some firms in the food industry have taken the liberty of using the pandemic as a platform for marketing in ways that are all but conducive to restraining body weight," he explained. "Our observed association, between COVID-19 mortality and the share of the overweight in nearly 5.5 billion adults residing across 154 countries that host almost 7.5 billion people around the globe, serves as a caution against putting more lives at stake."

---

Explore further

COVID-19 takes nine million years of life from people in the US

---

More information: Bernard Arulanandam et al, COVID-19 mortality and the overweight: Cross-Country Evidence, Public Health in Practice (2021). DOI: 10.1016/j.puhip.2021.100179

https://medicalxpress.com/news/2021-10-associates-excess-body-weight-covid-.html

Investor behind Gilead's Immunomedics deal says Merck-Acceleron tie-up too early, too cheap

 Merck hopes its $11.5 billion Acceleron buy will quickly wrap up in the fourth quarter. But revolt from an activist investor threatens to derail that plan.

Hours after Merck’s Thursday announcement, Avoro Capital slammed the New Jersey pharma’s $180-apiece price, arguing it “drastically undervalues” Acceleron. The investment shop owns about 7% of Acceleron shares.

Avoro argues that, instead of going on sale right now, Acceleron should wait for more clinical trial data from the deal centerpiece—pulmonary arterial hypertension (PAH) candidate sotatercept—to get a better price. The investment manager feels “incredibly strongly” that the transaction would hurt Acceleron shareholders if allowed as is, it said in a statement.

Avoro, previously known as venBio, has intervened in a portfolio company’s dealmaking activity before. The company is perhaps best known for nixing Immunomedics’ $2 billion tie-up with Seattle Genetics, now known as Seagen, in 2017.  

Seagen in February 2017 proposed up to $2 billion for rights to what would later become Trodelvy. The TROP2-targeting antibody-drug conjugate was then close to an FDA filing in triple-negative breast cancer. But venBio, led by Managing Partner Behzad Aghazadeh, criticized the low price. It took control of Immunomedics’ board of directors with Aghazadeh as chairman and installed a new management team.

Trodelvy went on to snag its first U.S. approval in April 2020. Then, last September, Gilead Sciences, yearning for an expansion in oncology, shelled out $21 billion for Immunomedics, with Trodelvy at the center. Aghazadeh himself reaped a massive $2.35 billion payout from selling his ownership in Immunomedics.

Now, Avoro and Aghazadeh are advocating the same “patience is a virtue” argument for Acceleron.

Merck’s current markup to Acceleron’s share price ranks at the bottom of 19 other comparable biopharma transactions since the beginning of 2020, Avoro said.

When Bloomberg and The Wall Street Journal first reported on the deal a few days ago, SVB Leerink analyst Geoffrey Porges noted that the $180-per-share price would represent a 45% premium to Acceleron’s average share price from mid-April to mid-August. Avoro calculated the premium at 38% against Acceleron’s stock price before the rumor and noted that the premiums of biopharma M&As since 2020 have averaged about 89%.

Porges' team has put the per-share value of Acceleron at $182 if sotatercept successfully makes to the market, suggesting Merck’s offer is fair. Piper Sandler’s Christopher Raymond, in a Thursday note, said Merck is pricing Acceleron at about 15 times the biotech’s estimated 2025 revenue, which he also labeled as fair.

Avoro’s conversations with industry watchers also tell it Acceleron is getting the highest premium available. But the unsatisfied activist investor raised the question: “Why sell now at such a price?”

“Based on our own analysis and that of other prominent scientific observers, we have full confidence that Acceleron’s pipeline will continue to perform well and only further demonstrate the value of the company,” Avoro said in a statement.

Sotatercept is currently in phase 3 testing in three trials, with first results expected in 2024. Merck has touted the drug’s first-in-class potential as the first disease-modifying agent for PAH among many existing treatments that target symptoms by dilating blood vessels.

Porges has put sotatercept’s peak sales at over $2 billion. Raymond currently estimates the drug could reach $1.4 billion sales by 2027 but also noted the number could go higher given Acceleron is moving it beyond PAH and into pulmonary hypertension with left heart disease.

https://www.fiercepharma.com/pharma/trouble-builds-for-merck-s-11-5b-acceleron-buy-as-activist-investor-behind-gilead-s

Malaysia in talks to procure Merck's COVID-19 pills

 Malaysia is in talks to procure an experimental antiviral pill developed by Merck & Co for COVID-19 treatment, the health minister said on Saturday.

Health Minister Khairy Jamaluddin said in a tweet that he has started negotiations to procure the new drugs, referring to a Reuters story on Friday that the pill developed by Merck https://www.reuters.com/business/healthcare-pharmaceuticals/mercks-covid-19-pill-cuts-risk-death-hospitalization-by-50-study-2021-10-01/?taid=6156ea3f76ce46000139546f&utm_campaign=trueAnthem:+Trending+Content&utm_medium=trueAnthem&utm_source=twitter could halve the chances of dying or being hospitalised for those most at risk of contracting severe COVID-19.

