It's a classic Hollywood tale: scientists race against time to decode a killer virus that is spreading across the world. But the scientist who advised Oscar-winning director Steven Soderbergh on his new thriller, Contagion, says the events and themes of his latest film carry a very real warning for our times.
Dr Ian Lipkin, professor of epidemiology, neurology and pathology at New York's Columbia University, was recruited as a senior technical adviser on Soderbergh's blockbuster. The film, which opened in cinemas on Friday, charts the emergence of a deadly infectious disease that ignites a pandemic.
Scientists are first alerted after Beth Emhoff, played by Gwyneth Paltrow, becomes sick after returning from a business trip to Hong Kong and dies two days later. As the virus quickly spreads and the death toll rises, it is down to a team of scientists – including Dr Erin Mears, played by Kate Winslet – to decode the virus so that a vaccine can be produced.
According to Lipkin, the plot is anything but unrealistic. Virus outbreaks are an increasing threat in the 21st century, he says, because of greater international trade and travel, urbanisation, loss of wildlife habitats and inadequate investment in infrastructure for surveillance, vaccine production and distribution.
"Scientists have been accused of overreacting and crying wolf over the threat of virus outbreaks after the influenza pandemic of 2009," Lipkin told the Observer. "Sars [Severe Acute Respiratory Syndrome] didn't progress beyond a few locations, but outbreaks and pandemics will occur and we need to get our heads out of the sand and realise the real risks that we face. More than three-quarters of all emerging infectious diseases originate when microbes jump from wildlife to humans.
"Our vulnerability to such diseases has been heightened by the growth in international travel and the globalisation of food production. In addition, deforestation and urbanisation continue to displace wildlife, increasing the probability that wild creatures will come in contact with domesticated animals and humans."
Lipkin says societies need to be more proactive in combating the dangers. "People need to understand that science is critical to address these kinds of challenges and respond in real time," he said. "We need to be prepared. We need better bio-surveillance, with better detection and better ability to develop vaccines. However, our public health system is underfunded and overwhelmed, and we need more scientists."
Lipkin added: "When I was a kid, the launching of Sputnik made us aware that the United States was falling behind the Soviet Union in the race for space. Now all of us are in a battle that is potentially devastating, only it is not against another country but against microbes."
In Contagion, Soderbergh draws on real-life disease outbreaks, including the 2003 Sars epidemic, which started in Hong Kong and spread to 37 countries, infecting more than 8,400 people and causing 916 deaths.
Lipkin assisted the World Health Organisation and the Chinese ministry of health in managing the Sars outbreak, at some personal peril – he became ill and was quarantined on returning to the US.
"The events portrayed in this film are based largely on real experiences," said Lipkin. "For example, there are scenes in the movie where at the height of the pandemic the streets are deserted, there are food and supply shortages and political instability, and this directly comes out of my vivid memories of what it was like in Beijing during the Sars crisis.
"I was also able to advise actors from personal experience what it feels like to be quarantined – an eerie experience where you are behind glass and cut off from loved ones."
Lipkin is one of the world's foremost microbe hunters and over the past decade has identified more than 400 new viruses. But unlike British cosmologist Dr Martin Rees, who controversially predicted in his book Our Final Hour that civilisation had no more than a 50% chance of surviving until 2100, Lipkin is an optimist.
"Since the Sars outbreak, there has been increased investment to look at wildlife around the world and there is better integration between the different public health agencies both nationally and internationally," Lipkin said. "So there is reason to be optimistic, and I believe we can address the problems.
"We are one world – humans and animals – and we need to take care of one another. We also, for example, need to insist that people move away from technologies that slow down the production of vaccines so that we can develop a vaccine in three months instead of six."
Contagion pays tribute to the scientists and public health officials who dedicate their lives to trying to solve the problem of emerging viruses. Winslet's character is based on Italian scientist Carlo Urbani, who was the first to identify Sars and became infected with the disease while treating patients and died aged 46, leaving his wife and three children.
"The most moving portions of the film were those where I saw people who were very similar to people whom I've known, people who didn't have well-known names, who died in the service of science and public health," said Lipkin. "The film is in some ways a living memorial to them."
Contagion may only be a film, but can scientists handle the real-world threat of a global flu pandemic?
