An Infectious Diseases Doctor Views Contagion

1918 Influenza Scrapbook, The College of Physicians of Philadelphia By Thomas Fekete, MD, FCPP, Section Chief, Infectious Diseases; Professor, Medicine; Associate Professor, Microbiology and Immunology; School of Medicine, Temple University

Going to the movies is a time-honored way of getting away from the vagaries of work and home life and inhabiting a different and exotic place. I don’t know if car mechanics can really enjoy chase movies or cowboys can appreciate Westerns, but as a specialist in Infectious Diseases, I rarely get a chance to see someone plying my trade inside the multiplex. There are spoilers ahead, so read on cautiously if you have not yet seen Contagion and plan to go.

The new Steven Soderbergh movie, Contagion, is a fairly realistic guesstimate of what might happen if a highly contagious, new infectious agent started moving around the world and destroying people willy nilly like a marauding tornado. While there has never been an infection quite like “MEV-1” as depicted in Contagion, the question of how we would respond as a medical community and as a society is a worthy one to address. Whether the answer is right or wrong – well, let’s hope we never find out.

From an Infectious Diseases angle, the infection in Contagion is crafted to be highly transmissible and fatal. This would be like a hybrid of the 1918-1919 pandemic flu, Nipah virus and SARS. The end of the movie shows the mechanism via which MEV-1 began to infect humans, and it is highly reminiscent of Nipah and SARS. Thus it has some built-in credibility as it builds on diseases that we already understand. It is also eerily reminiscent of the most recent big flu outbreak (A/California/2009 H1N1) where the virus contained elements that came from birds, pigs and people. The rapidity of spread lends the movie much of its terror, but is not far off the rapidity of spread of influenza. Similarly, the incubation period and time to death is also reminiscent of the 1918-1919 pandemic flu. So the filmmakers have done their homework and created a plausible disaster scenario.

The medical and public health response to the outbreak also feels about right. Some reviewers thought that the movie was too kind to the CDC and the medical community, but it can be hard to compress months of devastation into a 100-minute movie without some shortcuts. Most of the characters in the medical and public health arena make mistakes (some political and some medical). But the medical mistakes get worked out in time. This seems true to the spirit of medical inquiry because it is easy to see that eagerness to find answers can lead down some false trails; the beauty of the scientific approach is its trajectory toward self-correction.

On the other side of this divide is Jude Law who plays Alan Krumwiede, a journalist/blogger. He is plugged into the zeitgeist of mistrust and fear that is always around but seems to be stoked by uncertainty and loss. In a simplistic formulation, blame and anger tend to be directed at the government (from the right) or corporations (on the left) even though we know that we hold a great deal of responsibility in our own hands. The movie conflates these fears and our own insecurity into something almost palpable and very understandable. There ought to be another explanation for this crisis, another approach, a way to be safe and survive the unimaginable other than waiting for a rational solution – especially if you doubt it will come in time to save you and your family. The movie shows that the rejection of the scientific approach in favor of doing something (even something futile) has its own baggage and risk. Many reviewers thought that Krumwiede rings false. But this may be the result of the moviemaker’s need to compress many people and ideas into one character to make the film more streamlined and efficient. Are there people out there trafficking in innuendo and misdirection? Each viewer can be the judge of that.

On a personal basis, I enjoyed Contagion’s art of film-making (cinematography, acting, sets, costumes), but professional critics have plenty to say about that and it bears only indirectly on the degree to which the film resonates professionally. The bigger issue for me is whether the audience understood the potential gravity of a new pandemic or just got scared because of the magic of cinema. I suspect the former. There was no chatting or disruption during the movie. That seems amazing in an era where the communal theater is often treated with the abandon of the private living room. After the film, most of the audience stayed for the credits. I believe they were trying to digest the movie both as entertainment and cautionary tale.

Among my colleagues, I have heard praise and criticism about the “facts,” but I think we were all thrilled to see that major components of our work-life have been shared with the public and it was not found wanting in terms of excitement or importance. The diligence and even heroism that go into developing a vaccine are, perhaps, a bit romantically displayed and unrealistically condensed in Contagion. But a movie where no vaccine or cure is developed would feel like a speeded up and much more appalling version of HIV – a disease that has now been known for 30 years and still commands a strong measure of fear and anxiety. I do not think a movie audience could sit through 100 minutes of losing one-quarter of the earth’s population in a matter of a year or two no matter how compelling the narrative and acting.

More alarming is the idea that we really are much closer to one of these pandemics than anyone would like to admit. The notion that the reason why we have been spared these massive epidemics is a testament to our virtue or skill – that is just a notion. We know that the terror in parts of the world that have seen outbreaks of Nipah virus, ebola, Marburg and SARS is just as real as that seen in Contagion. People tried to escape their community lest they become infected but in many cases brought the infection with them. Maybe Contagion is the lead-up to The Canterbury Tales for our times.