Diagnosing the movie ‘Contagion’

(Alice Huang of Caltech; Dr. Peter Katona, an infectious disease expert at UCLA, center; and Dr. Arthur Kellermann, an emergency medicine physician, discuss “Contagion” after a screening.) Medical experts do a checkup of the thriller’s premise of a pandemic. The scary part? They find it mostly gets it right. By Eryn Brown, Los Angeles Times September 19, 2011 The hit movie “Contagion” depicts a nightmare scenario: a bat virus jumps to pigs and then to humans, infecting them with abandon since they have no immunity to the novel bug. The virus circles the globe in a matter of days, causing coughs, fevers and seizures as scientists from the World Health Organization and the U.S. Centers for Disease Control and Prevention scramble to identify the pathogen and develop a vaccine. Before they do, millions are infected and about a quarter of them die. Those who are not sickened hunker down at home or panic in the streets, scrounging for food and supplies until the outbreak can be contained. Could such a calamity really occur? To find out, we invited three experts to watch the film with us at the ArcLight Sherman Oaks. Our panel included Alice Huang, a virologist at Caltech; Dr. Peter Katona, an infectious disease expert at UCLA who did a two-year stint in the CDC’s Epidemic Intelligence Service; and Dr. Arthur Kellermann, an emergency medicine physician and director of Rand Health in Santa Monica. The three sat down with us after the show to discuss the facts behind the fiction. The lively conversation, edited for space and clarity, appears below. Spoiler alert: Plot details will be revealed. Let’s start with the basics. Is any of this scientifically possible? The virus kills Beth Emhoff (Gwyneth Paltrow) in less than a week, but her husband, Mitch (Matt Damon), never even gets sick. Alice Huang: I found it a little hard to believe that the incubation period and the disease manifestation would be so quick. It was virtually within 24 hours. Several days would be more typical. But they wanted to make this virus a really scary one, and that did it. After that, everything that they presented seemed very realistic. The fictional MEV-1 virus begins to spread when an infected bat drops a piece of banana that is eaten by pigs. Could that really happen? AH: It could, yeah. This was based on the Nipah virus, which can travel from bat to pig to human. If the virus in the movie were that virulent, it wouldn’t take many virus particles to spread. Arthur Kellermann: They did a wonderful job of dramatizing interspecies transmission and recombination in an animal cooking vessel — which is often a pig — and then making the jump to humans. They made a complex biological concept understandable to the public. The other thing they did beautifully was emphasize the potential for rapid virus spread in a globalized society. Beth Emhoff got sick in Hong Kong, and by the time she was on a plane home, people she had contact with were sparking outbreaks around the world — even before she was symptomatic. Peter Katona: Assuming the vaccine would work right away was a little misleading. Vaccines take a bit of time to kick in — a few days or a week. AK: Right. You’ve got the dose, you’re immune to go out that night — it doesn’t work that way. PK: Transmission was a little bit of an issue for me too. They kind of implied there was respiratory transmission at the beginning, but the virus seemed to be passed through contact. Things don’t live on glass and surfaces very long. I think they took a little bit of liberty with that. AK: I had a science question for the two of you. When they told Mitch Emhoff he had natural immunity, I thought, “Oh, come on.” Even before they had characterized the agent or understood the biology, they declared that he couldn’t get the virus — that he was the 1 in a zillion that was naturally immune. It’s a heck of a coincidence that he happened to be the husband of Patient Zero. AH: They didn’t make that very clear. Almost all viral diseases have what we call the iceberg effect. Many people get infected but they have no symptoms. Others get infected and they have some symptoms but not very serious ones. And then a smaller number get infected and it’s very acute. Only a very few of those will die. So you think Mitch Emhoff may have been an asymptomatic case? PK: Yeah. In the movie they said that three-quarters of people get it and don’t die. He was lucky — a run-of-the-mill survivor. Did the symptoms seem plausible? PK: A little rapid. I thought those seizures looked pretty good. AK: The first seizure didn’t, but the second one was spot on. Generally that stuff was well done. The cough, the headache, the encephalitis [swelling of the brain due to infection]. And the laboratory scenes? AK: A little “CSI”-ish, but yeah. AH: I just saw the new lab at the National Institutes of Health’s Rocky Mountain Laboratories in Montana. The one in the film was quite realistic. The movie also took a close