By Phil Robinson for MailOnline
Updated: 23:17 GMT, 22 October 2011
How does the movie industry celebrate the start of the flu season? By releasing a film suggesting we're all about to die. The problem is, they might have a point
Scientists can't predict which type of flu will emerge, and don't completely understand why we have a flu season at all
The elegant American executive is playing dice in a bustling Macau casino. She tosses back her long blonde hair and jokes with the locals, who show her where to place her chips. The atmosphere is one of exotic glamour, but tonight there’s a killer in the room.
A new life form, born in the bloodstreams of diseased jungle animals, is being passed through the crowd by an unwitting human host.
Unseen and silent, it moves from person to person, transmitted by the most casual of contacts: residue on a lift button, a drink from the wrong glass, the brush of a stranger’s hand.
Soon the woman begins to experience symptoms akin to flu. Twenty-four hours after exposure to the virus she is reunited with her husband and son and promptly suffers a seizure; she drops to the kitchen floor to dance a silent jig. Her son watches terrified while his horrified father calls an ambulance. An hour later the woman lies dead on an emergency-room trolley. A day later her son joins her, killed by the embrace of his own mother.
A post-mortem of the woman shows encephalitis, brain swelling, brought on by the virus. Shocked doctors immediately send samples to the CDC, the Centre for Disease Control in Atlanta. As they run tests, the number of victims grows – two becomes four, four becomes 16, 16 becomes hundreds, hundreds become thousands.
The virus spreads through coughs and sneezes, and jumps to the hands and mouths of the uninfected because the microbes cling to door handles and light switches. In a matter of days the contagion is spreading around the world.
There is no cure.
Within weeks scientists have identified the genetic make-up of the virus. Desperate work begins to formulate an anti-viral vaccine. Over the next six months hospitals resemble scenes from wartime; stadiums fill with the dead and society itself begins to break down.
Fear and misinformation are rampant. Mobs burgle houses in quarantined areas and fires burn untended. All the living can do is wait…
This hypothetical scenario is at the heart of the most unsettling film of the year: Contagion – a hyper-real disaster movie starring Gwyneth Paltrow as a ‘super spreader’ who brings a virus back to the U.S. that kills hundreds of thousands. Directed by Steven Soderbergh, the all-star cast also includes Jude Law, Matt Damon, Laurence Fishburne, Marion Cotillard and Kate Winslet. The film is being released at the start of the flu season.
Contagion is the most unsettling film of the year - a hyper-real disaster movie about a virus brought into the U.S. that kills hundreds of thousands
The premise of Contagion might seem alarmist, but the scientific world has praised the film’s accuracy. Virologists working for the production went as far as designing a new, biologically possible super-contagious pathogen, scientifically linked to the Coronavirus (strains of Coronavirus cause contagious respiratory viruses such as SARS and the common cold).
As Soderbergh has claimed: ‘This film could do for elevator buttons and doorknobs what Jaws did for going to the beach.’
The chilling truth is that the events in the film are all scientifically plausible, even probable. Experts around the world are watching the world’s hospitals, as well as the planet’s animal populations, hoping to catch the next pathogen before it jumps across to human beings. But they are aware that a pandemic is inevitable.
Each year doctors battle a new subtype of influenza, thrown up by the biological lottery caused by mutating flu strains and even the last year’s immunisation programme.
The fact is that scientists can’t predict which type of flu will emerge, and don’t completely understand why we have a flu season at all. In the worst example to date, an outbreak of Spanish Flu in 1918 caused 50 million deaths, but common seasonal flu itself kills up to half a million people around the globe each year.
‘Over the past ten to 20 years, the frequency with which we are seeing reports of emerging infectious diseases has increased dramatically,’ says W Ian Lipkin, an American professor of epidemiology, neurology and pathology, who advised on the film.
‘Factors which have contributed to this include the movement of people into areas where they’re coming into contact with animals they didn’t previously see, and change in the climate that can redistribute biting insects, giving them the capacity to bring viruses into areas that are more temperate. In addition to people, we also have the movement of products all over the world.’
In London, Professor John Oxford, a world-renowned virologist, is more emphatic.
Asked if he believes if a widespread and fatal pandemic is likely, he states: ‘I do. If you ask a geologist if he or she thinks a fatal volcanic eruption is going to come, the answer is going to be yes. If you ask me as an influenza virologist whether we are going to have another outbreak?
'Well of course we are, it’s just that I don’t know when. It’s best to have a sign stuck in the sand, and my sign says, get yourself ready for 2016 or 2017.’