"As we transition to living with COVID, we will be adding new, innovative treatment options to our arsenal in addition to vaccines," he said.

Merck and partner Ridgeback Biotherapeutics are planning to seek U.S. emergency use authorisation for the pill as soon as possible and to make regulatory applications globally.

The pill molnupiravir, designed to introduce errors into the genetic code of the virus, would be the first oral antiviral medication for COVID-19.

Current treatment options include Gilead Sciences Inc's infused antiviral remdesivir and generic steroid dexamethasone, both of which are generally only given once a patient has already been hospitalised.

There was not immediate response to a request to clarify if the ministry's negotiations also included Gilead Sciences or Pfizer which is developing an antiviral pill with Swiss drugmaker Roche Holding AG.

https://www.marketscreener.com/quote/stock/ROCHE-HOLDING-AG-9364975/news/Roche-Malaysia-in-talks-to-procure-Merck-s-COVID-19-pills-36575979/

White House pushes U.S. airlines to mandate vaccines for staff by Dec. 8

 

The White House is pressing major U.S. airlines to mandate COVID-19 vaccines for employees by Dec. 8 - the deadline for federal contractors to do so - and is showing no signs of pushing back the date, four sources told Reuters on Friday.

White House COVID-19 response coordinator Jeffrey Zients spoke to the chief executives of American Airlines, Delta Air Lines and Southwest Airlines on Thursday to ensure they were working expeditiously to develop and enforce vaccine requirements ahead of that deadline, the sources said, speaking on condition of anonymity.

Large U.S. airlines have a number of federal contracts. President Joe Biden signed an executive order last month requiring federal contractors to mandate https://www.reuters.com/world/us/exclusive-white-house-wants-millions-government-contractors-vaccinated-by-dec-8-2021-09-24 COVID-19 shots for employees, with the White House last week setting the Dec. 8 deadline for completing the vaccinations.

American Airlines on Friday evening said more than 100,000 U.S.-based employees will need to get vaccinated, but did not specify a compliance date. It added that employees will be able to seek religious or health exemptions to vaccination.

"While we are still working through the details of the federal requirements, it is clear that team members who choose to remain unvaccinated will not be able to work at American Airlines," Chief Executive Doug Parker and President Robert Isom said in a memo https://twitter.com/davidshepardson/status/1444077561684938764/photo/1. "We realize this federal mandate may be difficult, but it is what is required of our company, and we will comply."

Some airline officials had asked the White House to push back the requirements, signed by Biden last month, until after the busy holiday travel season.

Zients urged the airlines "to act sooner than later to ensure as smooth of an implementation process as possible," one source said, and made clear the White House does not intend to relax the deadline. Zients also urged them to look at the United Airlines vaccine requirement https://www.reuters.com/business/healthcare-pharmaceuticals/united-airlines-says-more-than-99-us-employees-have-been-vaccinated-2021-09-28 that was announced in August.

The three airlines separately confirmed the calls took place but declined to discuss the specifics. Zients did not respond to a request for comment on the calls, first reported by Reuters.

"Employers should act now to protect their workforce," Zients told a press briefing on Friday, without directly discussing airlines. "More and more companies are stepping up to make vaccine requirements the standard across all sectors."

The Civil Reserve Air Fleet (CRAF) is among the federal contracts for major U.S. carriers. The reserve fleet was activated in August in support of the Pentagon, as airlines helped ferry people who have been evacuated from Afghanistan.

Biden's administration notified carriers on Thursday it will seek a modification of CRAF contracts to require vaccinations of airline employees, sources told Reuters. Other government agencies are also expected to seek amendments to contracts with airlines.

LABOR SHORTAGE WORRIES

The Allied Pilots Association https://www.alliedpilots.org/Portals/0/Public/DEPT/COMMUNICATIONS/Documents/Blast%20Docs/APA_VaccineMandate_AMOC_Final.pdf, which represents 14,000 pilots who fly for American Airlines, last week said that "mandatory vaccinations could result in labor shortages and create serious operational problems for American Airlines and its peers." Some employees of various U.S. businesses have quit rather than comply with vaccine mandates.

Two smaller airlines said earlier on Friday they would comply with the vaccine mandate for federal contractors. JetBlue Airways said it had "communicated this vaccine requirement to our crew members."

Alaska Airlines said it would comply with the federal contractor vaccine requirements, saying it believes it and other major U.S.  airlines are covered by the executive order.

Alaska Airlines said it "means all of our employees, including  certain  contractors and vendors, will be required to be fully vaccinated, or be approved for a reasonable accommodation such as medical conditions or religious beliefs that prevent them from being vaccinated."

It added: "The date by which employees must be fully vaccinated has not been confirmed by the government, but it could be as early at Dec. 8."

The Federal Acquisition Regulatory Council, which provides guidance to U.S. agencies on contracts and procurement, issued a memorandum https://www.whitehouse.gov/wp-content/uploads/2021/09/FAR-Council-Guidance-on-Agency-Issuance-of-Deviations-to-Implement-EO-14042.pdf on Thursday on incorporating a clause into their solicitations and contracts on vaccines. It is expected to issue guidance on exemptions on Oct. 8, sources said.

