Sex, Drugs, and Public Health

Chicken Little is at it again.

This time the chicken has taken his virus and gone to Hollywood.  The result is “Contagion,” a major motion picture designed to make money by scaring the audience (not a new concept).  The plot line involves a mutant strain of Influenza-like virus, so its greater story has a Public Health theme.

In the movie, a virus mutates and runs rampant, killing millions worldwide.  But the associated epidemic of fear causes more social disruption than the virus itself.

While surveillance of potentially dangerous pathogens is a big part of what we in Public Health do, and surveillance of various strains of virus has been going on for several years, scaring people is not what we do because it doesn’t help.

But there is some fact in this Hollywood tale, and it mirrors what Public Health has had to face.

In the movie, an animal virus enters human beings and runs rampant, killing millions.  The Microbiologist who “designed” the virus for the movie patterned it on a virus named “Nipah,” which jumped from bats to pigs, then from pigs to humans in the late 1990’s.  The resultant outbreak killed over 100 people in Malaysia.

In reality, most of the nasty outbreaks of human disease have been caused by organisms which were once animal diseases, then “jumped” to humans.  This includes Rabies (from carnivores), E. Coli and Mad Cow Disease (from cows), Yellow Fever (from monkeys), Plague (from rats), and, of course, Influenza (a bird virus).

The most recent large killer outbreak was the Spanish Influenza, which killed an estimated 50 million people world-wide in 1918.  A large percentage of those who died were young adults.  We haven’t seen anything that monstrous since then, but we were very worried that the H₁N₁ of 2009 could have mutated enough to cause a similar catastrophe.  You can’t predict in advance how a new virus will behave, so we had to prepare for the worst.  H₁N₁ did become a Pandemic (worldwide epidemic) because it was a strain of flu most people’s immune system hadn’t seen.   Luckily, it was not very severe.

In the movie, the audience is scared.

In reality, it’s we Health Care Workers and Public Health Officials who can be scared. In preparing for the arrival of the mutant H1N1 Influenza virus, we had to think about these issues:

Suppose we have two patients whose lungs are filled with fluid and need ventilators to survive.  But we only have one ventilator available and all surrounding hospitals are full.  How do you decide?  Suppose the two patients are both children.  Which one gets the life-saving device?  Suppose 25% of our Health Care Workers become ill.  How do we provide care?  Suppose the disease hits a doctor’s, a nurse’s, or first responder’s family.  Will the health care worker remain at the hospital, clinic, or ambulance to treat patients, or leave to be with his/her family?

In the movie, the entire community is involved somehow in responding to the epidemic. Our planning locally for the approach of H₁N₁ involved not just the Health Department, but the hospital, local doctors, Yosemite Park, County Fire, County Sheriff, the Red Cross, all local businesses, the school system, and many other partners.  We stockpiled anti-virals and held large vaccine clinics.  We practiced expanding patient care into a large space in case the hospital was full (we set up a MASH-like hospital at the fairgrounds).

These are just some of the issues we had to plan for.  And believe me, like nightmares, they can keep us awake at night.

One of the Public Health experts who worked as a consultant on the movie pointed out that Pandemics, which have occurred in the past, and will occur in the future, will not be optimally controlled unless:

1. Public Health is better funded and better staffed than our current overworked system.
2. International cooperation is improved for quick identification of outbreaks and quicker control of them.  Electronic reporting is needed.
3. We develop new technology for more rapid vaccine development.

Outbreaks DO occur and sometimes they grow to become Pandemics.  We have a Public Health system in place to watch for and respond to outbreaks, as showcased in “Contagion.”  But, we can’t let that system decay, or Chicken Little may, someday, be correct.