Infectious Diseases in Movies: What They Get Wrong and Right

Calling All Contagion Fans

We’ll start with one of the most recent and popular infectious disease movies: Contagion. This movie, starring Matt Damon and Gwyneth Paltrow, is about a deadly virus spreading worldwide. The Hollywood thriller, released in 2011, grossed 135 million dollars worldwide. The movie tells the story of a global outbreak of a deadly virus and the race to find a cure. Although the film is fiction, it is based on real-world viruses and events. The movie does a pretty good job of depicting how quickly a virus can spread and how easily it can cause panic. It also highlights some ways that public health officials try to contain an outbreak. 

While some critics praised the film for its accuracy, others criticized it for portraying certain aspects of infectious disease outbreaks and investigations. So, what does contagion get right and wrong about these sensitive topics?

First, the film presents a plausible series of events based on what we know about how viruses can jump from animals to humans; these types of diseases are known as zoonotic diseases. The disease starts in a bat which is forced from its home due to deforestation; from there, it ends up in a pig farm where it infects the pigs; these pigs are then used in food. One man preparing one of these pigs for a meal for restaurant patrons is shown not washing his hands while he meets guests in the dining room. From here, the disease is circulated to those who had come in direct contact with him.

When an outbreak is suspected in the movie, the CDC dispatches investigators from the Epidemic Intelligence Service to outbreak areas to try to identify people with this new infectious disease, and it sets in motion disease control protocols to stem the outbreak tide.

However, there are some inaccuracies in contagion regarding the speed of transmission and some of the pathways shown. For example, the film hints that on the day Paltrow contracts the virus, she visits a casino, blows on dice, and touches a bowl of nuts, which become fomites that spread the virus. It’s unlikely that Paltrow would become infected and spread an illness quite as quickly as the film portrays. The time between exposure and being infected with a disease is known as an incubation period. It is common in films to truncate or substantially shorten the incubation time. This can lead to a sense of heightened drama and move the plot along quickly, but it isn’t entirely accurate.

If we think about COVID (everyone’s favorite infectious disease), the average time before transmission typically can occur is about 5-6 days. Influenza or intestinal infections have the shortest incubation periods of infectious diseases, and yet still, a one-day turnaround from infection to transmission to others is more uncommon than not. Aside from that, the way the disease is represented in the movie, transmission via fomite is less likely than other disease transmissions. While it is possible for viruses to be spread via fomites, Paltrow is more likely to contract the virus we see in the film through direct contact with an infected person.

Also, we love the mention of the Ro (r-naught) and PPE (personal protective equipment) used by public health professionals but let’s not get started on the representation of the vaccine development in the film. We also appreciate how social discord is displayed in the face of an unknown disease pandemic. It truly gives a look into the information and misinformation that public health groups face in these scenarios. This is something we recently saw with the COVID pandemic as well.

Overall, contagion offers a realistic portrayal of how an infectious disease could spread globally and highlights the importance of public health measures like vaccination and handwashing. Although there are some inaccuracies, these are mostly minor details that do not take away from the film’s overall message.

Hello Hot Zone

There are also several movies and TV Shows about Ebola. One of them, The Hot Zone, is based on a true story. It is a show based on the best-selling novel by Richard Preston, chronicling the true story of the Ebola virus and its arrival on American soil in 1989.  The book is considered one of the most accurate portrayals of the disease and the investigation process. 

The Hot Zone book was released in 1994, and the show follows the book closely, but some differences exist. The book is more detailed and technical, while the movie is more focused on the human story. The book does a good job of explaining the science behind the disease and the investigation. It also provides a lot of background information on the outbreak.

The show, however, is more focused on human drama. It doesn’t go into as much detail about the science, but it provides a more personal look at what it was like for those affected by the outbreak. While the show is mostly accurate in its portrayal of events, there are some inaccuracies that are worth noting.

The show does a good job of depicting the symptoms of Ebola and how easily it can spread. However, it also gets some things wrong. For example, people infected with Ebola start bleeding profusely from their eyes. While conjunctivitis and other eye infections can occur when someone is infected, it is unlikely blood would gush or spurt from their eyes. Additionally, the show depicts public health officials as heavily reliant on military support during their investigation when the CDC was the lead agency involved. 

The show also depicts the labs in which the infectious disease professionals work, including PPE. Now, as with most films and TV, they try to get the idea behind PPE, decontamination, and more, but it usually just misses the mark. This show, like a few others, tends to make the lab experience more dramatic and also likes to show people going through decontamination processes at the wrong time. For example. a few films and shows tend to show decontamination protocols before they come into the biohazard area rather than as they leave. This would not be a particularly useful way to decontaminate as they would just drag whatever they came into contact with in the hazard area into the public clean space.

The Hot Zone isn’t the only piece Hollywood has made based on Ebola, either.

On The Movie Outbreak

According to many public health professionals, the 1995 movie “Outbreak” is the least accurate portrayal of an infectious disease outbreak and investigation in recent film history. This movie, starring Dustin Hoffman, is an action movie filled with explosions as it focuses on a deadly virus that threatens to wipe out an entire town. It tells the story of a semi-fictional disease (a form of hemorrhagic fever whose symptoms are very similar to Ebola) that breaks out in a small California town.

The disease starts in an African village that is being used by the U.S. military during a war. Upon discovering the disease, the town is bombed in the hope of preventing it from spreading and killing everyone there, including residents and military members. 30 years later, the disease comes back and is rediscovered in this area. The disease finds its way into a host, a monkey in this case (though the monkey shown in the film is not native to Africa at all). This host is then relocated to the United States in some animal smuggling setup. The monkey bites and scratches the pet salesman and the young man named Jimbo, who was organizing the animal smuggling. From there, the disease continues to spread from these two across the country. The way the spillover event is shown is not entirely accurate, but it does present the audience with an understanding of how the disease made its way into humans. Though, other films like Contagion address this spillover in more accurate ways.

