Pop Culture Broadcasts Fear and Stigma of Viral Hemorrhagic Fevers
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Ask Dr. William Fischer how he felt the first time he was deployed to care for patients in an Ebola outbreak and he will tell you the story of how he left his wedding ring—a family heirloom—with his father, just in case he didn’t make it back. Trained as a pulmonary critical care physician, his perception of viral hemorrhagic fevers (VHFs) was shaped by what he saw and read in popular culture, and he was scared. Yet as soon as he started working, he realized that his fears were overblown; his patients with Ebola virus disease (EVD) were not so different from other patients who are critically ill.
On the latest episode of Transmission Interrupted, NETEC hosts Lauren Sauer and Rachel Lookadoo talked to Dr. Fischer about his experience caring for patients with EVD, Sudan ebolavirus disease, and Lassa fever. They discussed how the fear and stigma around VHFs has been amplified by pop culture depictions of these pathogens. If we can dispel those myths, we can empower communities and health care providers, improve patient outcomes, and reduce mortality.
In the Hot Seat: The Hot Zone and Jack Ryan
Richard Preston’s The Hot Zone: A Terrifying True Story was published 20 years before Dr. Fischer deployed to West Africa to support the international response to the 2014-2016 EVD outbreak. But in 2014, this best-selling nonfiction book about an outbreak of Reston ebolavirus at a primate quarantine facility in Virginia made its way back up the charts, and continues to be a point of reference to Ebola in pop culture.
In 2018, the TV series “Jack Ryan” featured an episode in which terrorists dig up the body of a person who died from EVD and harvest the virus for use as a biological weapon.
Spoiler alert: Both stories got it wrong.
Stanching the “Hemorrhagic” in Viral Hemorrhagic Fevers
The Hot Zone portrays a ghastly scene of blood streaming out of the body, the liquification of organs, and violent hemorrhaging causing patients to bleed out. While some patients infected with VHFs experience bleeding from orifices it is typically seen in only the most severe cases and the volume of blood is rarely great enough to be the cause of death—it is more often caused by multi-organ failure.
In fact, the early signs and symptoms of VHFs are like those of other febrile illnesses, which is what makes it difficult to distinguish. Learn more about the signs and symptoms of VHFs (CDC, https://www.cdc.gov/vhf/abroad/assessing-vhf-returning-traveler.html, Accessed 5/16/2023).
Ebola Doesn’t Come in a Pill
Outbreaks of VHFs, including EVD, usually start with a single spillover event in which a person is infected with the virus through contact with an infected animal. At that point, human-to-human transmission occurs through direct contact with blood, bodily fluids—or indirect contact with contaminated objects—from a person who is sick or has died from EVD. Ebola viruses can also spread through the semen of a patient who has recovered from EVD.
In “Jack Ryan,” terrorists obtain an Ebola virus specimen by digging up bodies of individuals who died from the disease and inject the virus into vitamins or pills. It is true that the level of Ebola virus increases as a patient gets sicker and deceased individuals can have some of the highest levels of virus. But just because viral RNA can be detected in body fluid does not mean it is infectious virus that can be transmitted. Transmission occurs through direct contact with the body or bodily fluids and mucus membranes like the mouth. The idea that Ebola virus can be put in a form that can be ingested is fictionalized.
Learn more about how Ebola spreads (CDC, https://www.cdc.gov/vhf/ebola/transmission/index.html, Accessed 5/16/2023).
Is That What You’re Wearing? Appropriate Personal Protective Equipment
The TV show based on The Hot Zone depicts health care workers wearing positive pressure suits (PPS), a personal protective equipment (PPE) ensemble that prevents air from rushing into a suit if it is punctured. These suits are often used in biosafety level 4 laboratories or special biocontainment units. Most Ebola treatment centers are not set up with the infrastructure to support PPS.
Health care workers in the field wear full PPE, including a coverall, hood, goggles, N95 or higher respirator, and gloves. Developments in Ebola treatment units have improved access between the patient and provider. For instance, the CUBE—a portable, disposable, and low-cost negative pressure unit with transparent walls, one of which is fitted with plastic glove-like inserts—allows health workers to monitor patients and perform routine operations without having to put on PPE.
