Illness Skilled Compares “Contagion” to Covid-19 | Trigger + Management | WIRED

published on July 3, 2020

– Hi, I'm doctor Seema Yasmin

and from 2011 to 2013, I was an officer

in the Epidemic Intelligence Service,

so today I'm gonna match
the timeline of Contagion

with the timeline of COVID-19

[contemplative music]

Contagion starts on day two,

and we see Gwyneth
Paltrow's character is sick

and then a montage of
other sick civilians,

all demonstrating symptoms
within one day of transmission

Everyone we see who gets sick with this

has a cough, a fever, seizures,

and then dies within three to four days

The virus in Contagion is fictional

It's called MEV-1, but it is a hybrid

of two real life infections,
influenza and nipah

Nipah is a real life
virus, a very serious one,

that can cause fever, shortness of breath,

swelling of the brain, coma, and seizures

The illness caused by
MEV-1 is very different

to COVID-19, where people
get sick over the course

of two to 14 days

And unlike the fictional
virus in Contagion,

death from COVID-19 isn't
typically so sudden

– [Man] Honey?

Oh, Beth, Beth, hey

[contemplative music]

– So in this scene, we're
looking at day five,

which is the day that the
World Health Organization

is notified of the outbreak

– [Announcer] What we
are hearing from Beijing

is that the outbreak is contained

to the Chrysanthemum Complex in Hong Kong

– We're also looking
at samples from London

Two clusters–

– Here's the first time that
they use the word cluster

and that can refer to
cases that are literally

clustered together in time and place

We still don't know who
was the first person

to become infected with SARS-CoV-2

and when that was, but we do know

that Chinese officials alerted
the World Health Organization

on December 31st of 2019

Then it would be day 21
when the United States

identified its first cases

[contemplative music]

On day six in Contagion, the CDC learns

of a cluster of cases at an
elementary school in Minnesota

– There's a cluster in
an elementary school

– And we start hearing here
some very familiar language

– We're isolating the sick
and quarantining those

who we believe were exposed

– And that's exactly what
happened here in the US

People who had symptoms were isolated

from others and those
who were exposed to those

who had symptoms were then quarantined

– The average person touches their face

two or 3,000 times a day

– Two or 3,000 times a day?

– So in this scene, we have Kate Winslet

playing an officer in the
Epidemic Intelligence Service,

the job that I used to have,

and she's talking to health officials

at the Minnesota Department of Health

– I say we have to believe
this is respiratory,

maybe fomites, too

– What's that, fomites?

– This is stuff they would already know,

especially when you're looking at the fact

that it's the Minnesota
Department of Health,

which is known to be one
of the best departments

of health in the country

– It refers to transmission from surfaces

– Fomites are inanimate
objects and surfaces,

things like a door
handle or a light switch

– Those things become fomites

– One of the things
that's very silly to me

about Contagion is that
Kate Winslet is sent,

on her own, to investigate this epidemic

In real life, with
something of this magnitude

with a novel infection,
you'd be sent with a team,

not alone

Epidemic investigations
are all about teamwork

– For every person who gets sick,

how many other people are
they likely to infect?

We call that number the R-naught

– Her description of R-naught is accurate

– R stands for the
reproductive rate of the virus

– R-naught is the basic
reproductive number of an infection,

which means the average number

of people one infected
person will go on to infect

in a susceptible population

Once it gets to below one,
meaning that one infected person

is, on average, infecting
fewer than one people,

that's when you see an epidemic stop

because you're breaking
the chain of transmission

The R-naught of SARS-CoV-2 is thought

to be somewhere between 15 and 35

[contemplative music]

– We did Pilates together

I called her after she got
back, I never heard from her

– So you had no contact with her?

– In this scene, the Epidemic
Intelligence Service Officer

is doing what we call contact tracing

With contact tracing, you
first talk to the person

who is sick and then you find out

when were they contagious

– Did she go to the class?

– I didn't see her there

– Then you follow up on
that long list of people

– Is there anyone else who might

have had contact with her?

