If its films are any kind of guide, the English-speaking world views the prospect of a pandemic with the fascination of a trapped man watching an approaching snake. There is a sense of horror, of inevitability. Films about epidemics show us people in their thousands (or more) dropping in the streets, social disintegration and approaching havoc. However, there is a catharsis. In many of these films there are heroes or heroines, doctors or scientists, who ultimately save what is left of the human race. Some of these movies, such as John Ford’s 1931 film of Sinclair Lewis’s novel Arrowsmith, were made long ago, but most are fairly recent. Think of the 1995 film Outbreak, starring Dustin Hoffman and Morgan Freeman. Or the 2007 film I Am Legend, starring Will Smith. Or the popular TV series The Last Ship. Or Steven Soderbergh’s gripping 2011 version, Contagion. Soderbergh’s film opens with an American business executive, Beth Emhoff, taken ill on her way home from Hong Kong. She’s coughing and sweating. We see others similarly affected, in Hong Kong, London, Tokyo . . . This is turning into a public health emergency though it is totally unclear how it started, or where, or what is causing it. It is a private tragedy as well. Of course it is many private tragedies, but the film focuses on how Beth’s collapse and rapid death affect her family. Her husband Mitch is at first incredulous, then bereft, then put into an isolation ward, and finally discovered to be immune. The public health side of things focuses on the Center for Disease Control (CDC) based in Atlanta, Georgia, and in particular on an epidemiologist named Erin Mears who has to trace and map the spread of the disease, on her boss Ellis Cheever, and on Ally Hexhall, a virologist who’ll be given the job of identifying the causal agent, which proves to be a virus. The action shifts to Geneva, where the World Health Organization (WHO) is based, and where reports are coming in of deaths and millions of cases from some of the world’s most densely populated metropolises. The WHO, which has developed protocols for dealing with this kind of emergency, is going to send Dr Leonora Orontes to investigate. What precautionary measures should governments be advised to take? Should schools be closed? Is there a risk of panicking people needlessly? How does the virus spread? Epidemiological investigation would have to establish how infectious it is. What kind of virus is it? Is there a chance that a known pathogen (anthrax? smallpox? ‘Bird flu’?) has been turned into a weapon and that this epidemic has been started deliberately?

It’s the work of epidemiologist Mears (out in the field) and of the virologists manipulating samples in their laboratories that forms the core of the movie. Because Mears is able to establish that Beth was ‘patient number 1’, and that she became sick as a result of eating some infected poultry, and because the virologists succeed in identifying and then growing the virus, a vaccine can be made and mankind saved. But this isn’t a documentary, so it’s embellished by a number of dramatic flourishes, some of which point neatly to real-life complications, dilemmas and concerns. Orontes, who is dispatched to Hong Kong, suspects that that is where it all started, but discovers that the authorities are anxious to prevent any such announcement being made. Moreover, plenty of people think there is money to be made. We are introduced to Alan Krumwiede, an influential (but shady) blogger, who claims that there’s a simple, cheap ‘natural’ cure for the disease, which the public health ‘establishment’ and the pharmaceutical industry are keeping secret. They want to develop and profit from an expensive vaccine. We subsequently learn that he is hoping to make money himself from this plant extract. Demand becomes insatiable, and riots break out at drugstores across the USA as people try to get hold of it. There are roadblocks and looting. The impression we are given is that the social disruption caused by the epidemic is at least as serious, and certainly as frightening, as the virus. An epidemiology of fear is evoked. As one of the characters points out, in order to get sick you have to be in contact with an infected person or something that they’ve touched. In order to get scared you just have to get in contact with TV or the Internet.

If this dramatic rendering is compared with the histories of real epidemics—comparisons that characters in the movie often make—it is clear that the film-makers did a great deal of preparatory research. (I wasn’t surprised to be told that that they’d visited the World Health Organization to learn how epidemics are dealt with.) Though the likelihood of an epidemic leading to social breakdown surely varies from one society to another, a documentary about a real-life global epidemic could draw on this account of a fictional one. It is not just that the story is a distillation from real-life happenings. It is also that it provides a script: a resource for writing about epidemics. Nearly thirty years ago the eminent historian of medicine Charles Rosenberg offered a dramaturgical way of writing about epidemics. Inspired by Albert Camus’ novel The Plague (1947), Rosenberg suggests that in the past epidemics tended to evolve in a well-structured narrative sequence. Act I of the imaginary play is a community’s reluctant acceptance and public acknowledgement that disease has struck. Act II, which he calls ‘Managing Randomness’, involves the search for some explanatory framework: a way of making sense of the fact that some die while others survive. It is this framework that can provide a guide to action and to control. In earlier times this framework tended to be rooted in widely held assumptions about proper and responsible behaviour. Then, in Act III, a ‘public response’ is negotiated: a set of ‘collective rites integrating cognitive and emotional elements’. Whether these rites emphasize collective fasting and prayer, or quarantine, they represent an enactment of community solidarity. Finally, in the last act of Charles Rosenberg’s narrative, the number of cases has declined. The epidemic is under control. Some have died and others have recovered. Now there is time for remembering and reflecting, though this can probably be entrusted to the historians. ‘Has a heedless society reverted to its accustomed ways of doing things as soon as denial became once more a plausible option?’ ‘Epidemics’, Rosenberg notes, ‘have always provided occasion for retrospective moral judgment’.² If this was a reflection on an era when there were no virologists, written for an age when time and space hadn’t been compressed to the extent they are today, then Contagion provides us with an update. It offers a way of imagining and writing about epidemics as they evolve, as they spread, and as the desperate search for control—today centred more on the laboratory than on the house of prayer—gathers pace.

Fear

When we are told that some horrific pandemic is in prospect—something like the 1918 Spanish flu that killed tens of millions of people (an estimated 3 to 5 per cent of the world’s population), or that a previously unknown virus has emerged from its remote jungle home (as in Contagion)—we now turn expectantly to virologists like Ally Hexhall and the high-security labs in which they go about their business. An example that hit the news in the first weeks of 2016, and that almost no one who wasn’t a virologist had heard of up till then, is the Zika virus. It was discovered in the Zika forest, in Uganda, by researchers who were actually investigating yellow fever. Both viruses, and that responsible for dengue, are spread by the same species of mosquito, Aedes aegypti. Infection with the Zika virus was nothing to panic about. Although the virus had been found in 1947, the first reported case of someone becoming sick from it was only in 1964. After three days of fever and some aches and pains, the victim had fully recovered. Studies showed that many cases of infection were totally without symptoms. But as the virus was carried further afield its effects appeared to change. Epidemics in various Pacific islands in the early 2000s showed more serious symptoms, in particular Guillain-Barré syndrome. And then it found its way to Central and South America. Evidence began to accumulate that if a pregnant woman became infected her baby might be born with an abnormally small head (a condition known as microcephaly). A significantly higher than usual number of babies have been born with microcephaly in Brazil, where the virus has spread rapidly. Researchers are discovering that it is not only mosquitoes that spread it. Some women seem to have picked it up from infected semen and possibly even from sweat. . . .