look at public health officials, such as CDC deputy director Dr. Ellis Cheever (Laurence Fishburne). Investigators like Dr. Erin Mears (Kate Winslet) and others work to fight the disease. How accurately did the film depict their work? PK: They did a good job with Winslet’s character — though Epidemic Intelligence Service officers are usually not the ones who go into a stadium to set up emergency facilities — that’s usually local people who make that decision, not federal people. At first I kind of wondered if the CDC should have sent more than one officer. Sometimes they’ll send more than one if they think the thing is big or about to be big. But they wouldn’t have known that yet. They got on it in five days. That’s pretty quick. That may have been a little on the unrealistic side that they got to it so fast. The doctor in the emergency room who told Mitch Emhoff that Beth had died seemed a little cold. AK: That was really over the top. I’ve worked in some of the busiest ERs and Level 1 trauma centers in America, and we would never stand in the middle of a public hallway and tell a husband that his wife had just died. With anything like that, it would be a private room and there would be a chaplain. It’s one of the most profound moments in clinical medicine. We just don’t work that way. PK: The workers mentioned a shortage of body bags at one point. But they didn’t mention that these respiratory devices they’re wearing — called powered air purifying respirators, or PAPRs — were going to run out real fast. We hardly have any of them. How about food? “Contagion” shows people fighting over emergency rations, but the principal characters seem to remain well-fed. Would there be enough to eat? AK: Not with the infrastructure collapsing. PK: If you cut off the entire food supply to a city, you have five days. Five to seven days for gasoline. So, yes, that’s an issue. AK: That was hinted at, but they focused more on social panic than on the fact that this very complex, just-in-time economy we now have would absolutely fall apart. Jude Law plays Alan Krumwiede, a blogger who questions the CDC’s statements, pushes a questionable natural “cure” for the virus and otherwise makes life difficult for the public health team. In one scene, he faces off against Cheever during a TV interview. What did you make of him? AK: He was a caricature, but it was well done and he illustrated a really important public health concept. He’s influencing millions of followers who are just grasping at the first thing they read on the Internet. An outbreak, more than any other time, is when you need to trust authoritative sources, like the CDC. That’s another important object lesson here. AH: The movie certainly is anti-blog. PK: The blog represented misinformation. AK: I wanted Cheever to really go at that guy on television. We can’t have public health leaders be wimps when they’re dealing with people like that, who are a public health threat. You’re going to take on powerful forces and venomous critics. Public health is a contact sport. So what’s your final verdict? PK: I liked the movie a lot. Some of the reasons had nothing to do with science. I thought the public health people were portrayed as being kind, benevolent people — which I think they deserve. A doctor is beloved for saving a life, but public health people are behind the scenes, and they don’t really get as much respect as they should. I also liked the fact that the movie took the disruption of society and laid it against the non-disruption of society. They could still go home and do things. People think that when all hell breaks loose, everything falls apart — it doesn’t. Certain parts of society do and certain parts don’t, and I think they portrayed that well. AH: It’s refreshing to see a movie that tries to be as authentic as this one. I thought it was really good at depicting the real situation. It’s very nice to see a movie where scientists aren’t the evil ones. And I also must admit I was really pleased to see women who were strong and capable and who showed leadership qualities. But when they were in the village in Guangdong — I objected a little bit to the caricature of the Asian being very selfish and only worried about his village. AK: As opposed to the Americans who were tackling each other and stealing their drugs and their food and shooting people in their houses? There was some caricature, but this film effectively conveyed public health concepts: the importance of infrastructure, the importance of personnel, the notion that germs don’t care about your politics or your ideology. Hats off to Hollywood. What makes this movie scarier than the typical horror film is that it could happen. The errors in the film weren’t errors; they were poetic license. I’d want every medical student to see this movie. AH: More would become epidemiologists! Now I wish they’d do this for basic science. http://www.latimes.com/health/la-he-0919-contagion-experts-20110919,0,4892286,full.story