Contagion – Pearls on Working Through a Pandemic

In Medical Concepts by Nadim LalaniLeave a Comment

Electron Micrograph of H1n1 from the BBC

Unlike my usual posts this one is more ‘medical’ so here’s my disclaimer: the following is my opinion. You need to read around my post and make up your own mind.

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Watched the movie Contagion the other night. Scary stuff. There’s a few things that struck me [other than the mediocre job that the ER doc did breaking bad news].

Most of these killer diseases present with non-specific symptoms.

  • Both SARS and H1N1 present with “flu-like illness” – slam-dunk if you have all the criteria, but most patients don’t have all the findings at the same time. In the movie patients presented with seizures.
  • Influenza presents atypically as high as 50% of the time.
  • This makes it crucial that we are on the lookout – so that we don’t get blindsided like we did with SARS.

We may still be incompletely equipped to deal with a major pandemic.

Administrative Interventions:

  • Thankfully we are more vigilant. [GOC H5n1 info]
  • Reporting seems better as is international and local collaboration.
  • We did a pretty good job about educating the public during H1n1.

Engineering Interventions:

  • Most ER’s are still poorly planned, overcrowded and ideal for ‘super-spreading’ of airborne illnesses.
  • We may not be able to handle the converging masses.

Personal Protective Equipment PPE:

  • I know how to use my fitted N95
  • I don’t know how to use a respirator suit yet [but I see we’re training people]
  • We do not practice disaster plans enough

Public buy-in:

  • People need to get informed
  • Movies like this will add to the lowest common denominator knowledge level
  • We need to modify how we treat animals and how we use land. It seems that there is a need for more efforts into prevention of zoonotic infections.

There will be a lag time for vaccines to be produced.

  • During pandemics, governments have agreements with pharmaceutical companies to produce vaccines. Unfortunately much of this stuff is done by a few overseas firms and takes months.
  • This makes it crucial that people get educated about hygeine, etiquette and social distancing.

There remains the real risk of people losing control and turning into violent mobs.

  • Widespread panic only make things worse.
  • In the movie the army was there – one hopes that they will be able to maintain civility.
  • Again – this requires a concerted effort to practice and plan [by everyone – including the public].

We live in a reality where there is a real threat of someone deliberately using weaponized viruses.

  • Recently the US government censored a Scientific Publication about the successful modification of H5N1 so that it is easily [airborne] transmitted between mammalian hosts. I have to ask what were they thinking? Okay it seems like this particular strain of virus was sensitive to antivirals, but surely these scientists have heard of antigenic shift? What if it got out or into the wrong hands?

Many people think that we over-reacted to H1N1 or that it was all a ruse by big pharma to cash in on vaccines.

Personally I don’t think that we overreacted. H1n1 had features similar to the Spanish Flu, about 15,000 people died including 12 in our province – many who died were young [Try telling their loved ones that we over-reacted]. Even if this wasn’t as bad as they predicted, I like to think that the WHO and our Government learned a thing or two for next time.

There is nothing wrong with being vigilant and conservative – I love saving lives, but don’t relish the prospect of putting my life on the line [as many healthcare workers did during SARS and H1n1] So …

  1. Get educated [here’s a neat infographic on Swine Flu]
  2. Get vaccinated [because influenza can and does kill]
  3. Be part of the solution by having a plan.
  4. Insist on good health for your fellow animals. [WHO and Wiki links on Zoonoses]
  5. Healthcare workers – know your plan and take PPE seriously. Consider specialising in Public Health. [Physicians stop engaging in activity that erodes public trust]
  6. Take pandemics seriously – better safe than sorry.

Here’s some great infographics on these topics from

Nadim is an emergency physician at the South Health Campus in Calgary, Alberta. He is passionate about online learning and recently made a transition into human performance coaching. He is currently working on introducing the coaching model into medical education.