Contagion: The BIO230 review

via IMDB

My non-majors science class, Unseen Life, is using the book Twelve Diseases that Changed Our World as a jumping off point for discussions on how microorganisms affect all aspects of society.  I was quite excited while putting the final touches on my Fall syllabus to see a movie preview for a major Hollywood release that looked to be completely on topic with the intentions of the course. Consequently, I decided to take the class to the movies today to get their impressions on a plausible scenario of world destruction.

Contagion is the newest release by accomplished director Steven Soderbergh, and details the outbreak and containment of a rapidly moving infectious agent throughout the world. The movie opens with a number of scenes around the world, showing major cities and their population totals, which focus on individuals moving throughout their lives. Interactions between these strangers are highlighted by camera shots of hands touching doorknobs, touching faces briefly, handshakes. In the opening scene (Day 2) we see Gwyneth Paltrow’s Beth Emhoff in a Chicago airport lounge waiting for her flight, and looking a bit under the weather after a business trip to Hong Kong.  Her character dies in the first act upon her return home, and the body count rapidly ramps up as the movie progresses. Most of the film is spent detailing the actions of Laurence Fishburne’s character CDC executive Ellis Cheever as he leads the government’s response to the microbial disaster. There is a subplot involving an investigative blog author (played by Jude Law) and his attempt to find conspiracy within the government and the progress of research against the outbreak. By the end of the film, millions have succumbed to the pandemic, however a vaccine enables the outbreak to be curtailed.

So what about the plausibility of the film? The film postulates the existence of an infectious agent, which can persist for a relatively short time outside of the human body and be transmitted indirectly, or directly via droplet transmission. Initial symptoms are respiratory in nature,  but the major lethality of the agent is due to rapid infection of the central nervous system, culminating in seizures, coma, and death. The agent has a very short incubation time, and the disease course occurs over a matter of a few days. Some people appear to be immune due to fortuitous genetics, but most people are very susceptible, and successful infection results in death approximately 25% of the time. No cure is available once someone is infected, and the disease must run its ultimate course. Ultimately, a vaccine is developed which is able to protect those individuals who have not been previously infected.

Let’s tackle these one by one:

  • Transmission of the disease via respiratory droplets or indirect contact: extremely plausible. There are plenty of diseases like this already, and these represent the most common methods for disease transmission. The mucous membranes of the respiratory tract are the most commonly used portal of entry for pathogens of humans.
  • Rapid incubation time and development of disease: mostly plausible. There are some viral diseases that show a rapid onset and disease progression; hemorrhagic fever like Ebola is an example. The problem with the way that the virus is shown to spread in the movie is that if a virus is incredibly virulent and kills a high percentage of those afflicted, the epidemic will rapidly burn out. This is why Ebola outbreaks are typically confined into small geographic areas.
  • Immunity of some individuals: extremely plausible. The movie had several infodumps, or expositions of a technical nature in the middle act and these outlined how the virus attached to human cells to initiate the infection. Attachment involved the lock and key interaction between a virus protein and a protein receptor on a human respiratory cell. Different genetics in individuals would lead to small differences in the structure of the respiratory receptors, which confer innate immunity to that virus in that person. Matt Damon’s resistance was not due to his immune system being better and fighting off a virus infection in the movie, but due to the inability of the virus to cause infection in the first place.
  • Lack of cure for the virus: extremely plausible. Antibiotics are ineffective at combating a viral infection, and are only effective against bacterial, fungal, or protozoan pathogens. Antiviral medications are not hugely effective, and will work by attempting to prevent the virus from reproducing in the body. But since viruses will reproduce inside our own cells, these compounds will effectively shut down the ability of our cells to grow as a serious side effect. Many antiviral treatments consequently (eg. fever reducers like aspirin) will instead only attempt to ameliorate the symptoms associated with viral infections, and the disease will need to run its course. Of course, if the ultimate progression of disease is death, and your amelioration of the symptoms is not 100% effective, you are still dead in the end.
  • Vaccine development: somewhat plausible. This was actually the part of the movie that I had the hardest part with, because I personally think that it was incredibly optimistic in showing the vaccine coming to be used. Consider: you need to have a way to produce virus, which as shown in the film was a significant technical hurdle to overcome. Then you need to have a way to produce a virus that is non-lethal, so that you can administer it to a subject and confer immunity. Then you need to see if that protection is effective, and then mass produce the vaccine for delivery to up to 8 billion people. I think that the steps of this process were laid out very nicely in the film, but I don’t think that they could be done in the timeframe shown. The majority of this complaint is unavoidable though, due to the need to show that laborious, convoluted process within the constraints of a 100 minute film, so I will give the editors/scriptwriters a pass here.
  • Initial infection of the respiratory system, with CNS pathology: conditionally plausible.  Where the science surprised me a bit was with a what I felt was a stretch. MEV-1 (the virus of the film) caused convulsions and seizures in the latter stages of infection, as the virus spread to the central nervous system. Many viruses are responsible for causing encephalitis in humans (West Nile, Herpes Simplex, and many others), but they are typically not spread by the means shown in this film.  However, a quick visit to Pubmed indicated that influenza can be responsible for encephalopathies, in addition to the standard upper respiratory symptoms.

The origin of the virus outbreak came from literally nowhere and rapidly spread throughout the world. Again highly plausible, and a very real scenario. The coda of the film goes back to the beginning (Day 1) to show the origin in the forests of South East Asia, and nicely demonstrates in a visual manner the danger we are in with the mutability and prevalence of these pathogens.

My favorite scene of the movie involved a conversation with the head of the Department of Homeland Security, who was very rightly concerned that the outbreak was the initial salvo of a bioterrorism event. He was asking Laurence Fishburne’s  character Ellis Cheever whether the disease could be weaponized bird flu. Cheever’s reply:

Someone doesn’t have to weaponize bird flu. The birds are doing that.

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About ycpmicro

My name is David Singleton, and I am an Associate Professor of Microbiology at York College of Pennsylvania. My main course is BIO230, a course taken by allied-health students at YCP. Views on this site are my own.

Posted on September 17, 2011, in Danger danger danger!, Wash your hands! and tagged , , , . Bookmark the permalink. 2 Comments.

  1. This movie really scared me. It is also going to make a trip to Wal-Mart with my germaphobic husband even more difficult than it already is. I enjoyed reading your professional response to the plausibility of this event. It did seem like there were a few holes in the film; was Jude Law ever really infected? Also, I thought the virus mutated, so wouldn’t the vaccine no longer be effective? Either way, I am staying away from bats and pigs.

    • No, Jude Law never was infected; there was a throw away line when he was picked up by the Homeland Security guys which said that his blood tested negative for any antibodies against the virus, indicating that he was never challenged with the virus in the first place. So, the writers did cover that hole, but it may have been easy to miss.

      The virus mutated initially, with contributions from a bat virus and a pig virus, in a process called “recombination.” Once that virus entered human populations, it was relatively genetically stable,although it did appear to increase in infectious potential about mid way through the film (the R zero number they referred to). Different smallpox isolates historically varied in infectious ability, however the vaccine provided protection against all isolates, so the premise as presented in the movie is not too far fetched.

      Won’t do you any good to stay away from bats and pigs. Recall that the pandemic in the movie started out with bats and pigs, and entered into human populations in China, but spread to Minnesota within two days.

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