Separately, the Labor Department will issue an emergency https://www.reuters.com/world/the-great-reboot/us-retail-industry-seeks-90-day-lead-time-covid-19-rules-2021-09-21order covering more than 80 million private-sector employees to require either regular COVID-19 testing or vaccines. That order is expected this month https://www.reuters.com/legal/government/white-house-wants-millions-government-contractors-vaccinated-by-dec-8-2021-09-24.

Delta said on Friday that 84% of its employees are vaccinated and it continues "to evaluate the administration's plan." Southwest said it "continues to strongly encourage employees to receive the COVID-19 vaccine."

United Airlines said 99.5% of its U.S.-based employees have been vaccinated, excluding those who have sought an exemption. The carrier said only 320 U.S.-based staff are not in compliance with its vaccination policy.

United, which in August became the first U.S. carrier to require vaccinations for all domestic employees, had asked staff to provide proof of vaccination by Monday or face termination.

https://www.marketscreener.com/news/latest/White-House-pushes-U-S-airlines-to-mandate-vaccines-for-staff-by-Dec-8--36573953/

NYC Restaurateurs: Business Down 40-60% Due To Vaccine Mandate

By Enrico Trigoso of Epoch Times,

New York City restaurateurs are complaining that their business has been slashed severely by the COVID-19 vaccine mandate, which requires people 12 and older to show vaccination proof for indoor dining, indoor fitness, and indoor entertainment.

O'Donoghue's Pub and Restaurant in Times Square, N.Y., on Sept. 30, 2021. (Enrico Trigoso/The Epoch Times)

Pre-pandemic, O’Donoghue’s Pub and Restaurant was a successful business that has been open for 10 years in Times Square, Manhattan. Fergal Burke, the owner of O’Donoghue’s noticed that his business has seen “a massive drop,” since the vaccine mandate came into effect.

“We don’t have the money here to survive without the help of our landlord, [who] has been very supportive and has been giving us breaks on the rent, but without our landlord, we would not be in business,” Burke told The Epoch Times. He said that he needed to hire another person to be at the door checking for vaccination proof, which increased his expenses.

Comparing the clientele from pre-mandate to when it kicked in about two weeks ago, “Our business is definitely down 50, I’m going to say 60 percent,” Burke said with a somewhat downhearted tone. “There’s just not people coming into the restaurant, they have the fear of being asked for vaccines.”

Burke and his staff have had to refuse a lot of customers for not having the passes.

“They’re being refused and they get a resentment against us, they don’t get a resentment against Bill de Blasio or Biden, or whoever is mandating us to check for this.”

“It comes as a personal rejection,” he said, further stressing that it’s not O’Donoghue’s that wants this. “We don’t want this mandate, we want nothing to do with this.”

He also noted how the subway is full of people but there’s no requirement to show vaccination proof.

“I mean how is that fair in New York City, that the trains are jammed with people with a silly mask on and they’re not being mandated to show nothing, and yet they’re coming against the heart of the city. We’re the ones that’s trying to keep 20 people employed here,” Burke said.

“We will go out of business if this continues, it’s gonna force us to shut our doors.”

Despite winter coming soon, they now need to build an outdoor dining area to facilitate an outdoor space, which will cost about 10 to $15,000.

Luke’s Lobster in Manhattan, N.Y., on Oct. 1, 2021. (Enrico Trigoso/The Epoch Times)

Some restaurants like Luke’s Lobster have been less affected by the vaccine mandates since their restaurant has little indoor dining space and is located near a park and many outdoor tables on Broadway. The manager there told The Epoch Times that people are mostly compliant, and if anyone can’t dine-in due to lack of proof, they will go to the tables outside.

“Some people are obviously not super happy about it but they will comply and if they don’t want to comply they’ll take it outside,” she said.

‘No One Size Fits All’

Restauranteur Stratis Morfogen, a managing partner at Brooklyn Chop House, thinks that the government needs to start considering bailouts to help the restaurant industry again.

“Business is down probably 50 percent because people are not comfortable with being forced to take a vaccine,” Morfogen told The Epoch Times.

“All of a sudden, we dropped 40 percent from week to week, since the mandate started.

“The politicians don’t understand it is that there is no one size fits all with medicine. And you can’t tell a person has just finished chemotherapy, that they have to take a vaccine to have a dinner, when their doctor says they can’t.”

Morfogen said that now they have to police COVID-19 vaccination cards, most of which are written in pen. He says 2 million were distributed before the city implemented a central database.

“It’s as smart as my 1983 driver’s permit. My daughter who is 13 can print out one of the fakes on her bedroom printer and you want me to question the customers if this card is legitimate, when every one of them is pretty much is written in pen?”

Morfogen said that his business did fairly well during COVID-19 and survived the restaurant crisis, but that he feels a responsibility to speak up.

“Nobody steps up for the little guys,” he said.

