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Infectious Diseases Hollywood-Style

Written by Samantha Elliott, Assistant Professor of Biology

The single biggest threat to man’s continued dominance on the planet is the virus.  − Dr. Joshua Lederberg, biologist and Nobel laureate

Swine flu. SARS. West Nile. This quote from the opening scene of the 1995 movie “Outbreak” could describe any of these recent health scares. With such real-life fodder for screenplays, it is no wonder that Hollywood is fascinated by infectious diseases. From “The Last Man on Earth” in 1924 to “I Am Legend” in 2007, the theme of epidemics that cause devastating illness and death has resonated with audiences. But how scientifi cally accurate are these movies? I sat down to watch the movie “Outbreak” to find out.

“Outbreak” is a biological thriller that deals with the lethal spread of a fictional virus called Motaba, which causes hemorrhagic fever. Motaba is based upon a real-life virus called Ebola. The pictures of Motaba in “Outbreak” are actually the Ebola virus. Ebola was fi rst discovered in Africa in the late 1970s, when epidemics occurred in Sudan and Zaire. However, how Ebola naturally existed remained elusive until it was discovered in monkeys imported from The Philippines at a quarantine facility in Reston, Virginia, in 1989. The natural host for Ebola in Africa appears to be bats.

Viruses like Ebola that rapidly kill their hosts are considered to be rather new infectious diseases in that species—they have not evolved to co-exist with their new hosts without killing them. In “Outbreak,” Motaba is being developed by the military as a biological weapon because of its lethal nature, and so we spend much of the movie watching the conflict between the lab scientists (led by Dustin Hoffman), who wish to cure the disease, and their military bosses who want to keep the technology for governmental gain (led by Donald Sutherland).

Early on, we see a series of laboratories where scientists in starched white lab coats are working on different projects for the military. Those spotless lab coats make it clear that they have never been used. My own lab coat is rather wrinkled and spattered with the brightly colored dyes that I use in my experiments.

I was happy, however, to see that “Outbreak” shows teams of biologists rather than an isolated person working in the laboratory. The stereotype of a scientist is someone who is an anti-social nerd, working alone in the laboratory and cooking up experiments like Gene Wilder in “Young Frankenstein.” In actuality, as technology advances we become more specialized, and it is necessary to recruit multiple biologists to work on a single project. Also, because science requires peer review in order to receive funding and publish results, it is impossible to work in true isolation.

The opening scenes of “Outbreak” illustrate the four biosafety levels that determine what laboratory precautions are taken when working with infectious microorganisms. I cringe a bit at the people moving between laboratories while wearing gloves. If these scientists were indeed working with something infectious, they would have spread it throughout the building with this behavior. However, the main ideas are correct—as the biosafety level increases, the precautions in the lab increase. Instead of merely gloves, scientists don masks and use special equipment to protect them from their research subjects.

Ebola and other hemorrhagic viruses are indeed among the microorganisms used at Biosafety Level 4. This requires scientists to don special suits with independent air supplies, and go through vigorous decontamination procedures. As there is no known vaccine or cure and they are highly infectious, a small amount is enough to cause illness.

In “Outbreak,” Motaba infects humans by exposure to monkeys that have the virus. The route of infection is apparently from saliva since the infected monkey both bites and spits on people who then become ill. As we have seen with swine and avian flu, the same virus can infect different species, so this is possible in real life.

How easily a virus can jump between species depends on similarities in terms of the route of infection and the cells that the virus infects. Cells in pigs and humans have enough similarities that swine flu can infect people, and vice versa. Avian flu has a more difficult time directly infecting people, and if it does, it cannot easily initially spread between humans. It must mutate in order for this to happen. However, because pigs can be infected by  flu viruses from people and birds, they act as a mixing reservoir for different viral strains. If a swine or avian flu hybrid virus manages to infect people via pigs, an epidemic is likely because it introduces a completely new virus to the human population.

This real-life example parallels the movie when Motaba jumps from monkeys to people and causes an epidemic because humans do not have immunity to this new virus. However, based upon the structure of the virus, Motaba/Ebola will never have the ability to mutate in the same way as influenza.

The biggest plot twist in the movie is when Motaba mutates and spreads through the air. While this is great storytelling, it is not likely to happen in real life. Viruses are often very specialized in terms of how they infect their hosts. They will usually infect very specific cells of the body. Switching from a virus that infects via bodily fluids to one that infects via the lungs is not likely.

How they find the cure − and find it so rapidly − is also unrealistic. In one scene, the scientists on Hoffman’s team determine that the virus has mutated by looking through a microscope. This is completely inaccurate: a microscope would never detect such a thing. However, it was probably chosen because microscopes are easily identifiable by the general public and can create a picture that the audience can understand. Furthermore, once the infected monkey is caught, the cure for the virus is miraculously attained within days. In reality, it would take months or years to manufacture such a cure, if one was even possible.

Why, you may ask, did they find a vaccine for H1N1 so quickly then? The difference with H1N1 versus something completely new is that we’ve been making the flu vaccine for years. Yes, the H1N1 strain is new, but the scientific knowledge on how to make that particular vaccine is not. A new virus, like in the movie, would take a very long time to delineate the immune response, figure out what proteins to use for the vaccine, and then test it to make sure it’s effective.

“Outbreak,” like many movies, sacrifices scientific accuracy to tell a good story. Overall, however, real biological findings are the basis for the screenplay. While some of the details are sensationalized for the sake of the plot or simplified for the general public, the basic premise is accurate.

The largest fallacy in the movie revolves around the likelihood of finding a cure or creating a vaccine. For any one infectious disease, this encompasses many years worth of effort and testing and may ultimately not be successful.