Directed by Steven Soderbergh, the all-star cast of Contagion includes Jude Law, Matt Damon, Gwyneth Paltrow, Laurence Fishburne, Marion Cotillard and Kate Winslet (pictured)
Near the main building at the Royal London Hospital, Whitechapel, a separate annexe is home to a brightly lit, immaculate quarantine unit. It’s here that Professor Oxford and his staff of 30 deliberately infect young, healthy volunteers with influenza.
Test subjects can remain in this facility, owned by UK company Retroscreen, for up to two weeks in 20 modern white rooms, equipped with TVs and en suite bathrooms. People taking part in the studies are in the 18 to 45 age range, though tend to be mostly students and people travelling in their twenties and thirties; they are paid from £1,500 to £3,500 depending on the study.
When they arrive, patients lie on their beds and tilt back their heads while a doctor drips a solution laden with the virus into the nose. Every day, nurses (immunised and wearing protective masks) return to wash out their subjects’ noses, take temperatures and fill out diary cards. Even patients’ handkerchiefs are collected and weighed to monitor the strength of the virus.
All the data is scrutinised in Professor Oxford’s lab. For all the frenetic activity of microbes within it, this is a quiet and calm environment. Viruses are studied inside large safety cabinets so as not to risk infection. The key focus of his work is to study how the diseases spread through people. He and his team are important contributors to VIRGIL: the European Vigilance Network for Management of Antiviral Drug Resistance.
‘What we see are the effects of the virus,’ he says. ‘We grow layers of human cells on plastic dishes, and add the virus.
'Within three days the healthy cells will start curling up and you can quantify how much virus you have by how many destroyed cells there are on the plate. You can see the activity but not the viruses themselves.’
His doom-laden prediction for a pandemic so soon is chilling news, especially for those still quaking after exposure to Contagion – where our survival as a species rests on a small team of CDC scientists in America. In reality, however, we aren’t completely outgunned.
‘The fact is,’ says Professor Oxford, ‘there are probably 50,000 dedicated people around the world who are on the lookout for these new infections. That’s their entire job, and they bear a huge responsibility. We depend on these people to stay alert to new infections, to alert everyone else that something is happening.
‘Quietly working day and night, this network of virologists is constantly on the look-out for something unpleasant, and reacting and telling us about it so that the whole world can react. If there is an infection anywhere, pretty soon it can spread to the rest of the planet.’
Each year doctors battle a new subtype of influenza, thrown up by the biological lottery caused by mutating flu strains and even the last year's immunisation programme
One of the scientists at the vanguard of the fight is biologist Nathan Wolfe, head of Global Viral Forecasting (GVF), who was another adviser to Soderbergh. Wolfe and his staff are funded by bodies as diverse as the U.S. Department of Homeland Security and Google, and work in the dense jungle of West Africa.
It is here in remote, poverty-stricken settlements that animal pathogens are most likely to make the jump to human beings. Wolfe says he uses these high-risk groups ‘like canaries in the coal mine’ because they are likely to be the first to be infected by any new strains of monkey pox, Aids or bird flu.
The main cause of the problem here is humans eating the meat of infected chimpanzees, the Ugandan equivalent of venison. Such bush meat is a major source of both nourishment and deadly infection. While human hunters sell chimp carcasses at market for $20 a throw, chimpanzees have also been known to grab children from the villages, kill and eat them – which can move human viruses back to the monkey population.
Villagers will butcher chimps in the open. This provides microbes with the opportunity to jump back and forth between people and monkeys. Wolfe, author of new book The Viral Storm, describes this set-up as ‘the perfect recipe for pandemics’.
GVF has spread sample kits around West Africa in the hope that hunters and butchers will test themselves. The results, analysed in local laboratories, give Wolfe and GVF some idea of which strains are evolving.
His own research has shown that primates (which make up just 0.5 per cent of the animals on the planet) actually seed 20 per cent of all infectious human viruses. Our shared heritage means that viruses that evolve in monkeys are a particular threat to us.
‘As we move animals quickly and efficiently around the world, microbes that have never encountered each other until now will form new mosaic agents capable of spreading in ways that neither of their parents could manage. In short, we’ll experience a new wave of epidemics.’
In 2004, a re-emergence of bird flu in humans arrived in Hanoi and Ho Chi Minh city in Vietnam – which, happily, is where Oxford University’s Dr Jeremy Farrar has spent the past 16 years.
‘Thankfully we’d got ourselves ready for SARS, which had been the year before,’ he says.