“I’m not fighting for myself. I’m fighting for the ones that don’t have a platform that are getting screwed by these politicians every day.”

“The Counter” custom burger shop in Times Square, N.Y., on Aug. 7, 2021. (Enrico Trigoso/The Epoch Times)

The manager of custom burger restaurant The Counter located in Times Square told The Epoch Times that “everyone is losing thousands of dollars,” and that they will go out of business due to the vaccine mandate.

“The mayor is a jerk,” she said.

https://www.zerohedge.com/markets/nyc-restaurateurs-business-down-40-60-percent-due-vaccine-mandate 

Ransomware is a patient mortality risk, driven by COVID, third-party vendors

 A new report from the Ponemon Institute reinforces the patient safety risks posed by ransomware attacks: 22% of surveyed providers saw an increase in the rate of mortality in their health care organization after a cyberattack. The driving factors include the COVID-19 response and security gaps within the third-party vendor ecosystem.

“The possible adverse impact on patient care due to third-party risks is the biggest pain point in organizations,” according to the report. “Cyberattacks have resulted in more extended hospital stays and delays in procedures and tests that have resulted in poor outcomes.”

For the Censinet-sponsored report, Ponemon researchers surveyed 597 IT and IT security professionals from health care delivery organizations (HDO) to assess the impact of COVID-19 and the rise in cyberattacks like ransomware on patient care and patient data security.

Industry stakeholders have long warned of the imminent risk to patient safety posed by cyberattacks and the downtime brought on in response.

But outside of a 2019 report, data on specific mortality incidents have remained sparse, driving the need for threat sharing and first-hand accounts to better inform the industry on specific scenarios increasing the risk of patient harm. In multiple attacks this years, patients reported facing long wait times, delayed appointments, canceled surgeries, and other care challenges brought on by ransomware-induced network outages.

With Ponemon’s report, health IT leaders confirm the direct link between cyberattacks and patient care through providers’ experiences. In the last two years, 43% of the surveyed health care organizations experienced a ransomware attack, with 33% falling victim to two or more attacks.

Of those providers, 71% reported an increase in the length of stay and 70% saw delays in procedures and tests that spurred poor care outcomes. Another 65% found an increase in patients transferred or diverted to local care sites as a direct result of an attack, with 36% reporting increased complications from medical procedures.

For more than half of respondents, patient safety was named the largest concern after an attack, followed by care disruption. “Our findings correlated increasing cyberattacks, especially ransomware, with negative effects on patient care, exacerbated by the impact of COVID on health care providers,” said Larry Ponemon, chairman and founder of the Ponemon Institute, in a statement.

Third-party vendors adding to overall risks

The report saw a number of factors increasing the risk and overall lack of preparedness in health care. Prior to the pandemic, 55% of providers felt able to manage ransomware risks. But as COVID-19 worsened, 61% of respondents reported feeling no confidence or not confident they’d be able to adequately respond to an attack.

During the height of the pandemic, credential theft attacks saw the biggest spike in health care for 60% of organizations, followed by compromised or stolen devices (55%) and account takeover attacks (43%).

As many reports have shown, the national emergency introduced a host of new risk factors to delivery organizations, such as the rapid adoption of remote work, new services and devices quickly implemented to support IT, staffing challenges, and elevated care requirements.

But third-party risk was seen as the driving force for response challenges and security risks, both before and amid the pandemic. Of the organizations that faced a ransomware attack within the last two years, 36% said it was a third-party that caused it.

The leading cause of vendor management challenges is the complexity of the technologies that support risk management and the lack of skilled personnel, according to the report.

The average number of third-party vendors contracted with a single organization is about 1,950. In the next year, the average number will jump to 2,541. As health care continues to digitize and shift into greater interoperability, these challenges will persist — particularly with devices that hold a range of components not developed by the provider organization.

“Third-party products and services are a necessary and critical part of the IT blueprint, but each brings another set of risk factors to the table,” according to the report. “The risk created by the third party or the [organization’s] use of the third party needs to be managed. The burden is on the [entity] to perform assessments throughout their relationship with the third party.”

However, 44% of respondents said their third-party risk assessments are only partially accomplished by their organization. Just 40% of providers said their organization completes a third-party risk assessment before contracting with a vendor.

Even worse: 38% said their leadership team ignores the assessment findings. And while reassessments are crucial to maintaining secure, vendor relationships, 53% admitted their organization only conducts reassessments on demand or without a routine schedule.

The results of these security mishandlings are evident: with 60% of the surveyed organizations experiencing a data breach within the last two years.

But COVID-19 spurred some positive reactions within health care with an increase in staff and demands for more risk assessments. For half of these organizations, the third-party risk management program has been completely or partially outsourced to a managed service provider in direct response to the pandemic.

Just 30% said that nothing has changed to their organizations’ risk management.

“The combination of data breaches, ransomware attacks, and COVID-19 has created the perfect cybersecurity storm and the worst two years on record for IT and security leaders in health care,” Ed Gaudet, CEO and founder of Censinet, said in a statement.