– One thing that I do find strange

about the current COVID-19 pandemic

is, here in the states, contact tracing

got shifted to the back burner

almost as if officials were saying,

"There's too much spread
and now it's too difficult

"to do contact tracing"

And compare that to South Korea

where there's been very
thorough contact tracing

for every single person
who's shown symptoms

[contemplative music]

In this scene, the researchers are talking

about sequencing the virus in the movie

– We've sequenced the virus
and determined its origin

and we've modeled the
way it enters the cells

of the lung and the brain

– And sequencing is where you analyze

the genetic material inside the virus

– The virus contains both
bat and pig sequences

– [Seema] Here, they're
analyzing the protein structure

of the virus

– [Health Investigator]
Blue is virus and the gold

is human and the red is the
viral attachment protein

and the green is its
receptor in the human cells

– [Seema] This kind of
molecular structuring

rendering is accurate

Researchers look at 3D models like this

to determine how a virus
invades human cells

– So we have a novel virus

with a mortality rate in the low 20s,

no treatment protocol, and
no vaccine at this time?

– That is correct

– It is accurate to say there
are novel characteristics

because that's what you say

when you're dealing with a very new virus,

one which you haven't seen
anything quite like it before

Sequencing a virus is really important

so that you can develop a test for it

The test that we typically
use is called PCR,

which means polymerase chain reaction

And the way it works is you take a sample

from somebody's nose, for example,

and then you are putting
it through this system

that amplifies the genetic
material inside the virus

And they did this really
quickly within 10 days

in the movie, which is pretty close

what we saw in real life with SARS-CoV-2,

where Chinese scientists
had sequenced the genome

by January 7th

And that's about day
eight of our timeline

And this timeline actually matches up

pretty well with the movie

– [Dr Cheever] He grew it?

– [Dr Hextall] He tried antibodies

and a multilogical
knockout lines like we did,

but the key was a fetal
bat cell line from Geelong

– This scene is really accurate because,

if you can't grow the
virus inside a laboratory,

then you're not able to study it,

propagate it, and really
understand what it looks like,

how it behaves, and
how you might treat it

– But the key was a fetal
bat cell line from Geelong

We didn't have it

– And the scientist says they were able

to successfully grow
the virus inside cells

that came from bat lungs

In the case of SARS-CoV-2, it was also

successfully propagated early on in a lab

using a different kind of cell, though

It used kidney cells that came

from a specific kind of monkey

This is a really important step

in terms of developing
treatments and vaccines

for a new virus

[contemplative music]

So here's a really great question

that one of the characters asks

– [Mitch] If I'm immune,
can't you use my blood

to cure this?

– This is something we
actually do in medicine

It's a technique that dates back

to the Victorian times
where, say somebody survived

an infection with a virus

You can take their blood,
separate the antibodies

out of it, those are the proteins

that helped them fight off the infection,

and give those antibodies
to others to help them

It's often a stop-gap measure that's used

during epidemics like with
the Ebola epidemic of 2014

We didn't have any specific treatments,

we didn't have a vaccine,

so while all of that
stuff was being developed,

we took blood from Ebola survivors

and used that blood to
treat and protect others

For SARS-CoV-2, there
are currently studies

looking into antibody treatments

where blood transfers
could help sick people

fight off the virus

[contemplative music]

On day 13 in Contagion, they report

more than 3,000 cases in
the suburbs of Minneapolis

– Over 3,000 cases have been confirmed

in the western suburbs

– In our timeline, on March
26th, Washington State officials

announced more than
3,200 cases in the state

And that would be day
65 since the first case

in the US was reported

Again, it just shows how
different the disease is

in the movie compared to COVID-19

[contemplative music]

