The Missing Nurse: “Contagion” and Public Health

Published in the The Nurse Alliance Roundup on Oct. 29, 2011

A Review of the Feature Film: “Contagion,” by Sasha Cuttler, RN, PHN, PhD and SEIU 1021 Member

Despite the best efforts of overworked scientists and healthcare workers, infectious disease continues to be one of the top causes of death in hospitals around the world. Unless treated within hours of onset, the infection causes death within days. Mortality from the ensuing shock and organ failure is as high as 30%. Hospitals struggle to avert contagious disease while paradoxically creating a central meeting place for humans and microbes. Physicians and epidemiologists become exhausted but continue to seek causes and cures. Sadly, the health system is overwhelmed and the epidemic spreads unchecked. Tragically, this scenario describes both reality and the 2011 film “Contagion”.

The pandemic of “Contagion” presents a nightmare characterized by the absence of public health. Intentionally or not, the film-makers depict an epidemic of disappearing nurses. The most inconceivable feature of “Contagion” is that nurses don’t show up to work because of ignorance or lack of compassion. That is where the film diverges most seriously from our current reality. In the real world, despite the increased risk of work-related transmission, health care workers around the world are valiantly fighting many epidemics. From tuberculosis to SARS to H1N1 to Listeriosis, real epidemics are treated by nurses showing up at work from Malawi to Milwaukee.

As a public health nurse, I remember being asked to assess the health of individuals in home quarantine suspected of having Severe Acute Respiratory Syndrome (SARS). Because the transmission of SARS was not fully clear at that time, I needed to have a protective layer over my clothes and a protective mask. In order to protect the privacy and dignity of the patient, I awkwardly donned the “moon suit” just before entering the home of the patient. While there, I evaluated the current state of health of the patient and asked them to remain in their home and not receive visitors until SARS was ruled out. In addition, the SF Department of Public Health provided trainings and updates to health care workers. Luckily, there were no confirmed cases of SARS in San Francisco. If there were, San Francisco’s proud public health tradition meant that nurses both in the community and the hospital would do the best they can. Just as nurses cared for people with AIDS before and after the occupational risk was identified and quantified. Just as nurses care for the frightened person just told they have tuberculosis. Nurses did not and do not “sick out” or strike to avoid caring for patients. In the film “Contagion” nurses are conspicuously absent. The only nurse that appears is wearing a nun’s habit, falsely suggesting that only a devoutly religious person would care for someone dying from a deadly infectious disease.

The curious parallel to the fictional epidemic is that budgets for public health in general and infectious disease in particular continue to erode as the social conditions that cause disease flourish. Nurses are traditionally educated to focus on the individual or family. Without understanding that racism and poverty cause disease, nurses and doctors may unconsciously blame the victim. Similarly, policy makers and hospital administrators are forced to look at life and death through the lens of the “bottom line” and public health nurses do not bring in enough to pay their salaries.

Public sector workers are now considered one of the causes of the current economic woes. But now that our population ages and as poverty multiplies alarmingly, there is increased pressure on society to do something. The question that is often posed is “Do we cut the budget on containing disease or do we cut the retirement benefits to those who provide the care?” Actually, both disease control and public health employees continue to disappear. The specter of disaster when faced with a new disease is very real.

Ignorance, fear, and laziness as portrayed in “Contagion” do not explain the epidemic of vanishing public health workers. But the paradoxical impulse to blame the victim is unfortunately spreading widely throughout the United States. Irish immigrant Mary “Mother” Jones lost her family to an outbreak of yellow fever. Just as immigrants and public workers are blamed for disease today, we would do well to remember what has been attributed to Mother Jones: “Pray for the dead, and fight like hell for the living”.

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