“The Ponemon Research results are an urgent wake-up call for the health care industry to transform its cybersecurity and third-party risk programs or jeopardize patient lives,” he continued.

https://www.scmagazine.com/analysis/ransomware/report-ransomware-is-a-patient-mortality-risk-driven-by-covid-third-party-vendors

Valley Fever Is Spreading Through a Hotter, Drier Western US

 At 5 am on December 4, 2017, Jesse Merrick got a text from his roommate. “Hoping your family is OK,” he remembers reading when he woke up. The Thomas Fire had just broken out in Southern California and was quickly growing into a nearly 300,000-acre behemoth. Jesse frantically tried to reach his relatives in Ventura. When he finally got hold of his mom, she was broken. “She answers the phone and she’s crying hysterically,” Jesse said. “She says, ‘It’s gone. It’s all gone.’” 

The Merricks’ ranch-style home, with most of Jesse’s childhood stuff in it, burned down that day. A week after the fire, he flew out to help his mom salvage what was left. They spent days sifting through the rubble. Jesse, a former college football player, took on the strenuous task of sorting through the wreckage in the deep, charcoaled hull of their basement. The whole family wore masks to protect their lungs from the dust and gloves to shield their hands from sharp objects. But it wasn’t protection enough from the danger lurking in the dirt.

Three weeks later, Jesse had to fly back home to Alabama, where he was working as a sportscaster. He was in charge of covering the annual Sugar Bowl college football game in New Orleans—a big opportunity. But when he got there, something didn’t feel right. “I felt like I had gotten hit by a bus,” he said. Jesse chalked it up to jet lag and pushed through with the broadcast. But his symptoms didn’t subside. Instead, they got much, much worse. Within a couple of days, he was coughing and running a low-grade fever. A rash had appeared on his upper torso. “I remember being miserable,” he said. “I wasn’t sleeping.” Once the rash started moving up his neck, about four days after he first started feeling sick, Jesse knew he had to get to an urgent care clinic. 

That was the first of many doctor’s visits. For a month, Jesse’s symptoms worsened. Giant welts appeared around his joints like someone had whacked him all over with a baseball bat. He developed pneumonia, which made everything hurt, even breathing. Walking was painful. “It felt like someone was stabbing the bottom of my feet with knives,” Jesse recalled. 

By the time his primary care doctor discovered a 6-centimeter mass in his lung, Jesse was starting to think that whatever disease he had might actually end up killing him. He was scheduled for a biopsy and a spinal tap—last-ditch efforts to find the source of his illness. But on the morning of the procedures, a team of infectious disease specialists appeared in his hospital room. “It was like I was on an episode of House or something,” Jesse said, chuckling. The biopsy and the spinal tap were suddenly irrelevant. The specialists were able to give him what his regular doctor couldn’t: a diagnosis. 

Jesse had a disease called valley fever. It’s caused by one of two strains of a fungus called Coccidioides, Cocci for short, that thrive in soils in California and the desert Southwest. The mass in his lung wasn’t cancer, it was a fungal ball—a glob of fungal hyphae, or mushroom filaments, and mucus. The infectious disease specialists started him on an intravenous drip of fluconazole, an antifungal medication. “Instantly, I started feeling better,” Jesse said. 

Jesse got lucky that day. The infectious disease experts were in the right place at the right time. Some 60 percent of valley fever cases produce no symptoms or mild symptoms that most patients confuse with the flu or a common cold. But 30 percent of those infected develop a moderate illness that requires medical care, like what Jesse had. And another 10 percent have severe infections—the disseminated form of the disease, when the fungus spreads beyond the lungs into other parts of the body. Those cases can be fatal.

Doctors don’t know why certain people experience no symptoms while others wind up in the emergency room. But they do know that pregnant people, the immunocompromised, African Americans, and Filipinos are especially at risk. And they also know that Cocci is a generalist. Any person, dog, or other mammal who breathes in air laced with the fungal spores is at risk of developing the disease, which kills roughly 200 people in the US every year. No vaccine currently exists, and the antifungal treatment is a Band-Aid, not a cure. 

Jesse’s difficulty getting a fast and accurate diagnosis isn’t an isolated incident. The Centers for Disease Control and Prevention estimates that some 150,000 cases of valley fever go undiagnosed every year—and that’s likely just the tip of the iceberg, doctors and epidemiologists say. The disease is endemic to certain geographic areas, and it’s technically considered an “emerging illness,” even though doctors have been finding it in their patients for more than a century, because cases have been sharply rising in recent years. In some places, astronomically so. According to CDC data, reported valley fever cases in the US increased by 32 percent between 2016 and 2018. One study determined that cases in California rose 800 percent between 2000 and 2018.

In most states where the disease is endemic, public health departments have been slow to grasp and advertise the breadth and potential impact of the illness, experts say, and the federal government could be doing more to fund research into a cure or vaccine for the infection. To date, there’s only been one multi-center, prospective comparative trial for the treatment of valley fever. And, more troubling, researchers haven’t pinned down exactly what’s behind the rise in cases or how to stop it. One thing is nearly certain, though: Climate change plays a role.

