Excellent review of Contagion

[Guest guest]

http://www.scottmcpherson.net/journal/2011/9/12/contagion-is-a-deeply-unsettling\

-haunting-and-mostly-realist.html

Contagion " is a Deeply Unsettling, Haunting – and (Mostly) Realistic – Pandemic

Film

Posted on Monday, September 12, 2011 at 02:19PM by Registered Commenter

McPherson in Contagion, Dr. Ian Lipkin, Dr. Osterholm, H1N1, H5N1,

MEV-1, Nipah, Politics and government, Popular Culture, SARS, Soderbergh,

bird flu, influenza and infectious diseases

Those of us who have made pandemic preparedness part of our curriculum vitae

could not have been more excited about the premiere of Soderbergh's

latest film, " " Contagion " . "

And we were not disappointed. " Contagion " is a paragon of what an intelligent

biological thriller should be: hyper-accurate, absorbing, and, most of all, a

film that reminds us of our own individual responsibilities within a civilized

society.

Not to say that there's not a little bit of Hollywood in this film. More on

that later. First, let's take a look at how the movie was made, the etiology of

the fictional virus, and what Hollywood got right. And in many cases, they got

it absolutely right.

What " Contagion " got right

The MEV-1 virus in the movie is the brainchild of Dr. Ian Lipkin, of Columbia

University. Dr. Lipkin directs the Center for Infection and Immunity at the

Mailman School of Public Health at Columbia. He was contacted by Soderbergh

and the film's writer, Z. Burns. He agreed to come on board the

production as a paid technical and science adviser.

Dr. Lipkin created a virus for the film that is patterned after an actual virus:

The Nipah virus. Nipah was first discovered in Malaysia in 1999. The natural

reservoir of Nipah is in the Malaysian fruit bat population. The WHO reports

that Nipah has also been found in bat urine and in partially-eaten fruit in the

region. Oh, by the way: The real-life bats in question are migratory. Toward

that end, antibodies to a virus very similar to Nipah have been found in India,

Indonesia and Timor.

There is a danger in making bats the heavy in the film. Bats are essential in

such areas as insect control. And North American bats are dying by the

millions, due to " white-nose syndrome, " a fungal infection that essentially

suffocates bats during their annual hibernation.

But bats are also vectors of some of the world's most dangerous diseases,

especially Ebola – and SARS.

While the MEV-1 virus is patterned after Nipah, the pattern of infection is

modeled after the SARS virus. How quickly we forget how threatening SARS really

was. In bookstore remainder bins all over the continent, one can find Karl

Greenfield's seminal work on the SARS epidemic, titled, " China Syndrome: The

True Story of the 21st Century's First Great Epidemic. " I highly recommend his

book.

While the original vector of SARS in 2002/03 was a " civet cat, " a

peculiar-looking mammal, it may be that the civet cat in question was infected

by a bat. SARS virus has been found in Brazilian bats, so the danger is not

localized to Southeast Asia by any means.

Had SARS been more like influenza and less like the common cold, we would have

seen a pandemic that would have made 1918's Spanish Flu look like the common

cold. In the US, the H1N1 Spanish Flu pandemic killed 2.5% of everyone it

infected. In contrast, SARS killed 10% of those it infected, worldwide. But

luckily for us ( " us " being the world), SARS infected so quickly, public health

professionals got in front of the disease and eventually beat it down. It is

counterintuitive to be sure, but a disease that infects quickly is easier to

corral than one with a days-long incubation period, such as influenza.

To go into how SARS infected and killed would also produce those obligatory

" SPOILER ALERT!! " warnings and disclosures, which I want to avoid (where

possible) in this review. So suffice it to say that " Contagion " is disturbingly

accurate when it comes to how quickly it was able to infect on a global scale.

SARS was not the exclusive province of China, Toronto or Singapore. Two

prominent Tallahassee residents (who I obviously cannot identify for HIPAA

reasons) were infected by SARS during a visit to China in 2003. The CDC and

WHO were actually monitoring their health following their return to Tallahassee.

By proxy, they were monitoring Tallahassee for signs of SARS infection.

So what Soberbergh, Burns and Lipkin created were a perfect fit of an

established disease and historic established routes of transmission. In other

words, extremely realistic.

Dr. Lipkin also taught the cast how to correctly don protective gear, and how to

speak the language of disease.

In the movie, the Elliott Gould character, Dr. Ian Sussman (yes, a probable nod

to Dr. Ian Lipkin) is able to finally grow a sample of MEV-1 to produce a

vaccine candidate. This storyline parallels the first attempts to grow H5N1 in

chicken eggs to produce a vaccine. Bird flu was killing the eggs. That was

eventually overcome. Of course, H5N1 poultry vaccines have arguably done more

harm than good, but that is a matter left to my previous blogs on the subject.

