Flu Season and Fiction: What <i>Downton Abbey</i> and <i>Contagion</i> Tell Us About Facing Reality

With flu season now officially underway across the country, according to The Centers forDisease Control, it is appropriate to reflect on the notion that Hollywood's Academy Awards madeno mention recently of the movie Contagion, just as PBS ended season two of itsacclaimed series Downton Abbey with the penultimate episode about the1918 Spanish Flu.

As a public health researcher who studies epidemic preparedness and a fanof Downton Abbey, I was especially nervous when the teaser announced thatthe the program would feature a visit of the Spanish Flu to the Crawleyestate.

I was also curious about the portrayal of medical care. The one doctor remaining inthe area after Downton's conversion from a wounded soldier's infirmary didnot impress me with his medical competence. Having seriously misdiagnosedthe paralysis of Downton heir Matthew Crawley and the self-destructivedepression of a wounded soldier, he appeared to be unqualifiedlyself-assured, inflexible and snobbish. If he remained healthy as theepidemic spread, he would undoubtedly be overwhelmed by needy patients.Certainly, he would respond immediately to the aristocratic members of theCrawley family, but would he also minister as carefully to their servantsand village folk?

As it turned out, I needn't have worried. About the only realistic factsassociated with this portrayal were that the disease was an unpredictablerespiratory illness, and that, unlike most influenza, the largest numberof deaths inexplicably occurred among the healthy young adult age group.Hence Lavinia Catherine Swire, fiancée of the designated male heir, diedwhile the Countess and butler recovered.

While there were reports of other maids being sick, there was no mention of their suffering. Life atDownton was only nominally disrupted; the wedding was reluctantlypostponed perhaps in part because there might be a shortage of healthyservants to attend to their guests. Alas, the wedding became a moot issuewhen the prospective bride suddenly succumbed to the disease. She diedlooking gorgeous even if pale and gasping for breath as she spoke to herfiancé. He sat by her side holding her hand while others stoodnearby -- all apparently oblivious to the possibility of infection.

Ironically, the Countess, who in one scene appeared to be near death, didnot look quite so lovely. She was seen bleeding from the nose andappearing to vomit. Contrary to expectations, however, she pulledthrough and none of her attendants got sick. Similarly, the doctor made apoint of visiting the servants who were ill.

Thus, the show, whose storylines revolved around social class distinctions, made no reference tothe particular difficulties experienced by the poor and working classes inaccessing medical services, receiving help during their suffering, andavoiding destitution when they had no income because illness kept themfrom working.

There was still drama aplenty in the script, but it came primarily fromthe viewers' fear for the characters rather than the fear of thecharacters for the disease. This too was unreal. In his monumental bookon The Great Influenza, John Barry writes: "There was terror afoot in1918, real terror. The randomness of death brought that terror home. Sodid its speed."

The public could trust nothing and sothey knew nothing. So a terror seeped into the society that prevented onewoman from caring for her sister, that prevented volunteers from bringingfood to families too ill to feed themselves and who starved to deathbecause of it, that prevented trained nurses from responding to the mosturgent calls for their services. The fear, not the disease, threatened tobreak society apart.

The Downton Abbey episode stands in sharp contrast to the docudramapresented in the 2011 movie Contagion. The fictional, but credible andfrightening, film version of a future pandemic did not attract a largeaudience.

Certainly, art need not imitate life even when a story's plot depends upona major historical event. The British television drama sought toentertain effectively allowing us to ignore the realities of the diseasethat ravaged the world in the early 20th century. PBS frequently presentsexcellent informative and educational programming about current issues,although few of these attract a viewership as large as Downton Abbey. Itis ironic, if not surprising, that Hollywood, whose primarily goal is toentertain, could not attract a large audience to a realistic movie thateducated viewers about a potentially serious threat to modern society.

From the perspective of the viruses, not much has changed from the time ofDownton Abbey to the near future of Contagion. Medical care and medicinehave indeed advanced, but the increase in world travel and human contactwill tax our capacity to treat those suffering from an unknown virus forwhich we have no vaccine and possibly no wholly effective treatment.

We have no way of assuring that the present income gap will not make it moredifficult for the poor, the unemployed, and those in medically underservedcommunities to access medical care and support services. That we havethus far been lucky does not mean that every contagious disease will bemild or containable. In a crisis we cannot expect that all the planningwill work as expected.

Americans understandably preferred the pure fiction of Downton Abbey asthey were reluctant to find reality of Contagion entertaining. We musthope, however, that if life imitates art and confronts us with a noveldeadly pandemic, we will do more than sit back and watch for a happyending.

Leslie Gerwin is Associate Director, Program in Law and Public Affairs,Princeton University; she teaches Public Health Law and Policy as anAdjunct Professor of Law at the Benjamin N. Cardozo School of Law.