IN 1892, A medical student in Buenos Aires named Alejandro Posadas met an Argentinian soldier who was seeking treatment for a dermatological problem. Posadas documented a fungal-like mass on the patient’s right cheek. Over the course of the next seven years, the soldier experienced worsening skin lesions and fever, and eventually died. His story is the first case of disseminated Coccidioidomycosis on record. 

Around the same time, a manual laborer in the San Joaquin Valley walked into a hospital in San Francisco with skin lesions that looked a lot like the lesions on the Buenos Aires patient. The methods doctors used in San Francisco to treat the patient were barbaric. They cut chunks out of his face, treated the lesions with oil of turpentine and carbolic acid, and scrubbed his raw skin with a bichloride solution. They only succeeded in torturing their patient, who eventually died. 

Over the next few decades, as more people got sick with Coccidioidomycosis and died, doctors figured out that the organism causing this disease often entered victims through the lungs. In 1929, a 26-year-old medical student at Stanford University Medical School cut open a dried Coccidioides culture and accidentally breathed in its spores. Nine days later, he was bedridden. But this time, the patient’s conditions improved and he eventually recovered. His illness would soon help doctors make a crucial connection.

It was only a few years later that the Kern County Department of Public Health in California began investigating the causes of a common disorder called “San Joaquin fever,” “desert fever,” or “valley fever,” which got its name from the state’s Central Valley, where the disease was prevalent. As doctors reviewed evidence from Kern County, they noticed commonalities between cases of valley fever there and the disease the Stanford student experienced. Valley fever, they hypothesized, represented the Coccidioidomycosis infection.

Over the following decades, researchers would discover some important truths about valley fever. They found that it is endemic to certain areas of the world, that the fungus that causes the disease lives in soil, that a majority of people infected by it are asymptomatic, and, crucially, that weather patterns and seasonal climate conditions have an effect on the prevalence of Coccidioides.

A FEW YEARS ago, Morgan Gorris, an Earth systems scientist at Los Alamos National Laboratory in New Mexico, decided to investigate an important question: What makes a place hospitable to Cocci? She soon discovered that the fungus thrives in a set of specific conditions. US counties where valley fever is endemic have an average annual temperature above 50 degrees Fahrenheit and get under 600 millimeters of rain a year. “Essentially, they were hot and dry counties,” Gorris says. She stuck the geographic areas that met those parameters on a map and overlaid them with CDC estimates on where Cocci grows. Sure enough, the counties, which stretch from West Texas through the Southwest and up into California (with a small patch in Washington) matched up. 

But then Gorris took her analysis a step further. She decided to look at what would happen to valley fever under a high-emissions climate change scenario. In other words, whether the disease would spread if humans continued emitting greenhouse gases business-as-usual. “Once I did that, I found that by the end of the 21st century, much of the western US could become endemic to valley fever,” she said. “Our endemic area could expand as far north as the US-Canada border.”

There’s reason to believe this Cocci expansion could be happening already, Bridget Barker, a researcher at Northern Arizona University, told Grist. Parts of Utah, Washington, and northern Arizona have all had valley fever outbreaks recently. “That’s concerning to us because, yes, it would indicate that it’s happening right now,” Barker said. “If we look at the overlap with soil temperatures, we do really see that Cocci seems to be somewhat restricted by freezing.” Barker is still working on determining what the soil temperature threshold for the Cocci fungus is. But, in general, the fact that more and more of the US could soon have conditions ripe for Cocci proliferation, she said, is worrying. 

There is a massive economic burden associated with the potential expansion of valley fever into new areas. Gorris conducted a separate analysis based on future warming scenarios and found that, by the end of the century, the average total annual cost of valley fever infections could rise to $18.5 billion per year, up from $3.9 billion today. 

Gorris’ research investigates how and where Cocci might move as the climate warms. But what’s behind the rise in cases where Cocci is already well established, like in Ventura, where Jesse Merrick’s family home burnt down, is still an area of investigation. 

Jesse thinks the cause of his valley fever infection is obvious. “I clearly see a correlation between the fires and valley fever,” he told Grist. But scientists aren’t exactly sure what environmental factors drive Cocci transmission, and neither are public officials. 

In a December 2018 bulletin, Ventura County health officer Robert Levin cast doubt on the connection between Cocci and wildfires. “As health officer for Ventura County, I don’t see a clear-cut connection between wildfires and Cocci infections,” he said, noting that only one of the 4,000 firefighters who worked on the Thomas Fire in 2017 got valley fever. Jennifer Head, a doctoral student at UC Berkeley who works for a lab studying the effects of wildfires on valley fever, hasn’t seen much evidence backing up such a connection either. “The media talks a lot about wildfires and valley fever, and the general speculation is that wildfires will increase valley fever,” she said. But the closest thing Head could find linking the two was a non-peer-reviewed abstract—a scientific summary—that wasn’t attached to a larger paper. 