Around day 13, Dr Mears
sets up a temporary hospital

in a public space

– [Dr Mears] I want 25
rows of 10 beds apiece,

the most febrile cases at this end

– And they say that it
needs to be operational

within 24 to 48 hours

– [Dr Mears] We'll need to be operational

within the next 24 to 48 hours

– This scene actually does match up

with what we saw happen in New York City,

which quickly became
the American epicenter

of the pandemic

In March, New York
governor Cuomo announced

that the Javits Center would be converted

into an emergency hospital

and the Army Corps of Engineers went in

and converted that space

into a 2,000 bed makeshift hospital

In real life, though, it took over a week

to set that up, not the 48
hours that we see in the movie

We call these kinds of
hospitals Mobile Field Hospitals

and many states and
countries will have plans

in place to make those appear quickly

in the case of an emergency

[contemplative music]

In this scene, CDC scientists

are tracking down the index patients

– [Dr Mears] Are we any
closer to an index patient?

– Could be your Beth Emhoff
or the guy on the bus

in Japan, someone else
who crawled off the grid

– And the find out that it's

Gwyneth Paltrow's character, Beth

– [Dr Orantes] Emhoff
is the index patient

– Index patient is a term
that you may hear used

interchangeably with
the term patient zero

When I was in the Epidemic
Intelligence Service,

I was taught that the index case

is the first case that you identify,

but patient zero is the true
first case in the epidemic

In this scene, there's
a health investigator

watching video footage of who they think

is their index case in a casino

– Okay, okay

– [Dr Orantes] It's
transmission, so we just need

to know which direction

– With SARS-CoV-2, the
investigation is still ongoing

and we don't know who the
first human cases were

or where and how they became infected

There was a lot of
finger-pointing early on

at a particular seafood market in Wuhan,

but some of the genetic analysis

and the epidemiologic analysis

shows that actually,
there were people infected

earlier on who may have had no contact

with that particular market

Similarly to the casino in Contagion,

there have been outbreaks
of COVID-19 traced back

to densely populated areas and places

like a church in South Korea

[contemplative music]

So, I wanna call out
something from the movie

that is pure Hollywood

Kate Winslet's character, playing the role

of the officer in the
Epidemic Intelligence Service,

dies from the very virus
that she is investigating

And as far as I know,
this has never happened

in the 69 year history of the
Epidemic Intelligence Service

[contemplative music]

In this scene, the media starts talking

about a drug called Ribavirin

– The drug Ribavirin has been shown

to be effective against this virus

– This is a real life
medication that fights viruses

and has been around
for a really long time

And, similarly, with
the COVID-19 timeline,

the president of the US did bring up

an existing old-school medicine

and asked if that would work
against the new Coronavirus

So the drug that he mentioned
was hydroxychloroquine

and chloroquine, which are
old-school malaria drugs

also used nowadays to treat lupus

and some types of arthritis

There is little evidence
that hydroxychloroquine

is a reliable treatment for COVID-19

– There are therapies we know

are effective right now, like Forsythia

– Jude Law plays this
really sleazy character

who's saying that they cured themselves

using a kind of homeopathic treatment

and then trying to sell this to others

and profit from it

– [Alan] This is Forsythia

If I'm here tomorrow,
you'll know it works

I'm not the first person to make money

off the fact that our immune system

is a work in progress

– This is really common during
epidemics and pandemics

With COVID-19, we've seen
internet personalities

and people like Alex Jones, no surprise,

peddling fake cures and trying
to profit off the crisis

[contemplative music]

– Whoa, whoa, whoa

Where did you come from?

– In this scene, CDC scientists find out

that by day 21, the virus has mutated

– It's mutated

– A phylogenetic analysis is basically

like creating a family tree for a pathogen

to figure out where it originated from

and how it evolved

– [Dr Hextall] The Durban
cluster is highly divergent

– What they're talking about there

is the virus has mutated so much

that it looks very different
to the original strains

– We have a new R-naught, Ellis

It's not two anymore

– And then we hear that
the R-naught has changed

It's not two anymore, and
that can definitely happen

during the course of an epidemic

The R-naught can increase and decrease

Ideally it decreases because
of all the interventions

you're putting into place,
like physical distancing,

health education,
development of a vaccine

Those things drive the R-naught down

– We tried using dead virus combined

with several adjuvants
to boost immune response

– [Dr Cheevers] And?