See NETEC’s matrix for PPE and precautions necessary for different viral hemorrhagic fevers.
The Impact of Popular Culture on Health Care
TV shows and books that dramatize high-consequence infectious diseases like VHFs may make for good entertainment, but the consequences of proliferating fear and stigma are that health care personnel and affected communities are less likely to take action to stop the spread of disease. Whether it is the doctor who does not volunteer to help in an outbreak or a family member who does not report an illness, the health and safety of our global community suffers.
Listen to the episode for more conversation about improving patient outcomes with better supportive care, how a changing climate and social determinants of health like access to care and resources impact special pathogen outbreaks, and why we need to shift our preparedness strategy from a cycle of react and retreat to prepare, respond, and recover.
About the Experts
William A Fischer, II, MD, serves as an Associate Professor of Medicine in the Division of Pulmonary Diseases and Critical Care Medicine at The University of North Carolina at Chapel Hill School of Medicine. He is a Pulmonary and Critical Care physician at the University of North Carolina School of Medicine with expertise in severe emerging viral infections, clinical research, and international health. Dr Fischer graduated from the University of North Carolina at Chapel Hill School of Medicine and completed a residency in Internal Medicine and a fellowship in Pulmonary and Critical Care Medicine at the Johns Hopkins Hospital where he was an Assistant Chief of Service.
Dr Fischer has extensive field experience providing medical care in resource limited settings and was deployed as a WHO critical care physician to care for Ebola-infected patients in Gueckedou, Guinea, the epicenter of the 2014-2016 Ebola outbreak, N’zerekore in response to a resurgence of Ebola virus disease (EVD) and the Democratic Republic of Congo for outbreaks in 2018 and 2019 where he helped launch the use of novel therapeutics and optimized supportive care.
Dr Fischer has active research programs exploring the clinical complications of Ebola virus disease, the prevalence, pathogenesis, and persistence of Lassa Fever (PREPARE study), and serves as one of the principal investigators for an NIH study (PREVAIL IV) evaluating a novel antiviral compound for efficacy in reducing or eliminating Ebola virus shedding in male survivors of EVD. He also has research programs exploring respiratory viral infections in high-risk populations including the elderly and HIV-infected individuals.
Dr Fischer serves as the Director of Emerging Pathogens for the Institute for Global Health and Infectious Diseases at the University of North Carolina School of Medicine. He is also a member of the WHO Epidemic Clinical Management Team, the WHO Antiviral Working Group, the WHO Personal Protective Equipment End-User’s Advisory Council, the WHO Advisory Committee on Infection, Prevention, and Control, and was a member of the CDC Ebola Response Team.
Lauren Sauer, MSc, is an Associate Professor in the College of Public Health, Department of Environmental, Agricultural, and Occupational Health, at the University of Nebraska Medical Center and Core Faculty of the UNMC Global Center for Health Security. She is an Adjunct Associate Professor of Emergency Medicine in the Johns Hopkins School of Medicine, and the director of the Special Pathogens Research Network.
She previously served as Director of Operations for the Johns Hopkins Office of Critical Event Preparedness. Lauren’s research focuses on human-subjects research in bio-emergencies and disasters, in particular, ethical implementation of research and navigating the regulatory environment. The goal of her research is to provide health care facilities with the tools needed to conduct a clinical and operational research response in emergencies.
Rachel Lookadoo, JD, is an Assistant Professor in the Epidemiology department of the College of Public Health at the University of Nebraska Medical Center and serves as the Deputy Director of the Center for Biosecurity, Biopreparedness, and Emerging Infectious Diseases. She also acts as the Director of Public Health Policy for the Water, Climate, and Health program at the University of Nebraska Medical Center.
Ms. Lookadoo’s background is as an attorney, and she focuses on the various legal and regulatory issues that can arise in emergency preparedness and response. She specializes in public health impacts of climate change, healthcare surge events, isolation/quarantine law, crisis standards of care, infectious disease response, and general legal preparedness. Ms. Lookadoo also conducts emergency preparedness trainings and assessments for public health departments and healthcare facilities nationally. Ms. Lookadoo received her Juris Doctor degree from American University Washington College of Law, and her bachelor’s degree from Baylor University.