‘When we first saw the cases, we thought it was SARS again – the clinical picture looked very similar. It’s actually not possible to tell the difference at that stage. It wasn’t until we did tests in the lab that we could tell the virus causing the infection was a new type of influenza.’
The contagion that keeps most scientists awake at night is still a new variant of H5N1, otherwise known as bird flu
Dr Farrar and his team soon established that while the influenza was ‘very nasty’, it didn’t carry the same ability to pass from one person to another that has seen SARS kill healthcare workers in Hong Kong, China and Vietnam and Toronto.
While bird flu remains a sporadic infection, Dr Farrar, who runs the Vietnam Initiative For Zoonotic Infections, aims to understand how the viruses leap from animals to humans. Do they change in the animals then cross? Or do they cross to humans then cross back? It’s this constant viral chatter that must be understood.
‘Bird flu is still circulating in poultry in south-east Asia and in wild birds. If it mutated, if it joined with another virus and acquired the ability to go from human to human then it could be a very nasty infection. It does seem to have gone off the radar at the moment because of swine flu, but bird flu still has the capacity to become a global problem if it were to change. ’
Watching the information gathered by scientists like Dr Farrar are a host of doctors, virologists and epidemiologists around the world.
In Britain there are laboratories at most major universities, as well as those overseen by the Health Protection Agency (including Porton Down and the Centre for Infections at Colindale).
Scientists from the UK also staff the European Centre for Disease Control (ECDC) in Stockholm. The ECDC conducts surveillance of various viruses that might threaten Europe. It provides early warnings and helps countries respond.
Dr Angus Nicoll, head of influenza co-ordination at the ECDC, is currently in Greece to advise southern European nations on the role of intensive care units in the response to a pandemic. One of the main dangers of the constantly evolving flu virus is that it mutates beyond the reach of existing vaccines.
In other words, we are caught in a race against time to get information about these evolving viruses into laboratories so that virologists can continue to adapt our anti-viral response.
‘That’s what we did in the (swine flu) pandemic,’ confirms Dr Nicoll. ‘We were very lucky because it affected the United States first and then the UK. Influenza viruses generally spread through Europe from west to east. We don’t really know why, but we use the fact.
'Each season we look at the first outbreaks – commonly in countries like Portugal, Ireland and the UK, and quickly transmit those analyses to the countries likely to be infected later. The first outbreaks of the season are big news for us.’
If the virus turns out to have a mean streak, is there a castle wall we can build?
‘Well, the world is porous. Mother Nature is the biggest bio-terrorist around. The idea that you can shut out all viruses is a non-starter.
'There are some virus infections that you can contain by immunisation or by quarantine – the old example of that is smallpox – but when it comes to highly infectious diseases like influenza and measles, you don’t even know that a person has got it when they transmit it to you.’
The contagion that keeps most scientists awake at night is still a new variant of H5N1, otherwise known as bird flu. And what is the answer to the next deadly pandemic when it emerges?
According to Professor Oxford, it’s very simple. We need to be cleaner.
‘We can build up the stockpile of (anti-virals) Tamiflu and Relenza. And there are quite a lot of new drugs in the pipeline. I think by 2016 we should have some of these ready. But one of the most important things we can do is to educate people about hygiene. ’
So as you head off to watch Contagion at the cinema, bear in mind that over half the population don’t wash their hands at all. Be careful who you sit next to.
Just ten weeks to kill 750,000...
HOW A PANDEMIC COULD UNFOLD IN BRITAIN
Patient Zero enters the UK. She infects her family, who in turn pass the disease on. As Patient Zero enters hospital, swabs taken from her nose and throat are sent to the Health Protection Agency’s (HPA) Colindale Centre for Infections.
1,000 hospital cases are reported. The HPA declares the bug to be a new strain of flu. A meeting of COBRA convenes. Schools are closed. Airports remain open.
Supermarkets are shut, emptied by panic buying. Around the country, the toll of the sick and dying leads to a reduction in every kind of service. Public transport grinds to a halt.
The pandemic reaches its peak, with 22 per cent of all the people infected hitting the hospitals. Most infected suffer and possibly die at home. Rubbish piles up by the side of roads.
The first-wave infection is burning out. Many of the 750,000 dead are rolled into mass graves. Those requiring treatment are removed from their homes and held in vast quarantine facilities.
Three to 12 months
The second wave hits. In the 1918 outbreak of Spanish Flu, this wave was the most devastating. In total it was responsible for 90 per cent of deaths in the pandemic.
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