– No protective antibodies,
lot of dead monkeys

– So here the researchers
are failing in their attempts

to produce protective
antibodies to the virus

A live, attenuated virus is a virus

that's still alive, but
one that you've tweaked

so it can't be as potent

– Combined with several
adjuvants, adjuvants

– Adjuvants are chemicals that we add

into vaccines to stimulate
your immune system

so the vaccine works

At this point, with SARS-CoV-2, it's way

too early in the vaccine trials

to say whether any of
those experimental vaccines

actually work and produce
protective antibodies in people

[contemplative music]

By day 26, the world is staying at home

[suspenseful music]

This scene just shows a bunch of places

that have emptied out

Which kind of feels a bit overly familiar

with what we're going through right now

[contemplative music]

– [Announcer] As the death
toll in the United States

is now believed to have
reached 25 million,

the president issued a statement today

from an undisclosed location

– By day 29, in the Contagion timeline,

MEV-1 has killed 25 million
people in the United States

But, in real life, by day
29 of the COVID-19 pandemic,

there hadn't been any reported deaths

from the virus in the US

And the current projection
is that the virus could kill

between 100,000 to 240,000 Americans

Some early models suggested that COVID-19

could kill more than 2
million Americans in a year

if no measures were taken to
stop the spread of the disease

[contemplative music]

– If we even had a
viable vaccine right now,

we would still have to do human trials

and that would take weeks

– So the movie here portrays
quite well, I think,

the disconnect between
scientists and the government

– Then we would have to
get clearance and approval

to figure out manufacturing
and distribution

That would take months

– You see scientists working tirelessly

to develop a vaccine
while government officials

just don't understand that
it takes a really long time

to develop new vaccines

– Homeland Security wants to know

if we can put a vaccination
in the water supply

like fluoride, cure everyone all at once

– I'm going home now, Ellis

– And I have never heard of a vaccine

being put in a water supply

We are seeing that, with
this emergency of COVID-19,

that with some expirimental vaccines,

that whole testing in animal stage

is being skipped and we're going straight

to phase one trials in humans

[suspenseful music]

In terms of a researcher
acting as a human test subject

for a vaccine, it could happen,

it's pretty unusual, though

In the movie, the FDA
fast tracks the approval

of the new vaccine

– [Reporter] The Food
and Drug Administration

is accelerating approval
of the MEV-1 vaccine,

currently in production
at five secret locations

in the US and Europe

– This can definitely happen in real life,

both with a new vaccine
or with new treatments

If the FDA believes
there's a real need to,

it can fast track approval

In the movie, and this is very Hollywood,

the timeline jumps from day 29,

when the researcher is
acting as a test subject,

to day 131 when magically this new vaccine

is being distributed to many people

And I think this creates a
lot of false expectations

and false hope around the development

of a COVID-19 vaccine

There are ones being developed now,

even some that are being tested in humans,

but it's still too early to say

when a vaccine would be available

[suspenseful music]

I love how they end the movie

I think, to me, it's
the most prescient part,

showing the transmission of this new virus

from a bat to a pig and then to humans

This is probably really close

to how we're thinking
about the transmission

of SARS-CoV-2, probably from bats

to some intermediate
animal, maybe a pangolin,

and then from that animal to humans

and then, of course, from one human

to another until it's
spread around the world

[contemplative music]

In the end, there is a
lot of truth, I think,

in the Contagion movie in terms

of how a pandemic might play out

across the world and in the US

But, as you can see from
watching this video,

there's a fair amount
of Hollywood liberties

taken as well

I think some of the things that the movie

did not predict were the lack

of personal protective equipment

available in developed nations
like the US and the UK

And, of course, the movie, like so many,

focuses entirely on the United States,

doesn't give us a really good grasp

of how the pandemic plays out

in different parts of the world

So did I miss any scenes
that you're confused about,

or do you have any questions for me

about what it was like doing that job?

If so, please leave your questions here

in the comments section or
reach me on social media

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