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Glenn D. Braunstein, M.D.

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Contagions: Reality More Chilling Than Film Fiction

Posted: 10/03/11 06:41 PM ET

A chief health officer from the Centers for Disease Control and Prevention returns to an emergency operations center, feeling confident and relieved after giving a live television interview about a fast-spreading illness. But that calm proves short-lived for as she rejoins her colleagues, ashen and huddled around a speaker-phone, she learns that state health officials are just delivering the word that a pregnant woman is critically and probably fatally ill with the new virus. All who hear the news share a devastating reality: they are in the midst of a real pandemic and no matter what measures they take, what vaccines they distribute, or how many health care workers they mobilize, many people will fall gravely ill; many will die.

This wasn't a scene in the recent blockbuster Contagion, which raced to No. 1 at the box office its opening weekend. The virus wasn't science fiction. It wasn't ebola, one of the scarier real-life viruses that Hollywood often turns to for its plague-fright plots... Nor was it the Nipah virus, the illness that partly inspired Contagion.

This real scene occurred in 2009, and the virus was H1N1 influenza, another of the inspirations for Tinseltown's latest killer-bug flick. The teller of the true story is Anne Schuchat, who related her real-life scares as a top public health official with the Centers for Disease Control. In the American Journal of Obstetrics and Gynecology, she discusses the fright caused by the H1N1 flu strain, which accounted for more than 16,000 deaths worldwide -- a number the World Health Organization calls a "significant underestimate."

You don't need to look far to find real examples of pandemics and their huge tolls. But some of the deadliest diseases wouldn't be considered the least bit exotic by Hollywood screenwriters or even average Angelenos: these would include the flu, measles, tuberculosis and pneumonia, to name a few. It's a chilling fact that often the diseases that we know the most about and have the most preventive measures and precautions for still cause the most carnage.

Unforgettable, Lethal Pandemic

The most deadly of epidemics in the United States was the influenza epidemic of 1918. Before it ended, it killed 600,000 in the U.S. and an estimated 50 million worldwide. It struck in some cases like lightning: victims woke seemingly healthy in the morning and were dead by nightfall. It crept up on others, with some people taking on a bluish cast to their faces and coughing up bloody foam. These victims died slowly, suffocating from the buildup of liquid in their lungs. The epidemic closed schools, theaters and churches. In Los Angeles, merchants were discouraged from conducting sales that drew crowds. Hundreds of thousands of crude masks were distributed -- though, in hindsight, these were ineffective anyhow in stopping the disease's spread. All the public health measures of the era failed. It didn't help that World War I boosterism brought crowds into the streets for rallies, bond drives and parades. They infected each other. Soldiers in crowded transport ships infected each other. The disease raced around the world.

The then-surgeon general uttered a prediction echoed since in dozens of screenplays: "If the epidemic continues its mathematical rate of acceleration, civilization could easily disappear from the face of the earth within a few weeks."

Scientists of that day lacked microscopes powerful enough to permit them to identify the flu as a virus; they theorized they were dealing with bacteria. Today, we know a lot about various viral strains and vaccines to combat them. This year's flu vaccine protects against 2009 H1N1 and two other strains. Even so, as occurred in 2009, influenza still poses a significant health threat.

It's difficult to measure the precise number of people who die due to the flu. Often, many die because the illness aggravates an existing chronic condition -- such as congestive heart failure. Other victims may get a secondary infection or die of another complication. The CDC measures flu deaths in a range, looking back to 1976, and estimates the disease kills 3,000 to 49,000 per year -- which shows the unpredictability of flu-related deaths.

Influenza and pneumonia rank still among the top ten causes of death in the United States. Other communicable diseases garner far more attention -- West Nile, SARS, AIDS -- but kill fewer people. It's crucial to acknowledge these illnesses and to maintain our vigilance in stopping their spread and to continue to seek effective cures and treatments for them.

World Shrinks, Worry Grows

This has grown even more crucial in the globalized 21st century when travel to spots near and close not only comes with ease and convenience but also swift spread of disease vectors. A lawyer from Atlanta prompted an international health scare in 2007 when he boarded a plane with his fiancé and headed to Europe, where they planned to marry and honeymoon. The problem: he was believed to be infected with an extremely drug-resistant form of tuberculosis. When health care officials reached him in Italy, they urged him to turn himself in to authorities there. Instead, fearing he would be quarantined in Italy, he jumped on a commercial flight from Prague to Canada, and then drove to the border, crossing into New York.

Tuberculosis spreads through coughs, sneezes or the spittle in speech by the infected. Putting virulent and drug-resistant bacteria into a cramped, packed plane is not just a made-for-the-movies scenario, it was also why the real scenario created public clamor and concern. Fortunately, no other passengers tested positive; the attorney proved to carry a less serious TB strain than initially believed. That lesser infection still cost him part of a lung and treatment for his form of TB lasts two years.

Worried yet? Here's more to wring your hands about -- how global travel plays a role in the uptick of measles in the United States. Between January and mid-June of this year, 156 confirmed cases were reported to the CDC -- the most in 15 years. Measles is one of the most highly contagious known illnesses and can cause serious illness and death. Most of the confirmed cases were linked to Americans traveling to Europe, Africa and Asia where outbreaks are under way; most of those who got sick were unvaccinated against the disease.

More than 10,000 measles cases and four deaths were reported this year from nations in the European Economic Area as of May 2011, including 7,500 cases in France through March 2011, and outbreaks occurred in 38 other countries including Britain. Switzerland, Spain, Serbia, Macedonia and Turkey. In Africa, measles cases number in the tens of thousands, and deaths in the hundreds, including 29,871 suspected cases in Nigeria and 122 deaths as of April 2011. While those may not write themselves into summer-blockbuster numbers, the mortality and morbidity occurs from a disease "eliminated" in the United States in 2000; public health officials had declared their American triumph, citing the high number of people protected by the two-dose measles vaccine. The increase in cases here underscores the importance of immunizations and the persistent risk of cases carried home as unwanted souvenirs of business or vacation travel.

The World Health Organization has urged proper vaccination for all, especially those planning to travel.

Is this me, once again, prodding people -- young and old -- to get their needed and recommended shots? Absolutely. Scientists know that vaccinations fell after millions of parents refused inoculations for their children with the Measles Mumps Rubella vaccine after an utterly bogus 1998 study in the Lancet falsely linked the shot and autism. In 2000, 72 percent of the world's children received the vaccine. I've written already how that the Lancet study has been debunked as an elaborate fraud and its author Andrew Wakefield had been found guilty of serious professional misconduct, accused of falsifying his data. Levels of MMR vaccination coverage are slowly rising. The CDC urges travelers to be certain they receive two doses of MMR vaccine before their trip; this includes children 12 months or older.

Contagions? Planetary plagues abound, and unlike the smart or silly characters in the movies who can only wring their hands in fear and paralysis, there are things we can do to avert or minimize even the scariest diseases. Practice good hand hygiene. Stay home if you are sick so you don't infect others. And, if there is a vaccine available, get it -- don't rely on everyone else to get inoculated to protect their health and yours.