*Caution: Spoilers Ahead*
Though I am a few weeks late with this post, I wanted to review the recently-released disease thriller “Contagion”.
The film features an all-star cast of Matt Damon, Laurence Fishburne, Jude Law, Gwyneth Paltrow, and Kate Winslet, among others. The films follows the global spread of a deadly disease caused by a novel virus, focusing on the CDC and WHO responses, as well as the general response of the public.
As a movie, “Contagion” was very good. Perhaps not best picture material, but it was well-written and well-acted. It was most definitely worth seeing, and I would say the same even if I weren’t a scientist.
Oftentimes, Hollywood will sacrifice good science (or any science, for that matter) in order to make a more exciting movie. Luckily, “Contagion” sacrifices very little in the way of science and still comes out with a very exciting, very accurate film. The science portrayed throughout was all possible, though perhaps a bit improbable at times.
Now, onto the science.
The virus itself is designated as MEV-1 in the movie, and though I initially thought the film would be about H5N1 (or some other influenza strain), I was pleasantly surprised when the filmmakers went a different direction.
There’s a brief image of the sequenced genome in the movie, and it appears as if the virus is very similar to Nipah virus. Well played, Hollywood. I approve greatly of your virus choice, as Nipah is an emerging infectious disease of concern in the real world.
In terms of how the virus emerged, the events were a little rushed – but it is a movie, so it’s not like they can show years of evolution. But the general concept was right on target. Deforestation by a mining company drove a bat out of its natural habitat, forcing it to take shelter at a pig farm. The bat had been carrying a piece of fruit (I like to think it was a date palm), which it dropped to the floor, where a pig ate it. The pig was then slaughtered, cooked, and served for human consumption.
Once again, well done Hollywood. Nipah virus is thought to have emerged when agricultural intensification allowed for increased bat/pig contact, mediating the emergence of a novel pathogen. The emergence event in “Contagion” was very similar, and interactions of the same nature are occurring all over the world. The use of Southeast Asia was also very accurate, as that region is seen as a mixing pot for various animal and human pathogens.
In the film, the virus readily jumped from bat to pig, reassorted, and then jumped from pig to human, where it was able infect the host and maintain efficient person-to-person transmission. Though the rapidity with which it occurred is theoretically possible, it is extremely improbable.
To illustrate this point, I’ll briefly discuss the Pathogen Pyramid, a concept developed by Wolfe et al. in 2004 to summarize disease emergence.
Woolhouse, M. E. J., Haydon, D. T., & Antia, R. (2005). Emerging pathogens: the epidemiology and evolution of species jumps. Trends in Ecology & Evolution, 20(5), 238-244. doi: 10.1016/j.tree.2005.02.009
Each level of the pyramid represents a different degree of interaction between pathogens and humans: exposure, infection, transmission, and epidemic spread. Some pathogens are able to progress from one level to another, while others are blocked by natural, biological, or man-made barriers. The pyramid provides a basic overview of how pathogens go from existing in the environment or as an animal disease to causing sustained infection in a human population.
Though humans are exposed to many potential pathogens each day, only some of these are able to cause infection. Of this group, even fewer are able to spread from person-to-person. And an even smaller percentage has the ability to maintain person-to-person spread. Though it is possible for MEV-1 to have progressed through all levels of the pyramid rapidly and effectively, it would have required a perfect storm of variables.
Assuming that MEV-1 is similar to Nipah virus, then the movie’s portrayal of the disease progression is relatively accurate. The incubation time is 2 days, which is a little short, but not outrageously unbelievable. Regarding the actual disease, the respiratory and neurological symptoms of MEV-1 are consistent with observed outbreaks of Nipah. And in the film, the disease produces a case fatality rate of 25%, lower than the CFR of Nipah virus (~40% – 75%).
The epidemiology of the film was quite accurate. From concepts like R0 and contact tracing, the work done by the CDC’s Epidemic Intelligence Service and the WHO was very representative of what would happen in real life. Granted, the EIS would almost definitely have sent multiple officers to Minnesota along with Kate Winslet’s character, but again, Hollywood needs some poetic license.
Of all the science in the movie, the most unbelievable is probably the vaccine development. First of all, finding suitable cell lines to grow virus can be extremely difficult, and finding an effective animal model can be near impossible. Additionally, those discoveries were made in the film by individuals. During the 2003 SARS outbreak, identification of the virus took weeks of worldwide collaboration, a discovery hailed as being made with “unprecedented speed.” It is unlikely that mere days of individual effort would result in identification of the virus, successful growth in cells, and implementation of an accurate animal model.
And then we come to the vaccine itself. Discovery, development, and production of the vaccine were completed in just a few months time. This is exceptionally improbable – as it is, influenza vaccine can take months to produce, and there are many diseases that scientists simply cannot produce effective vaccines against. It would take an extraordinarily fortuitous set of circumstances to permit the development of a vaccine against a novel virus so quickly.
Stepping away from the science, I thought that the response to the outbreak was extremely well done – both from a public viewpoint and a public health viewpoint. In terms of the public response, mass panic would be extremely likely. Many people would stop going to work – including those performing essential duties, such as police, fire, and emergency workers. Schools would be shut down, and looting of food and other supplies would not be surprising. This response would be similar to what is seen in the aftermath of other disasters.
What some people may find unbelievable is the public health response. The movie depicted overcrowded, ineffective hospitals. It showed a lack of effective treatments. It showed the collapse of the public health system. Hollywood sensationalism? Surprisingly not.
The U.S. public health system is woefully underprepared for a large-scale emergency event. The system lacks “surge capacity”, or the ability to ramp up response capabilities quickly during an emergency event. If a large-scale disease event were to occur, most hospitals lack enough beds, equipment, and personnel to properly manage the crisis. Hospitals would not only be overrun by the sick, but also by the “worried-well”, individuals who are healthy but believe themselves to be infected. We do not have effective vaccines, therapeutics, and treatments to counter all the diseases that exist in the world today, let alone ones that have yet to emerge.
Finally, characters like Jude Law’s would prove to be a problem – fear-mongers and snake oil salesmen who aim to profit from the crisis. Law’s character champions the effectiveness of a natural treatment, though there is no scientific basis for his claims. He lambasts the CDC and their response and urges people to refuse the vaccine. People like him can single-handedly undermine a public health response.
I am sure that there are aspects of the film that I am missing, as I saw it over a week ago. But I believe many of the salient points to be included here.
During my time at Georgetown University, my two topics of interest were public health emergency preparedness & response and emerging infectious disease ecology. “Contagion” put both of these on display, and I am thrilled with the final product.
If I learned anything while obtaining my M.S., it’s this: diseases will continue to emerge, and we will most likely be unable to catch up with nature; therefore, we need to have a public health system that is ready to respond to an emergency, and despite a decade of improvements, we are still far from that goal.
“Contagion” has the potential to do for public health what “Top Gun” did for the military – increase public awareness and increase funding. Though America is fighting through very turbulent economic times, it is important that public health not fall by the wayside.
The world hasn’t seen a widespread disease event since H1N1, so it’s understandable that preparedness may slip away from the public’s eye. But that cannot be an excuse for an unprepared system.
Tags: contagion, emerging infectious diseases, film, nipah virus
