Contagion: A Public Health Perspective

E

Eximious

Well-known member
I saw Contagion last night and wanted to take the opportunity to open this thread to people who might like to discuss public health, the CDC, pandemics, etc. I am an MPH candidate at the Rollins School of Public Health in Atlanta, which fellow southerners might know is directly next-door to the CDC. I've created a similar thread over at RedUser, but I suspect we might get a more lively discussion here.

You might not know that Steven Soderbergh and screenwriter Scott Burns worked closely with a well-known epidemiologist (among many other advisers at the CDC and WHO). Their collaboration ensured that while the film wasn't 100% realistic, it was indeed quite plausible (if *knock on wood* unlikely).

You also might not know that this movie was partly financed by Participant Media, a media company founded by Jeff Skoll (a famous social entrepreneur). It was hoped that the film might dispel some myths about public health and introduce people to what organizations like the CDC actually do... while foremost being an incredible ride. I realize that many of us work in below-the-line gigs and don't usually have as much creative control as we might like. However, if you're ever interested in making great drama that also has a pro-social impact, I can direct you to a number of great resources.

So, feel free to ask about public health in general, topics from the movie, or ways to tell a great story while also doing some good for the public's health.

Did you learn anything new or interesting about public health from the movie? Did you enjoy the movie?
 
Oh Contagion's out. I'm in that. I'm the black reporter sitting behind Fishburne in the Senate. (if that made it in). I have yet to see the film though so I can't say anything about it.

-Nate
 
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Here's a question for people: What is your opinion on a) people constantly using hand sanitizer/companies putting automatic sanitizer dispensers in buildings? And b) an automatic soap dispenser for your house?

**The following is my personal opinion and I mean no disrespect to anyone**

I feel that both cases are taking 'cleanliness' to an unecessary extreme. On the one hand, you have people carrying around little bottles of sanitizer and using it whenever they have to come in contact with what they think is dirty; shopping carts, hand rails, door handles. I don't think the human body can/will develop its own natural ability to fight off disease if people are constantly looking for an outside source to rid themselves of bacteria/germs.
On the other hand, you have an automatic soap dispenser for your home. When did this become a world where people are too afraid of whats in their own house. Granted, their are countries/communities where you shouldn't be coming into contact with certain things, but that seems to be limited to third world countries.
I may be wrong, but growing up in the DC area, I played in the mud, crawled in drainage ditches, got my knee banged up on the sidewalk, and I turned out healthy as can be (aside from the smoking, which is where big companies should be turning their money/time to).

All that said, I think the main reason for all the hype is because of commercialization and what can be called 'media frenzy. Big businesses tell you what you 'need,' without even knowing who you are/what you really need.
 
I think you just described fear based consumerism.

Create a market (by invoking fear) and then make a product to fill the void in the new market. It's a brilliant strategy with a heavy price to pay in the long run. IMHO.

Dillon


shyguyfilms said:
Here's a question for people: What is your opinion on a) people constantly using hand sanitizer/companies putting automatic sanitizer dispensers in buildings? And b) an automatic soap dispenser for your house?

**The following is my personal opinion and I mean no disrespect to anyone**

I feel that both cases are taking 'cleanliness' to an unecessary extreme. On the one hand, you have people carrying around little bottles of sanitizer and using it whenever they have to come in contact with what they think is dirty; shopping carts, hand rails, door handles. I don't think the human body can/will develop its own natural ability to fight off disease if people are constantly looking for an outside source to rid themselves of bacteria/germs.
On the other hand, you have an automatic soap dispenser for your home. When did this become a world where people are too afraid of whats in their own house. Granted, their are countries/communities where you shouldn't be coming into contact with certain things, but that seems to be limited to third world countries.
I may be wrong, but growing up in the DC area, I played in the mud, crawled in drainage ditches, got my knee banged up on the sidewalk, and I turned out healthy as can be (aside from the smoking, which is where big companies should be turning their money/time to).

All that said, I think the main reason for all the hype is because of commercialization and what can be called 'media frenzy. Big businesses tell you what you 'need,' without even knowing who you are/what you really need.
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It is already being reported that kids that grow up in homes surrounded by anti-bacterial soap are prone to more illness as young adults specifically because their immunities have not been developed naturally by exposure when they were kids.
 
shyguyfilms said:
I may be wrong, but growing up in the DC area, I played in the mud, crawled in drainage ditches, got my knee banged up on the sidewalk, and I turned out healthy as can be...
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I was all that, plus I grew up drinking raw milk (dad milked for a cousin's dairy next door for extra cash plus milk, so we got it straight from the cow). I *never* get sick, and I credit that a lot to my upbringing (and parents who weren't germ freaks).
 
Excessive Hygiene / Immunology

Excessive Hygiene / Immunology

Although it doesn't directly tie into the movie, immunology is a very interesting discipline within the broader biomedical community. The public health world is concerned about excessive use of hand sanitizers and antibacterial soaps because it does limit antibody development, especially when we're talking about low-severity pathogens and moderately healthy populations. There's literature to support a higher risk of developing allergies if someone grows up in an excessively hygienic environment.

Higher on the priority tree for public health professionals, however, is a related problem: resistant bacterial strains. Antibacterial soaps and kitchen cleaning products do play a role. The larger threat, however, comes from over-prescribing antibiotic regimens and patients' failure to complete the entire regimen.

