Knowledge is weapon in fight against silent killers – Commercial Appeal

The first question my friends asked last week after we watched the new movie “Contagion” was: “Can this really happen?”

I should know. I am an infectious disease doctor.

“Not only can this happen, but it could be happening right now,” I said. This is not just my opinion but also that of the Centers for Disease Control and Prevention, the federal agency responsible for epidemic preparedness.

Dr. Manoj JainDr. Manoj Jain

We need only look back at the near misses over the past decade: SARS (severe acute respiratory syndrome) in 2003, H5N1 Avian (bird) flu in 2004 and 2006, and H1N1 (swine) flu in 2009. Each of those real-life viruses had the potential to be as devastating as MEV1, the fictitious virus that in the movie killed millions, shut down the government and quarantined a high school student so she spent her prom night in her decorated living room.

Each year at least one new contagion is discovered. In each century there are two to three influenza pandemics. Much like natural disasters, a major epidemic is a matter of time, and the key to reducing its impact is epidemic preparedness.

So how does one prepare? The CDC, the World Health Organization and similar agencies in other nations are continuously conducting surveillance — hunting for germs and investigating unexplained clusters of illness or deaths. When suspicion arises about a possible contagion, a team of Epidemics Intelligence Service (EIS) officers are deployed, much like CIA field agents, to begin a well-rehearsed process. Their goals are to define the illness; identify the germ; isolate, contain and treat patients; develop a treatment or a vaccine and distribute it equitably. We see this process dramatized in the movie.

I know this because I have been in an outbreak situation at the local level. Some years ago at one of the hospitals, we suddenly began to see an increase in illnesses and deaths due to a respiratory illness among patients from a nursing home. With help from the state health department, we began a 24/7 investigation. Patients at the hospital and nursing home were placed in isolation units, a clinic was set up at the hospital to screen health care workers who showed symptoms, and everyone caring for the ill patients was required to wear gloves, gowns and masks. The CDC flew in an EIS officer and we worked tirelessly following the initial steps of the investigatory process.

In the end we did not identify the virus, but with strict isolation procedures the epidemic died out. That often occurs as the body’s immune system builds antibodies to a virus and there are insufficient numbers of infected persons to spread the contagion.

During the SARS epidemic, an outbreak situation that rose to the global level, I cared for a pilot who was admitted at our community hospital with pneumonia after he had traveled to Hong Kong. Using the CDC’s invaluable guidelines and recommendations, we isolated and treated him and mandated strict protocols for all the doctors, nurses, respiratory therapists and other health care workers who came into contact with him.

Even with those measures, I remember when I went home to my three children in the late evenings, my wife made me change my entire wardrobe in the laundry room before I entered the living areas of our home. An epidemic brings out our deepest fears.

My patient recovered and over the next few months, the CDC, WHO and other agencies successfully contained the SARS epidemic globally.

But it could have easily gone awry. An epidemic is unpredictable — a battle between a mutating virus and 6 billion potential victims. As health writer Bryan Walsh noted last week in an essay in Time magazine, “Unlike a natural disaster or a terrorist attack, infectious disease doesn’t bring us together — it could well tear us apart, because coming together is exactly what would spread the disease.”

So how should this movie change our thinking? At a time when economic and debt crises loom and the nation’s unemployment rate is more than 9 percent, many Americans are calling for a significantly smaller federal government and deep budget cuts. I agree with them somewhat, but I fear that the CDC will be easy prey for such reductions. Since 2005 the agency’s preparedness budget has been already slashed by nearly a third (some $350 million). More cuts may be on the way.

We may recognize the benefits of these tax expenditures for government services only when a crisis arises or a close call is realized. But a Hollywood movie like “Contagion” can effectively dramatize the hidden workings of a virus and how a highly trained and specialized group of government employees fight to contain it.

The possibility of contagion is not sci-fi; it isn’t even a bio-thriller. It is a plausible feature story — much like that of the first days of the AIDS virus in 1981, the year of my high school prom.

Source: Commercial Appeal