Viewpoints: The ultimate fear of ‘Contagion’ tests trust in health care

Sacramento Bee By Christian Sandrock October 7, 2011 As a health care provider and pandemic expert, I have never been interested in movies or television shows involving a massive outbreak. I want entertainment to escape from my work, not to watch it unfold again in front of me. Few movies aside, the medical realism could also hinder my ability to generate compassion, empathy or fear. But “Contagion,” which opened in theaters last week, is different. “Contagion” tracks the anatomy of a viral pandemic, from its zoonotic origin to social disruption. The fear of a cough, disintegration of basic social services, the ineptitude of governmental officials and the death of loved ones are all employed to generate a primal fear that is familiar to viewers. But below the surface is an even deeper fear that society rarely engages – the disintegration and distrust of the health care system. This impact of a pandemic, which the film highlights well, is the greatest fear of health care and public health experts, and for that reason, it is a very scary film. Pandemic preparedness has encompassed many fronts in the past decade, many of which were never employed with SARS in 2003 and H1N1 in 2009. Active animal and human surveillance for high-risk viruses is ongoing, along with epidemiologic intelligence. Preparing for a lack of social services, rapid employment of triage centers and alternate care sites, and large use of isolation and quarantine, along with necessary security, has been extensively planned. All these plans, and their subsequent impact on society, are laid out in “Contagion” with great realism. I watched with interest and some curiosity, but not with any fear. My real fear, however, was with the sick and exposed health care providers and their dreadful need to allocate scarce medical resources. For health care providers, the impact of having a colleague sick and dying from a contagious disease generates some of the greatest fear. One of my friends was on the front line of the SARS outbreak. He watched as two colleagues died, and then when he was exposed, had to sit in quarantine for four weeks, away from family, alone, awaiting his fate. He still cries about this experience eight years later, whenever we discuss pandemic management. Another colleague, upon hearing that his child could be exposed, left his post to care for her. He is still so ashamed of the decision to leave his patients that he is unable to work. As health care providers, we rarely delve into this fear. What would we feel, after being exposed to a deadly virus? If we knew the death rate was 25 percent, would we come to work? Would we choose family over our patients? Would our family pandemic plan – we all have them in the health care world – work and save our family while we work? What if it does not and our decisions lead to the death of our children? Watching Kate Winslet, Dr. Erin Mears in “Contagion,” sit ill in a hotel room elicited some of the worst fear that I have experienced in a long time. Even more concerning is the overriding sense of scarce medical resources. In our current health care system, we rarely think or realize that our most critical resources, from medication to ventilators, will be limited. A small number of us have pondered this issue for a number of years, with a direct focus on an equitable and ethical delivery of limited resources in a pandemic. When the public riots at a pharmacy and doctors and nurses make tough decisions in the film, this issue is likely to be missed by most. But, for health care providers, this is the greatest fear. What if I have to choose between two critically ill children when I have only one ventilator? How will I decide? Can I live with my decision? Imagine if one hospital in Sacramento had a critical resource that another did not, and one hospital had patients dying while another could save lives. What would happen to public trust and structure? What if a community leader who had a poor prognosis expected you to save him over a child with a better likelihood of survival? How would you handle this decision and outcome? This fear hits us deeply. I couldn’t sleep for two nights after viewing “Contagion” as I reviewed my allocation plan over and over. Still, ultimately “Contagion” can be used as a great public health teaching tool. If we recognize the impact of a severe pandemic on society, the movie will provide benefit. If we can begin discussion on how our health care system and its providers will make critical decisions, from allocation of resources to worker protection, the film will have succeeded in shifting public perception.Dr. Christian Sandrock is the Yolo County health officer. Read more: http://www.sacbee.com/2011/09/15/3911328/the-ultimate-fear-of-contagion.html#ixzz1a9lexwo8