Elliott Gould's Dr. Sussman is handling the virus in a Level 3 lab, and the CDC

has already ordered all samples not contained in a Level 4 lab to be destroyed

by fire. Dr. Sussman's on-screen disregard for CDC protocols is reminiscent of

the spanking that real-life Dr. Yoshihiro Kawaoka of the University of Wisconsin

received in 2007 for handling " copies " of the dreaded Ebola virus in a level-2

lab.

ce Fishburne's admonition that " We don't want that virus leaving on the

bottom of someone's shoe " refers to a frequent and ongoing concern. For more

information, refer to my ongoing blog series, " When labs attack. "

What " Contagion " could have done better

Where the movie deviates from probability, in this reviewer's opinion, is in its

depiction of how society would react to the virus. These deviations are all

permitted, because they are clearly possible. It is just in the areas that were

left out that very minor – and forgivable – faults can be found.

In less than a month, society pretty much goes over the cliff. Garbage lies

uncollected and strewn about neighborhoods. Unions strike, rather than perform

their duties. Governors call out the National Guard and seal borders without

apparently seeking consultation from Washington. And while grocery stores are

ransacked and food is extremely scarce, the lights and phones somehow stay on.

The Enemy of the People in any pandemic is the stability of the supply chain.

That just-in-time supply chain is the most fragile part of our economy. The

level of global apprehension, not to mention the Case Fatality Rate of the MEV-1

virus in the film, would have produced much more damage to the global supply

chain.

Those of us who are sought-out as experts in pandemic preparedness often point

to unions as a cause for concern. In fact, pandemic planners factor in possible

union (in)actions in their calculations, but I believe that people are also

capable of doing heroic things. The public health experts in " Contagion " are

justifiably viewed as heroic. But as we saw on 9/11, and as we were reminded

this past weekend, heroism is not limited to one exclusive group of people.

However, the images of public employees such as law enforcement officers

abandoning their posts in New Orleans during Katrina – and even joining in the

looting and pillaging, in a few cases – is also testament to our individual

faults and failings. That, too, can be seen in " Contagion, " even at the higher

levels of the government.

The film did not damage the critical infrastructure enough. In a prolonged,

1918-type pandemic, we believe ports will clog, phones will become unreliable,

and power will come on and off – all because there will not be sufficient levels

of people healthy enough to work to maintain them, nor will there be sufficient

numbers of people to work, due to absenteeism to take care of loved ones. And

there are always those who will burn sick days just for a headache. We have

estimated that, at the height of a pandemic, as much as a third of the workforce

might be absent on any given workday.

The movie attempts to display the deterioration of society in a few select

scenes, but the film did not go far enough in its depiction of the degradation

of the infrastructure. It did show the requisite looting of grocery stores, and

certain unsettling acts of violence, and it did an excellent job in its frequent

shots of uncollected refuse.

In a real-life, lethal pandemic, the military would be called upon to perform

these tasks. That would include the National Guard, which I must believe would

be Federalized early on, in order to prevent the types of actions that were

undertaken by individual governors as the pandemic worsened. Federalizing the

Guard places those units under the direct control of the Pentagon. Governors

lose their Guard in that scenario. I would have to believe that the president

would exercise that authority very, very early on in this process.

Sealing the borders, for example, has been almost completely tossed as a

realistic countermeasure. The SARS epidemic and the H1N1v " swine flu " pandemic

showed how border closures would be ineffective to restrain any virus.

This point (along with the supply chain issue) was actually done very well in

the TV-movie " Fatal Contact: Bird Flu in America " . In that film, the military is

called home from Iraq and Afghanistan to help maintain law and order. I would

expect governors to call all their Guard units home, to assist in stabilizing

the infrastructure of their states and to curtail inevitable violence.

Other than the depiction of labor unions as petty and self-serving, " Contagion "

also serves as a confirmation of the Second Amendment during a crisis. Cops are

not around when the shooting starts. Self-defense is the order of the day.

Being armed equals being safe. These are two curious messages to be dealt by a

Hollywood director, and I found it to be refreshing.

SPOILER ALERTS COMING!

My family felt that it was a little preposterous that key public health people

would not continuously wear their masks and gloves, especially in public. We

have had many discussions regarding the efficacy of wearing masks in public,

however, and I defer to the writer and director on this topic.

Another concern (the most deeply-rooted one) is in the film's conflict between

the CDC and the Minneapolis public health unit. This is where the Hollywood

formula kicks in, resembling a Criminal Minds episode where the local cops

resent the FBI intrusion into their bidness. The reality is that local public

health units generally work very well with the CDC, and welcome their

participation when things go bad. In my experience, the CDC is a first-rate

organization, led by top-flight people. Local public health units do the best

they can do, especially in this current economy, but " overwhelmed " would be an

understatement on any given workday – let alone during a pandemic.

Dr. Osterholm, head of the Center for Infectious Disease Research and

Policy at the University of Minnesota (and who worked at the Minnesota

Department of Health for a quarter-century), alluded to this during a recent

" Contagion " -inspired interview. In fact, the Minnesota Department of Health is

one of the best-run departments of its kind in the country.

The other area that the movie (which runs a brisk 106 minutes) glosses over is

within the subject of vaccine production. Public health experts such as Dr.