What experts do know, however, is that disturbing soil, especially soil that hasn’t been touched in a long time, in areas that are endemic to Cocci tends to send the dangerous fungal spores swirling into the air and, inevitably, people’s lungs. That’s why wildland firefighters tend to get valley fever, not necessarily from the flames themselves, but from digging line breaks in the soil to help contain fires. Construction sites are responsible for a huge quantity of valley fever infections for the same reason. 

And the fact that researchers haven’t been able to find a link between wildfires and Cocci doesn’t necessarily mean that Jesse’s theory about how he contracted his illness is incorrect. Researchers have documented the Cocci fungi living in many parts of California. But the fungus isn’t evenly distributed throughout the areas where it grows. Think of a mountainside covered in wildflowers, John Galgiani, director of the Valley Fever Center for Excellence in Arizona, told Grist. Wildflowers grow in swaths across mountains, not evenly saturated throughout the landscape. Coccidioides similarly grows in flushes across the landscape. That means a wildfire that breaks out in an area that is endemic to valley fever won’t necessarily encounter a vein of Cocci fungi.

“If a fire happened to be where there was valley fever fungus in the soil, then that would be a risk,” Galgiani said. “But that’s a little different statement than all wildfires cause valley fever.”

And no research has been published yet on the possibility of Cocci being spread to humans in wildfire smoke, though plenty of research has been conducted on the effects of smoke on human respiratory systems. “The potential for human pathogens to be spread in wildfire smoke has been ignored by those working on the health impacts of wildfire smoke just completely,” Jason Smith, a professor of forest pathology at the University of Florida, told Grist. He’s working with a group of researchers across the US on a study that seeks to determine whether Cocci spores and a host of other fungal pathogens can travel via wildfire smoke. The portion of his research that focuses on Cocci is still in its early stages, but previous studies he’s worked on have demonstrated that fungal spores can indeed travel quite far in smoke. “There’s just no reason why Cocci would be immune from that,” he said. “Now, humans getting sick from it? More so than they do under ambient conditions? That’s the difficult part—determining that that’s occurring.” 

The connection between climatic changes and valley fever is a bit clearer. Researchers speculate that a pattern of intense drought followed by intense rain may be driving the rise in valley fever cases. When there’s a prolonged drought, the fungus in the soil tends to dry up and die. But no drought goes on forever—at least not in most parts of the US. When the rains eventually come back, the fungus flourishes. Then, when the next drought hits and soils and the fungus dry out again, it is easy for wind—or a firefighter’s shovel or a hiker’s boot—to disturb and disseminate the abundant rain-spurred spores. 

“The big issue is drought, it’s dryness,” Julie Parsonnet, a specialist in adult infectious diseases at Stanford University, told Grist. “And after a period of rain it’s even worse.” Parsonnet sees the real-world consequences of that dry-wet cycle at Stanford, where she works at a referral center that sees patients with even worse valley fever than Jesse had—the really bad cases. “We see really terrible disease with the fungus affecting their brains and their bones,” she said. “In terms of how severe it is and the lifelong requirement for some of these people for treatment, it’s worrisome. We don’t want to see it. It would be a bad thing to see more Cocci than we have already.” 

Parsonnet has been at Stanford for three decades, and over that time, she’s seen not only more valley fever cases, but more severe cases. “In the last few years, I’ve been taking care of three or four valley fever patients at any given time,” she said. “In the first 20 years I was here, I saw maybe one or two total.”

DECADES HAVE COME and gone since researchers first connected the dots between the Cocci fungus and valley fever. A growing body of research supports the idea that climate change is now making this disease worse. Yet public awareness of what valley fever is and how it works, in addition to the medical know-how to tackle this disease, is still lacking, even in states where valley fever is prevalent. “You’d be surprised by how delayed the diagnosis is,” Galgiani, from the Valley Fever Center for Excellence in Arizona, told Grist. “And that’s the patients who get diagnosed.” 

Part of the blame lies in the way doctors practice medicine. An accurate valley fever diagnosis may hinge on no more than where the attending physician went to medical school. “Many of the doctors who practice here learn medicine where the disease doesn’t exist, like in New York, for example,” Galgiani said. Another issue is the length of time it takes for the valley fever blood test to come back from the lab—typically around two weeks. Clinicians in an outpatient setting like an urgent care clinic or emergency room are often reluctant to order a test that won’t come back before the patient goes home. “If the test comes back positive, they have to find the patient and tell them, ‘There’s a problem here.’ It’s not what they like to do,” Galgiani said.

When doctors do order a valley fever blood test, the results of that test aren’t guaranteed to be accurate. One in five valley fever tests produce a false negative, said Steven Oscherwitz, an infectious disease doctor at Southern Arizona Infectious Disease Specialists. “It can be kind of silent and hard to diagnose because our tests just aren’t that great,” he said. 

