By Elizabeth Weise, USA TODAY 09/22/2011
The glassy stares of the dead, the garbage piling up in the streets, the frightened, angry mobs smashing their way into drugstores and attacking food lines. The images in the thriller Contagion may be delivered with Hollywood flair, but they also have a ring of truth to those on the medical front lines.
In a stark, almost documentary style, the movie shows what happens when a virus makes its way from a bat to a pig to a person, mutating along the way into a highly contagious pathogen that kills 30% of those who get it. Toward the end, a newscaster announces the death toll has reached 26 million globally.
For public health workers, the movie’s science-based premise is an excellent teaching tool — we can all learn from it, they say.
First, no dismissing the premise as a Hollywood fantasy that could never happen, says Richard Danila, Minnesota assistant state epidemiologist in St. Paul.
That 30% death rate? “It’s very possible to have a new emerging pathogen act that way,” he says. In fact, one reason why the movie is so realistic is that it’s modeled on a disease that so far has sickened 475 people in South Asia, killing 251 of them.
The Nipah virus, which causes inflammation of the brain, first appeared in 1999 among pig farmers in Malaysia and was traced to fruit bats, which infected the pigs. It is transmitted via respiratory droplets or contact with throat or nasal secretions from pigs. There have been 12 outbreaks since then, the most recent in 2008, all in South Asia, according to the World Health Organization. Victims have fever, headache, vomiting, dizziness, altered consciousness and then seizure, progressing to coma. There is no treatment and no vaccine available.
‘Willingness to respond’
The movie already has brought in more than $44 million at the box office in its two-week run. USA TODAY chatted with doctors and pharmacists who spend their days thinking, and sometimes experiencing, real-life worst-case scenarios when it comes to deadly epidemics.
Contagion shows a world where the people who keep civilization together — police, firefighters, sanitation workers, supermarket clerks — are either sick, dead or at home with their families while garbage piles up, buildings burn unchecked, and gun-toting thieves ransack the suburbs for food.
That’s close to real, too. It happened to a much lesser extent in Toronto during the 2003 Severe Acute Respiratory Syndrome (SARS) epidemic, which killed 44 people in Canada. “Support staff didn’t figure their jobs were important,” says Tom Kirsch, a doctor of emergency medicine and co-director of Johns Hopkins’ University’s Center for Refugee and Disaster Response, Baltimore. His center has been thinking hard about what he calls the “willingness to respond.”
“We realized that we’ve got to educate people about how important their jobs were,” he says. In Christchurch, New Zealand, after the devastating earthquake in February, many hospital support staff left their jobs to go and check on their families, which was “clearly” important, Kirsch says. “But they didn’t necessarily come back, because they didn’t see their role as being critical. But without them you can’t run the labs, you can’t run the clinics.”
In Contagion, Laurence Fishburne plays Ellis Cheever, the head of the Centers for Disease Control and Prevention who finds himself dealing with rising public fear and an antagonistic press even while fighting the deadly virus that kills 30% of people who get it. But he’s not always honest about the reality of what they’re facing.
Yet, honesty and providing as much information as people need is the only possible policy, and you can’t hide behind a podium, says Ronald Chapman, chief of the Medicine and Public Health Section at the California Department of Health Services. Sacramento.
During the 2009 global H1N1 influenza pandemic Chapman was the health officer for Solano County, one of the first California counties to report deaths in the epidemic.
When he decided to close a school where a child had died, “the TV crews were there, the parents where there, it was standing room only. The parents came up one at a time to the microphone,” he says.
“People were asking why we hadn’t told people” how dangerous the H1N1 flu was.
The multiple announcements and news reports before that day didn’t matter: “These parents were really scared” that their children might die, Chapman says. “By the end of two hours I was down in the audience, hugging people.”
Responsibility to others
The film’s writer, Scott Burns, says he started out just to write a thriller, but as he did the research he was struck by how much responsibility we have to one another when it comes to not allowing illnesses to spread. The “paranoia” of people who don’t get their children vaccinated has public health ramifications for everyone else. “I hope the movie makes the public more aware of those things,” he says.
If there’s only one thing people learn from the movie, let it be how important public health workers are to keeping everyone alive and healthy, says Lillian Shirley, head of Multnomah County Health Department in Portland, Ore. and president of the National Association of County and City Health Officials.
Public health is one of those things that no one notices if they’re doing a good job, she says. “You don’t see headlines in the paper that say ‘No Measles in Oregon!’ You see the headlines that say ‘Measles Outbreak!'”
Getting things right in the media is key, says Ali Khan, who directs the office of public health preparedness and response at the Centers for Disease Control and Prevention in Atlanta.
“If you don’t succeed, you get people putting out half-truths and that’s what panics people.”
Khan also liked that the scope of what CDC could do was so realistic. Their public health workers are shown slogging away in hospitals and in labs. Movies where CDC gets to call in airstrikes are a little “silly,” he says.
“I don’t have that kind of power.”
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