All that said, the use of hand sanitizer in high-risk times (e.g. flu season) or places (e.g. areas of hyperendemic infectious disease) can be very helpful. Keep in mind that most influenza deaths in this country occur in older or immuno-compromised populations (e.g. people undergoing chemotherapy). So if you, for example, work in a nursing home and it's flu season, you should be taking great efforts to ensure that you are as hygienic as possible. Your skin could be a temporary reservoir for flu droplets you've been exposed to and if you've been infected, most flu strains are contagious days before the onset of symptoms.

Very interesting and important question.
 
Eximious -
You seem to have a background in the subject of immunology, so I have a question that has been bouncing around in my head for many years:
A friend of mine had the flu and I suggested that he start an antibiotic regime. He told me that he didn't want to do that, that he was waiting to take antibiotics until he really needed them - that he didn't want to "use up his immunity." I told him that it is not the person that becomes immune, but rather the strain of flu itself. It does him no good to personally skip the antibiotic (although it would be better for the greater good so that a resistant strain doesn't develop). Is that correct? Although, I admit that it would better for the rest of us if he suffered through it.
 
cyclone said:
Eximious -
You seem to have a background in the subject of immunology, so I have a question that has been bouncing around in my head for many years:
A friend of mine had the flu and I suggested that he start an antibiotic regime. He told me that he didn't want to do that, that he was waiting to take antibiotics until he really needed them - that he didn't want to "use up his immunity." I told him that it is not the person that becomes immune, but rather the strain of flu itself. It does him no good to personally skip the antibiotic (although it would be better for the greater good so that a resistant strain doesn't develop). Is that correct? Although, I admit that it would better for the rest of us if he suffered through it.
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There are a couple of angles to this question. For one, I'm not sure if you meant to say "anti-viral" medication. Since influenza is caused by a virus, antibiotics (which kill bacteria) have no effect. However, many doctors still prescribe antibiotics for virus infections (like flu) due to diagnostic uncertainty / time pressures and patient demand. If your friend had requested antibiotics, his doctor may have obliged to get rid of him, but at best you would've seen a placebo effect.

But if we're talking about anti-virals (which try to slow down the virus) or viricides (which try to "kill" the virus), then the discussion becomes much more interesting (and you're mostly right). It's true that any time you deploy medications against a group of organisms or virions, resistant individuals may multiply and eventually constitute a greater proportion of the overall population. Natural selection. We do it too, after all!

More directly to your question, unless he had a serious case of influenza, there probably wouldn't have been a need for anti-virals (which always risk spreading resistant strains). But your central point, that what's good for him could be bad for society holds some truth. Any individual use of antimicrobial agents could contribute to the "resistant" problem, but it really only becomes a serious issue when abused en masse, as we're seeing today. If someone has a moderate to severe illness, they shouldn't have to tough it out and hope for the best.

Of course, you could look at it from another perspective. If he refrains from anti-viral medication, might he infect other people? Will he miss more work? Who takes care of him? These are all interesting counterpoints to consider. But for the most part, you should probably have a compelling reason to treat less-severe illnesses with antimicrobial drugs. There are, of course, many medications which treat the symptoms of disease. Those medications do not entail these kinds of issues.

Hope that answered your question.

As always, consult your physician for specific medical advice [/disclaimer]
 
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Very interesting, Eximious.
It becomes a question of being good for you and bad for society, since the individual doesn't build up resistance - only the bug does..
 
Really?

Lets get real. Is squirting hand sanitizer on my hands after I take a leak in a public restroom really going to eliminate all airborne germs, bacteria, and even 100% of the clumps and piles of said bugs on my hands as well? No, I don't think so. My immune system is going to suffer? I think not.

Some parents seem to "squirt-up" a lot. I don't disagree. But their kids still get spit on by the loud-mouthed little boy in class who sits next to them. Coughing swirls swarms of bugs into our faces all the time. I think this is all grumbling and nothing more. And patches and drops of sweat, germs and probably little pubic hairs await us on the back of door knobs, game controllers, steering wheels, light switches, etc.

Until people start wearing sanitizing whole-body condoms with a layer of anti-bacterial gel between them and the world I think most of what's said here is just a good excuse to drag out the dusty old "when I was a kid we ate mud..." stories.
 
You make a good point Snazzy. We are constantly surrounded by microbes, even if we use hand sanitizer. It's true that hands are one vector for pathogens to reach us, but aerosols can directly enter our eyes, we can eat improperly prepared food, etc. But if you're interested in this issue, you might want to check out this link to a University of Michigan study that you can find at NIH. Here's one key statement, "In the < 18-year age group, higher levels of triclosan were associated with greater odds of having been diagnosed with allergies or hay fever (p < 0.01)." Triclosan is a widely used antimicrobial agent in anti-bacterial soaps and such (http://ehp03.niehs.nih.gov/article/info:doi/10.1289/ehp.1002883). Of course, remember that correlation alone isn't causality either.

Food for thought, nevertheless.


Snazzy Flapper said:
Really?

Lets get real. Is squirting hand sanitizer on my hands after I take a leak in a public restroom really going to eliminate all airborne germs, bacteria, and even 100% of the clumps and piles of said bugs on my hands as well? No, I don't think so. My immune system is going to suffer? I think not.

Some parents seem to "squirt-up" a lot. I don't disagree. But their kids still get spit on by the loud-mouthed little boy in class who sits next to them. Coughing swirls swarms of bugs into our faces all the time. I think this is all grumbling and nothing more. And patches and drops of sweat, germs and probably little pubic hairs await us on the back of door knobs, game controllers, steering wheels, light switches, etc.

Until people start wearing sanitizing whole-body condoms with a layer of anti-bacterial gel between them and the world I think most of what's said here is just a good excuse to drag out the dusty old "when I was a kid we ate mud..." stories.
Click to expand...
 
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