While the movie does a good job of depicting the panic and chaos that can accompany an outbreak, it is not so accurate regarding the details of disease control and containment. For instance, in one scene, medical personnel are shown changing in and out of protective gear without properly washing their hands. This would never happen in real life, as even a small mistake like this could spread the disease. In addition, the movie portrays the CDC and government officials as bureaucrats who are more interested in protecting their careers than saving lives. In reality, the CDC is comprised of highly trained professionals who are dedicated to stopping outbreaks before they start.

It also represents the outbreak investigation as a chaotic scenario where everyone is running around, whereas actual outbreak investigations are usually more coordinated and involve much less jumping out of helicopters. Investigations done by public health professionals tend to be very organized and calm while they follow strict protocols and policies. So, while “Outbreak” may not be the most accurate portrayal of an infectious disease outbreak, it is still an entertaining movie highlighting some of the challenges in managing such a crisis. 

What About World War Z & Other Zombie Movies?

World War Z is a zombie thriller based on the 2006 novel of the same name, and it grossed over 500 million dollars worldwide. The movie follows former United Nations employee Gerry Lane as he tries to stop a pandemic that has spread worldwide.  Like many other movies, the virus in the movie is similar to Ebola, but it turns people into zombies.

While “World War Z” is not, by any means, a perfect portrayal of an infectious disease outbreak, it does get some things right. For example, the movie correctly depicts how easily a disease can spread through contact with infected bodily fluids. It also accurately portrays the challenges of trying to contain an outbreak and the importance of quarantine during an infectious disease outbreak. However, the film’s depiction of the virus causing people to become zombie-like creatures is not based on reality.

It also gets some other things wrong. For instance, Lane is shown injecting his vein with a needle full of what he believes is an infectious disease that can “mask” him from the zombies in one scene. Usually, people don’t or would not intentionally infect themselves with diseases. However, in history, this has happened a handful of times; for example, malaria fevers were used to treat syphilis before the invention of antibiotics. We have also seen award-winning scientists give themselves an illness or expose themselves to a pathogen to determine if their theories are correct- like H. pylori and the link to gastric ulcers.

Of course, many movies, and zombie movies, in particular, will show a vaccination being given, and often they show this being given in the vein (similar to how Pitt’s character administers the infectious disease to himself in World War Z). However, vaccines are usually administered orally, intranasally, subcutaneously, or intramuscularly, which is to say they can be pills, sprays, or injections to skin or muscle but not veins.   

Other zombie movies like The Crazies & the 28 Days series usually base their diseases on rabies. Part of the reason for selecting rabies as a metaphorical boogeyman is that it has a high fatality rate and can cause behavioral alterations, such as irritability and rage. However, both movies have some issues, like the disease incubation period is incredibly quick. The Crazies also suffer from presenting disease prevention and control as a very militant process where people are physically torn away from their families. Luckily, we have not seen this being done to prevent disease spread.

Public health organizations tend to rely on information and education instead of brute force when it comes to preventing disease spread. Aside from that, the movie also features some interesting testing protocols at a border to determine if individuals have the disease. They use a thermometer to see if someone has a fever, but they are shown simply jamming it in people’s ears with no time in between patients for sanitation, cleaning, or reusable tip disposal. This would never happen in real life for various reasons, not least of which is how unhygienic that type of thermometer test is.

Of course, there are a ton of other zombie movies out there. Another we can take some time to appreciate is Zombieland. Part of what makes Zombieland such a fun movie is that it is not too serious right from the beginning, and it takes time to add comedic relief. Zombieland opens with an explanation of what happened to cause this zombified apocalyptic future. We are told that someone had a burger that was infected with a “special type of mad cow disease,” which led to them turning into a rage-filled brain-eating machine. Now, it is a movie about zombies, so we certainly are willing to suspend disbelief on that basis alone, but it touches on a disease not commonly used in cinema.

Mad cow disease is actually a special type of disease known as a prion. Prions are unique in that they are directly related to protein-folding processes in the body. This also means that prion-based diseases are usually very slow to develop and are usually degenerative. These diseases can also cause behavioral changes, though we have never seen someone become a brain-eating rage monster from them. The film shows a very short incubation period, like most films due, rather than the decades it would truly take. This isn’t surprising when you consider that films and tv usually have very short periods to tell dramatic and emotionally charged stories to their audiences, so we can forgive the fast turnaround from exposure to full-blown infection in these films.

So, whether you’re a fan of zombie movies or not so much, they can provide some insights into what a real-life outbreak might look like and the challenges of managing them. So, the next time you watch a zombie movie, consider what it might be trying to teach you about the real-world threat of infectious diseases in between the brain-eating scenes.

More Movies

Of course, the list of infectious disease movies goes on and on, especially if you count zombie movies. Here are some honorable mentions:

• Night of the Living Dead (1968)
• The Andromeda Strain (1971)
• Day of the Dead (1985)
• 12 Monkeys (1995)
• Virus (1999)
• 28 Days Later (2002)
• I Am Legend (2007)
• 28 Weeks Later (2007)
• Quarantine (2008)
• Pontypool (2008)
• Pandemic (2016)

If you’re watching any of these and wondering what is based on fact and what is pure fiction, then you could use GIDEON to learn more about infectious diseases.