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September 27, 2011 / Dr. Toad

Contagion: don’t be afraid but be concerned

I do not (yet) have hand-washing OCD. That’s because I have not (yet) watched Contagion. But I will, now that I’ve been to last Thursday’s “Dissecting the science of Contagion” event at Seattle BioMed. And, the experts tell me, I will then develop the OCD.

As should we all. According to David Sherman, tuberculosis (TB) program director at Seattle BioMed, and Ann Marie Kimball, epidemiology prof at UW, yes to hand-washing as your first line of defense in the “extraordinarily realistic” (their words) scenario of the spread of an infectious disease just like in Contagion. I’m stockpiling hand sanitizer, but the important thing is to use it, I guess.

But it was interesting, what public health and infectious disease experts think makes the movie so remarkably realistic. Because it isn’t the timeline of both infection and vaccine development. At this point I should warn you that all of the following may contain spoilers, and I wouldn’t even know it because I haven’t seen the movie yet!



Anyway. The virus in the movie has no incubation period: the main character shakes hands with someone and the virus is transmitted, and immediately as she interacts with other people the same evening she transmits the virus to them. In reality, it would need at least a bit of time to burrow into her cells and multiply within her before she would become infectious to others.

The timeline of vaccine development, also not very realistic, is a significant speedup of lab tedium, which wouldn’t make for good plot development. All of molecular genetics and biochemistry, said Prof. Kimball, which in reality would take about 4 months of lab work in the best case, was compressed into 15 seconds.

Kate Winslet’s character Dr. Erin Mears who is dispatched into the disaster’s epicenter to single-handedly restore order and find the origin of the disease, would in reality be legions of workers. Dr. Sherman remembers the time in Seattle when there were two more TB cases than usual, and seven specialists from the Center for Disease Control and Prevention came here for months to do contact investigation.

But these are all details and artistic liberties. A symbolic character embodying the societal public health effort. A compressed timeline for entertainment purposes. What about the big idea that society essentially halts because 2.5 million people die of this disease? For the US, that’s about 1% of the population. Well, says Dr. Sherman, in South Africa, 1% of the population dies yearly of a combination of TB, HIV and malaria. That’s the reality there, not a fictional account. (I have to say that I found the percentage to me more like 0.3% of the population for all infectious diseases in South Africa, at least according to their official statistics from 2008.)

Mycobacterium tuberculosis

Mycobacterium tuberculosis

HIV diagram

HIV

Plasmodium falciparum

Plasmodium falciparum

I suppose society would truly break down if 90% of the population died suddenly within 3 days of the first recorded case of a strange and extremely infectious plague, like in the BBC series Survivors, but that particular unrealistic apocalyptic scenario wasn’t being discussed. Also, after watching episode 1 of season 1 of Survivors last night for some reason, I don’t recommend it for reasons that have nothing to do with science.

Back to Contagion. If all these things are essentially wrong, how come scientists gather in a discussion panel to argue that the movie is extraordinarily realistic?

It ties virulent pandemics to human agricultural practices. The spread of the virus from bats to humans via pigs was based on the trajectory of the Nipah virus which causes encephalitis (inflammation of the brain) and severe respiratory disease and has a 75% fatality rate. The Nipah virus outbreak in Malaysia has been tied to deforestation, which resulted in virus-carrying bat migration to fruit orchards in close proximity to industrial pig farms, where the bat urine and half-eaten dates got mixed up with pig feed, creating a perfect system for virus transmission. (See Chua et al. 2002 or a 2011 column by Laura Kahn.)

Pteropus Vampyrus

Pteropus Vampyrus, a carrier of the Nipah virus

It portrays the tension between safety and protocol, and speed of insight when it comes to lab research on infectious disease. And of course, the tension between individual freedoms and restrictive measures in a public health crisis. During the SARS epidemic in 2003, several cities and countries revived sweeping quarantine as a public health measure, with varying levels of regard for individual freedom. Surprisingly, a rights-aware Western democracy city like Toronto, Canada had 30,000 people in quarantine for its 3 million-strong population, the same number as communist Beijing for its population of 18 million and a much stronger initial outbreak (Jacobs 2007). It’s of course a much more constrained response than that of Seattle’s mayor Ole Hanson during the 1918 Spanish flu epidemic. He had closed down dances, theaters, all public gatherings, and banned public spitting to limit potential venues for virus exposure. Historical research shows it worked — Seattle’s infection rate was lower than San Francisco’s or Baltimore’s — but would we stand for such measures today?

Wash Your Hands Before Seizing Property

Wash your hands before seizing property!

To sum it up, the two big questions were the likelihood of a contagion crisis, and the level of our preparedness. And the answers are: well, yes for the likelihood of an outbreak. It happens all the time, there are already plenty of infectious diseases around, and it will happen again and again, especially if we continue to be careless with the environment. And Prof. Kimball answered moderator Warren Etheredge‘s hand-wringing question: “Is this country the least bit prepared for a pandemic?” with a sad smile. Yes, she said, we are the least bit prepared.

And now, if you’ll excuse me, I’m going to go wash my hands.

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