Osterholm have stated that the movie's scenario for vaccine production is too

rosy (my words). Vaccine production takes months, even in a " good " viral

situation such as producing an influenza vaccine. It took every bit of six

months just to produce the swine flu vaccine.

With a new and previously-unseen virus, especially considering the repeated

failures of the prototypes, it would take considerably longer. The wait for

vaccine could take almost a year, causing further destruction of the global

economy and the further erosion of the critical infrastructure. And this does

not even deal with the issue of who gets vaccine and who does not.

In another " Contagion " -imitates-life example, a Chinese group has kidnapped a

WHO official, and demands -- as ransom -- vaccine produced in the West. This is

a nod to the possibility of natively-produced substandard or even counterfeit

vaccine. It is nice to hear someone demanding America vaccine –anything –

because it is the best in the world. Note, at the end of the movie, the

architecture of the open-air school housing the Chinese children.

The vaccine issue is personalized within the village, but once again, the script

alludes to larger global issues. In this case, the rural, poor demand for

vaccine speaks to the problems caused by Indonesia in the fight against bird

flu. Back in 2007, the Indonesian government refused to share human bird flu

samples – or even to quickly report human bird flu cases and deaths – simply

because they felt their samples would make the global pharmaceutical companies

billions of dollars, and, at the end of the day, leave Indonesia without any

vaccine. It took years for the West to negotiate an agreement with Indonesia to

give them vaccine in exchange for human bird flu samples.

The movie did do a good job of showing the agony involved with waiting and

waiting until their vaccine lottery number was called. I found the prospect of

a " vaccine lottery " to be a curious and interesting (and fair) way to resolve

the issue of who got vaccine and when. The reality is, there is a schedule of

who gets vaccine, at least within the first responder community, the military

and the government. The Strategic National Stockpile has the goods. The

Department of Homeland Security and state governments have the plans. After

that, I doubt if there is a plan, so the lottery idea seems as fair as any.

Finally, we need to address the issue of the blogger character played by Jude

Law. " Blogging is graffiti with punctuation, " Elliott Gould admonishes Law's

character. Law's Alan Krumwiede is the worst sort of blogger, one who is only

interested in promoting his " brand " at the expense of the truth, not to mention

people's very lives, by promoting an unproven homeopathic " remedy. " He is the

21st Century snake oil salesman, shamelessly hawking an elixir that is

eventually proven to be dangerously ineffective.

Fortunately, I do not know any bloggers personally who would fit into those

shoes. My disease-blogger friends are all dedicated people who, in their minds

and in mine, are performing a valuable service by alerting their readers to some

very real threats and dangers. Their surveillance uncovered the swine flu

pandemic before the world's press did, and their work on tracking H5N1 has

proven to be extremely accurate. I hope Law's Krumwiede would not get the

attention he gets in the movie. However, having sat numerous times where Law's

character sat, in a quiet studio, in front of a television camera with an IFB in

my ear, talking to a reporter or a network news anchor, I can understand how a

marginal " playa " could become a fiend, mainstreamed by the press. It is up to

the individual to censor him/herself and to produce accurate content.

Summation

" " Contagion " " is an incredibly well-researched, disturbingly plausible, and

extremely well-made film. With the exceptions of the vaccine production

timetable and the downplaying of the damage to the economy and the critical

infrastructure, Soderbergh and Burns got it right. Soderbergh is his own

cinematographer as well (under a nom de plume), and his use of " available light "

in place of standard movie lighting techniques makes the film feel much more

realistic -- which means, of course, much more disturbing. The cast, without

exception, is fantastic. Gwyneth Paltrow factors heavily throughout the film,

so her apparent quick departure in the film's first act is compensated for

throughout the movie.

And equally exceptional is the villain, the MEV-1 virus. The fact that it is

based on a real virus should wake us all up to the need to engage more

strenuously in personal hygiene, and remember the things Momma taught us:

Wash your hands frequently.

Cover your cough, not with your hands, but with your sleeve, or a

handkerchief or napkin.

Keep a respectable distance from strangers.

Now go put on your Level 4 gear and go see the movie!

Here are some other sites, in case you want more " Contagion " stuff:

Mike Coston's superb Avian Flu Diary, and his entry on the movie.

http://afludiary.blogspot.com/2011/09/why-you-should-catch- " Contagion " .html

An interview with Dr. Mike Osterholm on the accuracy of " Contagion " :

http://www.startribune.com/lifestyle/wellness/129464038.html

And a dynamite Wired blog, written by the extremely talented n McKenna,

featuring an interview with Dr. Ian Lipkin. n has two books in print that

hypochrondriacs should not read. Her latest is on MRSA and it is called

Superbug. Find it at your local bookstore, if one still exists, or order it from

Amazon.

http://www.wired.com/wiredscience/2011/09/ " Contagion " -questions-spoilers/all/1

Last, and least, an article on " Contagion " from a Palm Springs, California

newspaper, with some quotes from yours truly.

http://www.mydesert.com/article/20110911/NEWS01/109110341/- " Contagion " -not-far-f\

etched