'The Last of Us': Hit Pandemic Show Is Fantastical but Not Scientifically Baseless

Paul G. Auwaerter, MD


February 07, 2023

This transcript has been edited for clarity.

Hello, and thanks for watching. I'm Dr Paul Auwaerter with Medscape Infectious Diseases.

Recently, I've noticed that pandemic-inspired entertainment continues to be popular in 2023, despite the SARS-CoV-2 virus having been with us for some time. I've been a film buff for quite a while, and looking back, there have been at least over a hundred films, entertainment television series, or so on that have used this device as part of their storytelling. But it's not a tradition new to these times.

The American novelist Sinclair Lewis published his novel Arrowsmith in the mid-1920s. A movie adaptation was released in 1931, which portrays an idealistic physician and researcher who travels to the West Indies and confronts bubonic plague. This film received four Academy Award nominations and remains worth watching, especially if you don't care to read one of the classic fictional books about infectious agents.

When I was growing up, one movie that fascinated me was The Andromeda Strain, from the book by Michael Crichton. The story it tells is a bit different. It's not about an alien coming to threaten the earth but rather an extraterrestrial microorganism that threatens the planet. It's also something that still plays well.

More recently, there were two films in this vein that both critics and audiences enjoyed. Outbreak is a 1995 film with Dustin Hoffman about an Ebola-like virus that breaks out in a small California town. Then, a little over a decade ago, in 2011, the film Contagion was also quite popular. This was a film about a highly fatal infection that starred Matt Damon and Gwyneth Paltrow, among others.

Most of these stories have used viruses, mainly because they're fast moving. This was true for a miniseries that debuted 2 years ago, Station Eleven, in which a virus wiped out 99% of people. Although that's not the definition of a successful virus for most of us, it certainly made for good fictional drama.

The Latest Pandemic Blockbuster

But the one piece of entertainment that inspired me to record this video is The Last of Us, a television series that just debuted in January 2023 and is a little bit different from the others. The series really grabs you from the start, at least if you have infectious diseases interests.

It opens with a 1968 television program that's modeled on something close to an episode of The Dick Cavett Show, where there are two scientists and a moderator. Because of the year in which it's set, perhaps this is the Hong Kong flu era.

The panelists discuss the potential for a pandemic, with one thinking influenza A virus would be the key culprit, and the other scientist stating that a fungus will be the somewhat unlikely cause. This is greeted with some skepticism by the other panelists. However, the scientist believes such a fungus might infect someone and translate into some form of mind control. He was inspired by psilocybin, which is a psychedelic compound more popularly known as magic mushroom, which is, of course, a fungus. The scientist proposes another fungus might do much the same to someone.

The scientist introduces the very odd concept of Ophiocordyceps, a fungus that can infect ants, change their behavior, and turn them into what are sometimes called "zombie ants." So there is some basis in nature for this particular entity.

The series then warps ahead to what seems to be the present day in Chicago, where a fast-moving and apparently lethal epidemic has been caused by a fungus called Cordyceps, which in reality doesn't infect humans, at least that we know of currently. This fungus is usually seen in warm climates. But in the series, this fungus apparently infects many, in turn producing zombie-like behaviors and so on.

An Eerie Echo in the Recent Literature

With this show mind, I found it somewhat eerie when I picked up a copy of JAMA and found a nice article by Rita Rubin discussing Candida auris.

This fungal pathogen poses several challenges, as it is often highly resistant and prone to spreading in facilities. Most people, even if they're colonized, are asymptomatic, but it can develop invasive infection. Mortality rates have been as high as 60%. There have been grave concerns because some isolates are highly resistant, including to fluconazole, and up to 5% to echinocandins even.

The state of Nevada has experienced an outbreak of Candida auris now since 2021. Several facilities have had issues, and some are screening high-risk patients for the pathogen to help prevent outbreaks.

And although Candida auris certainly doesn't cause zombie-like behavior, I think this is something that remains highly concerning. Of course, this may have been driven by the agricultural and human use of azoles in past years, but it had always been a bit difficult to distinguish from other Candida species. But now, we're paying more attention.

I'm not sure if you have an interest in watching miniseries or films about the pandemic. We may have had our fill. But this particular series, The Last of Us, uses this backdrop more to delve into human nature and conflict rather than on the details of fighting the pandemic, per se.

Certainly, the topic of a fungal infection does pose challenges for us in the future and in the control of such difficult infections.

Thanks so much for listening.

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