The concepts of outbreak and outbreak investigation are important to public health and relevant to the movie. An outbreak exists when the number of cases of disease exceeds the expected for a given time, place, or population; it is a sudden rise in the incidence of disease. In the movie, the outbreak was a result of humans consuming an infected food. The disease was highly contagious with a short period between contraction of the disease and death. Once the outbreak was known, public health officials began an outbreak investigation starting with confirming the existence of the outbreak, defining and identifying cases and populations at risk, and eventually evaluating a hypothesis and beginning control and prevention measures. In the movie, the public health officials realized that the disease did not target any specific group; every person was equally likely to become exposed once it started to spread. However, scientists could not create a vaccine for the disease before lives were lost on a grand scale. Isolation and quarantine are also important concepts. Isolation separates people from other people to prevent the spread of infection. Isolation is used for people who have already been sick from the disease. In the movie, the sick were often isolated socially as more and more people became sick; nurses and doctors did not want to help at the risk of contracting the highly contagious, untreatable disease themselves. Quarantine, however, is for people who have probably been exposed, but are not yet sick. In the movie, the man who lost his wife and son had probably been exposed and there is a scene that shows him being quarantined.
On another note, a major sector of public health is preparedness. In his lecture on public health preparedness and disaster management, Dr. Barnett stressed epidemiological investigations and surveillance as a means for preparedness. He mentioned that in Maryland - and many other states - it is required by law that a physician must report certain diseases to the local health department. The only problem with this measure, however, is that many diseases are unreported. In the movie, it was evident that at first that the disease was unreported because the first symptoms were similar to the common flu. Also, there were a few situations in the movie where public health agencies could have been better prepared. There was a scene where the father mentioned before and his daughter attempted to get food being distributed by the army. It was evident that the distribution was chaotic and ineffective when they ended up not being able to obtain any food. Public health agencies also could have been better prepared on the political front. For awhile, doctors were faced with prophet versus profit accusations.
The measures stressed by Dr. Barnett seem logical and if implemented perfectly, would reduce the spread of many contagious diseases. I do not think, however, that the failure to report certain diseases is a deficiency in the system. The movie, for example, had a disease that was initially indistinguishable from the common cold. Reporting such a disease would likely be ignored by the local health department and would only serve as noise. It is unavoidable that certain diseases cannot be recognized as potentially new and contagious diseases unless medical advances are made.
ReplyDeleteIt is scary to think that what a doctor thinks is simply a cold or the flu could really be a potentially dangerous infectious disease. I am not convinced that unreported diseases are a deficiency in the public health system. Many diseases share common symptoms, and as important as it is to identify potentially dangerous outbreaks, it could be just as harmful to get the public worked up over nothing. That idea is presented in the movie, where public health officials are skeptical that the outbreak could become just like the H1N1 fiasco.
ReplyDeleteWhen the doctors couldn't figure out the cause of death for the mom in the beginning of the movie I was very scared. I couldn't imagine having an epidemic of this magnitude and not be able to realize there is something completely new going on. It is terrifying to know that at any time we could face a situation like this one. Even though H1N1 didn't end up being as terrifying, I understand why so many people panicked.
ReplyDeleteAlthough it is a movie, Contagion did not do too badly in depicting how outbreaks occur and the role public health plays in outbreak investigation. In the movie, because of the virulence of the infective agent the investigating agent also contracted the infection. Isolating the infected individuals, or quarantining those with exposure to the infection so that their access to others was limited or prevented, would have slowed the spread, but they were not employed early enough allowing rapid spread. It bears noting that in real life most outbreak investigations start well after the initial peak of infective activity (often after the whole outbreak is over), and the public health agent is often not in such grave danger. I guess it would not have made for as exciting a movie without this element of danger, but I’m sorry that Kate Winslet had to die.
ReplyDeleteThe lack of reporting you mentioned Shelby is one of the big gaps in disease surveillance. Many times, things that should be reported are not, so passive surveillance must be backed up by active surveillance. Even with both, our system is not perfect, so primary prevention (washing hands etc,) so important. If Beth had washed her hands prior after shaking the chef's hand, there may not have been a movie.