Sunday, September 18, 2011

Stellaluna and Wilbur will kill us all: a review of Contagion

It will come as no surprise to anyone who knows me that (when time permits) I read a lot of books on science. My friends are, however, sometimes surprised by my collection of "scary disease books". I have books on plague, books on smallpox, books on Ebola. Sensational popular science writing like Richard Preston's The Hot Zone and The Demon in the Freezer, insightful memoirs by noted virologists like Joe McCormick and C.J. Peters, historical analyses like Scourge and Justinian's Flea. The one I go back to over and over again, though, is Laurie Garrett's The Coming Plague, an engagingly-written, exhaustively-documented overview of the field of emerging diseases.

The Coming Plague addresses not just emerging diseases and the microbes that cause them, but often the ecological circumstances that lead to a zoonotic outbreak. For example:
  • A political revolution isolates a region devoted primarily to ranching from its usual markets. Out of necessity, the ranchers become farmers, clearing and plowing land to grow crops for which they had previously traded. A formerly uncommon mouse, its original habitat disrupted but suddenly presented with a superabundance of food in the form of corn, increases greatly in numbers and begins to live commensally near humans. The mouse sheds a virus in its urine, and half the people in town become infected through eating contaminated food or breathing in dust from swept floors; half of those people die bleeding. This is Machupo, or Bolivian hemorrhagic fever.
  • After several years of drought in the already dry Four Corners area in the southwestern United States, a winter of heavy snowfall brings an infusion of moisture. The following spring and summer, vegetation rebounds, and piñon trees take the opportunity to produce a large seed crop. Deer mouse populations explode due to the sudden abundance of food, and as in Bolivia the mice increasingly come into contact with humans, shedding virus in their urine. Again, people die, this time gasping. This is Sìn Nombre or Muerto Canyon virus, a previously unknown hantavirus that causes acute respiratory distress syndrome.
  • The practice of hunting primates for bushmeat allows a virus from infected chimpanzees to enter human hunters or butchers, probably on several different occasions at different times and places. The chimpanzee virus adapts to its human hosts, becoming a new species (or two) in the process. The construction of a transcontinental highway and an attendant increase in travel, prostitution, and intravenous drug use allow the virus to expand its range beyond central Africa. People die rotting, unable to fight off viral, bacterial, and fungal infections. This is HIV and the global AIDS pandemic.
Varied and wondrous are the diseases in The Coming Plague. Some are widely known, and widely feared, by the general public. Others are widely known but taken all too casually. And still others are obscure, perhaps mercifully so. There exist, for example, a herpes virus found in squirrel monkeys, and another in spider monkeys, that seem to do their hosts no harm whatsoever. But when these viruses are transmitted to Old World primates, they trigger devastatingly lethal leukemias and lymphomas. Not scary enough for you? Okay...but these cancer-causing viruses are airborne.

* * *

So I was anxious to see the new Steven Soderbergh movie Contagion, but also a bit apprehensive that it might disappoint me, that it might get the science wrong or gloss over the science altogether. I'm happy to report that Contagion does not disappoint. Like The Coming Plague (it turns out that Laurie Garrett was a consultant on the movie), it tells a very scary story without sensationalizing it.

Basic plot summary: Scattered individuals fall ill with what appears to be a respiratory infection but rapidly escalates to meningitis or encephalitis. These isolated illnesses develop into clusters, which grow into a global pandemic. Mayhem ensues. The movie follows a few patients, as well as doctors from the CDC and WHO and others struggling to avert, understand, and ultimately survive the emerging crisis.

On both an individual and societal level, the film gets human nature right. An excellent cast helps: the big names are Matt Damon, Gwyneth Paltrow, Laurence Fishburne, Kate Winslet, Elliott Gould, and Jude Law, but many other fine actors breathe life into believable and variably sympathetic characters. No mustache-twirling villains here; the closest approach is Law's character, a blogger ("six million hits a day") with a penchant for conspiracy theory who is not immune to corruption, but he seems to be more self-deluded and opportunistic than willfully evil.

Likewise, the public-health worker (played by Chin Han) who conspires to abduct a colleague from the WHO (Marion Cotillard) has a reasonable and sympathetic motive: a hostage from among the world's medical elite makes it less likely that his village will be overlooked if and when a vaccine or treatment is developed.

The most despicable character is actually Paltrow's philandering patient zero, but while her misconduct does give the virus additional opportunity to spread, her benign conduct is just as destructive. This raises the point that, while the virus is certainly the major antagonist in the film, it is not really a villain in the usual sense. A virus lacks any sort of consciousness, knows nothing and cares nothing of human concerns. Terrifying in its effects, it is nevertheless not malevolent, it just is—life (or proto-life) at its most basic, replicating itself and incidentally leaving destruction in its wake, facilitated by the frequent contact within dense human populations and the ease and ubiquity of global travel.

I went into the movie looking for errors. Happily, I didn't find any. I'm just an interested layman, of course, but as far as I could tell, all the virology and epidemiology was spot on. The specific virus depicted in the movie (MEV-1) is entirely plausible, enough so that "hypothetical" seems a better descriptor than "fictional".

The film's commitment to realism extends to dialogue in which doctors talk to other doctors like doctors. A lesser movie, for example, might include a line such as "We should isolate the patients with higher fevers; they may be more contagious." Obviously another doctor would know this, and so the line is intended as explanatory dialogue for the audience. In Contagion the line is "Put the more febrile patients down here"—no explanation necessary for medical personnel, and so none given to the audience, who may or may not have "febrile" in their working vocabularies. When explanatory dialogue is included, it's always in a believable context: for example, the EIS officer defining R0 ("R-naught", a measure of transmissibility) to bureaucrats in a state health agency who are clearly not themselves epidemiologists—they are considering postponing the declaration of a state of emergency because it might adversely affect holiday shopping.

The drama in the film is never overplayed. Plenty of people, including major characters, die in the movie, but Soderbergh stays away from the usual format: a close-up shot of the patient, loved ones in emotional anguish nearby, sad violin music playing just in case we were about to miss the point. Contagion shows death more matter-of-factly, and more starkly: a delirious patient staggering into the road and being hit by a truck; a child left alone and found unblinking and lifeless in his bed; a doctor, discovering that she has contracted the disease, arranging for her contacts to be traced in one scene, and encased in a body bag, about to be interred in a mass grave, in the next. Combined with Soderbergh's refusal to dumb down the dialogue, this approach gives Contagion the gravitas of a documentary without making it any less a thriller.

Ultimately, the scariness of Contagion lies specifically in its realism. It is, in a sense, the opposite of The Andromeda Strain, which offers an easy deal: suspend your disbelief for as long as it takes to read the book or watch the movie, in exchange for some dramatic tension. This film is a wake-up call: Steven Soderbergh, Laurie Garrett, and the other people involved in making Contagion are using dramatic tension to try to dispel disbelief. The next big disease that will threaten humanity's existence, or at least life as we know it, is not an exotic life-form from outer space, waiting to hitch-hike on a probe returning to earth. It's here already. EVF-1, or something like it, is just waiting for a small ecological change to unleash hell on earth. The message of The Coming Plague, and of Contagion, is that it's not a question of if, but when.

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