But part of the blame also lies with states and the way their public health departments prioritize diseases. Laurence Mirels, an infectious disease specialist in San Jose, California, who is affiliated with the California Institute for Medical Research, said that valley fever has long languished behind HIV, West Nile virus, typhoid fever, tuberculosis, and other communicable or vector-borne diseases in states’ list of public health priorities. That’s despite the fact that the disease’s morbidity rate in the regions where it is endemic is comparable to polio, measles, and chicken pox before those diseases were stymied by vaccines. 

“The things that public health departments tend to focus on are things that can be transmitted and can increase exponentially if the source isn’t dealt with,” Mirels said. “Cocci isn’t quite that way.” The disease can’t be passed on from person to person. 

“It’s not like Covid where you’re well one day and dead the next week,” Parsonnet, from Stanford University, said. “If you have bad Cocci it’ll drag on for years and maybe even decades. And for that reason it makes less of a splash.” 

Out of all the states in the US where valley fever is endemic, Arizona is best equipped to handle the rise in Cocci cases. The state's Department of Health Services keeps close tabs on valley fever and regularly reports cases to the Centers for Disease Control and Prevention. It also has programs to raise awareness of valley fever among Arizona residents. And the Valley Fever Center for Excellence, housed within the University of Arizona, helps facilitate collaboration between doctors and researchers across counties and develops strategies for diagnosing and treating valley fever. 

There’s a reason Arizona is ahead of the curve. It has the highest rates of valley fever in the nation. “Arizona is a special case because it’s hard for them to ignore it,” Galgiani said. “It’s the second- or third-most frequently reported public health disease in the state. That’s not the case anywhere else in the country.” Other states like Utah, Texas, New Mexico, and Washington are also clocking rising rates of valley fever, but it may be some time before the disease poses a big enough risk to residents that public health departments in those states start dedicating significant time and resources to it. West Texas, for example, is an “intensely endemic” region, Galgiani said. But the Texas Department of State Health Services doesn’t even report valley fever cases to the CDC yet.

“I think it’ll probably take expanding numbers to get people’s attention to make this a higher priority among everything else that needs attention,” Galgiani said.

There’s evidence that that is already starting to happen in California, where valley fever is becoming an increasingly serious public health threat. In an email to Grist, a spokesperson for the California Department of Public Health noted that valley fever cases in the state nearly tripled between 2015 and 2019, from roughly 3,000 cases to 9,000. “The annual number of reported cases has increased significantly since 2010,” the spokesperson said. The Department of Public Health got funding from the CDC in 2012 to hire an epidemiologist to study fungal diseases in the state, and it launched a $2 million valley fever awareness campaign in 2018. “I think there is a kind of an awakening of the understanding that this is a problem,” Mirels said. 

But even in Arizona, the state at the head of the pack, more could be done to alert residents to the dangers posed by valley fever. Some residents suspect optics may be trumping public safety. “Imagine that you put ads up that say, ‘You’re going to catch this terrible disease if you come here, look at what it does to people,’” Oscherwitz said. “They’re not going to really want to do that because tourism would be affected, and nobody is going to come here who hears that.”

“I think there’s been reluctance by politicians to advertise this disease because it might deter people from coming here,” said Mark Johnson, president of the Tortolita Alliance, a conservancy group in Arizona that advocates for better valley fever awareness. “But that is not the important thing. They should be doing everything in their power to make people aware of the disease.” Johnson, who contracted valley fever last year after retiring to Arizona, argued that if the state was really dedicated to protecting Arizonans from valley fever, it would run advertisements on TV, put up signs at airports, and send out brochures, especially to new residents.

VALLEY FEVER ON its own is a formidable and expensive illness to contend with. But it’s not the only fungal pathogen lurking beneath our feet. There are three main types of fungi that cause lung infections in humans in the US, including Cocci. Histoplasmosis and blastomycosis also pose risks to humans. It’s possible that the same environmental conditions that may be helping Cocci spread into new areas and become more prevalent are also spreading those fungi. Researchers can’t say for sure whether that’s happening yet, but it’s something they’re working on. 

“I can’t really speak to what those predictions might be,” Barker, from Northern Arizona University, said. “But my colleagues have noticed similar trends where there’s an increase in reported disease.”

And another wrinkle: There aren’t nearly enough people studying these pathogens. Every time a human fungal pathogen researcher retires, the field grows smaller. “We’re behind all of these other groups,” Barker said. “We’re behind the bacteriologists and the virologists in terms of our understanding of some of these ecological principles driving distribution of these organisms and what might cause them to emerge in human populations.” 

For most of the rest of us, the pathogens hiding in the ground aren’t much of a consideration at all. That applies to Jesse Merrick, too. For him, valley fever is a distant, if terrible, memory now. He doesn’t let it stop him from doing the things he wants to do. He still goes on hikes and visits his mom in California. And he recently moved to Las Vegas, an area where valley fever is endemic. “It’s in the back of my head, but nothing where it’s something I think about daily or anything like that,” he said. 

It may only be a matter of time before we start thinking about fungus more often, Barker said. “I honestly think that the fungal pathogens are going to be a huge problem for us going forward.”

https://www.wired.com/story/valley-fever-is-spreading-through-a-hotter-drier-western-us/