The Story of the Deadly Virus

A review of Contagious. Cultures, Carriers, and the Outbreak Narrative, Priscilla Ward, Duke University Press, 2008.

We think containing the spread of infectious diseases is all about science. In fact, more than we care to admit, our perception of disease contagion is shaped by fictions: blockbuster movies, popular novels, newspaper headlines, and magazine articles. These fictions frame our understanding of emerging viruses and the response we give to global health crises. Call it the outbreak narrative. It follows a formulaic plot that goes through roughly the same steps of emergence in nature or in labs, human infection, transnational contagion, widespread prevalence, medical identification of the virus, epidemiological containment, and final eradication. It features familiar characters: the healthy human carrier, the superspreader, the virus detective, the microbe hunter. It summons mythological figures or supervillains from past history: the poisonous Typhoid Mary from the early twentieth century, the elusive Patient Zero from the HIV/AIDS crisis. Through these fictions, new terms and metaphors have entered our vocabulary: immunodeficiency, false negative, reproductive rate, incubation period, herd immunity, “flattening the curve.” We don’t know the science behind the concepts, but we easily get the picture. Outbreak narratives have consequences: they shape the reaction to the health crisis by leaders and the public, they affect survival rates and contagion routes, they promote or mitigate the stigmatizing of individuals and groups, and they change moral and political economies. It is therefore important to understand the appeal and persistence of the outbreak narrative in order to design more effective and humane responses to the global health crises that lie ahead of us.

The outbreak narrative

Another consequence of living immersed in fiction is that usually you only remember the last episode of the whole drama series. Published in 2008, Priscilla Ward’s book begins with a reference to “the first novel infectious disease epidemic of the 21st century, caused by a brand-new coronavirus.” The contagion epidemic was of course SARS, not COVID, and the “brand-new” coronavirus of the early 2000s was named SARS-CoV-1 as opposed to the more recent SARS-CoV-2. But it is difficult not to read Contagious in light of the ongoing Covid-19 epidemic, and not to apply its narrative logic to our recent predicament. Covid-19 rewrote the script of past epidemic outbreaks but didn’t change it completely. It built on past experience, both real and imagined or reflected through fiction. The scenario of disease emergence was already familiar to the public, and it shaped the way countries responded to the epidemiological crisis. It demonstrated that living in fiction leaves us fully unprepared to face the real thing: the countries that achieved early success in containing the virus were those most affected by past outbreaks and especially by SARS, which mainly spread in East Asia. By contrast, the United States is the country from which most fictions originate, but where response to Covid-19 outbreak was disorganized and weak. We need more than fiction to prepare us to the health crises of the future; we also need better fictions than the conventional outbreak narrative that casts the blame on villains and invests hope in heroes to provide salvation.

As Priscilla Ward reminds us, there was an earlier wave of fictional scenarios in the 1990s that popularized the outbreak narrative in its present form. Blockbuster movies, medical thrillers, and nonfiction books reached a wide public and dramatized the research results that infectious disease specialists were discussing at the time in their scientific conferences and publications. They include the novels Carriers (David Lynch 1995), Contagion (Robin Cook, 1995), The Blood Artists (Chuck Hogan, 1998), as well as the movies Twelve Monkeys (dir. Terry Gillian, 1995), The Stand (dir. Mike Harris, 1994), Outbreak (dir. Wolfgang Petersen, 1995), and the nonfiction bestsellers The Hot Zone (Richard Preston, 1994), The Coming Plague (Laurie Garrett, 1994), and Guns, Germs and Steel (Jared Diamond, 1997). Priscilla Ward use the movie Outbreak, starring Dustin Hoffman and Morgan Freeman, as particularly representative of the genre that came to shape the global imaginary of disease emergence. The opening scene of a desolate African camp decimated by an unknown hemorrhagic virus, as seen through the protection mask of an American epidemiologist, sets the stage for subsequent narratives. The story casts Africa as an “epidemiological ground zero,” a continental Petri dish out of which “virtually anything might arise.” It dramatizes human responsibility in bringing microbes and animals in close contact with (American) human beings and in spreading the disease out of its “natural” environment through the illicit traffic of a monkey that finds its way to a California pet store. It gives the US Army a key role in maintaining public order and makes US soldiers shoot their countrymen who attempt to violate the quarantine. Outbreak fictions often cast the military officer as the villain, sometimes in cahoot with private corporations to engineer bioweapons, and the public scientist as the ultimate savior who substitutes a medical cure for a military solution. Helped by visual technologies such as epidemiological maps, electron microscopes, and close-ups of the virus, experts engage in a race against time to identify the source of the disease and then to determine how to eradicate it. That effort constitutes the plot and storyline of the film: the outbreak narrative.

Healthy carriers and social reformers

The outbreak narrative as it emerged in the mid-1990s builds on earlier attempts to storify disease emergence and contagion. Much like the blockbuster movies and popular novels of the 1990s relied on the work of scientists writing and debating about emerging infections, discussions about disease and contagion in the early twentieth century were shaped by new and controversial research showing that a apparently healthy person could transmit a communicable disease. The idea of a healthy human carrier was one of the most publicized and transformative discoveries of bacteriology. It signified that one person could fuel an epidemic without knowing it or being detected, and it required the curtailment of personal liberties to identify, isolate, and treat or eliminate such a vector of contagion. For the popular press in the English-speaking world, the healthy and deadly carrier took the figure of “Typhoid Mary,” an Irish immigrant who worked as a cook and left a trail of contaminations in the families that employed her. She was reluctant to submit herself to containment or incarceration in a hospital facility and repeatedly escaped the surveillance of public-health officials, assuming a false name and identity to disappear and cause new cases of contagion. Typhoid fever at the time was a “national disgrace” associated with dirtiness and filth. It resulted from the ingestion of fecal matter, as many authors liked to explain, and could be combatted by personal hygiene and proper sanitation of homes and urban space. Typhoid Mary’s refusal to cooperate with public health authorities created a moral panic that combined the perceived threat of immigration, prejudices against Irish female servants, fallen-woman narratives, and violation of the sanctity of the family. In response, the Home Economics Movement emphasized “how carefully we should select our cooks,” and made familial and national health a central occupation of the professional housewife.

Communicable disease and the figure of the healthy carrier influenced changing ideas about urban space and social interactions. Focusing on poverty, city life, urban slums, marginal men, migration, deviance, and crime, the Chicago School was one of the first and most influential centers of sociological research in North America. Like other sociologists of his generation, Robert Park began his career as a muck-raking journalist and social reformer. While investigating the outbreak of a diphtheria epidemic in downtown Chicago, he was able to plot the distribution of cases along an open sewer that he identified as the source of the infection. This led him to use the concept of contagion as a metaphor for social interactions and cultural transmission. It wasn’t the first time biology provided models for the nascent discipline of sociology. In the view of early commentators, microbes did not just represent social bonds; they created and enforced them, acting as a great “social leveller” unifying the social body. In France, Gabriel Tarde and Emile Durkheim argued about the role of contagion and imitation in explaining social phenomena such as suicide and crime. Communicable disease in particular vividly depicted the connection between impoverished urban spaces and the broader social environment. Calling the city a “laboratory or clinic in which human nature and social processes may be conveniently and profitably studied,” Park and his colleagues from the Chicago School of sociology concentrated their analysis on social interactions in urban formations such as the tenement or slum dwelling, the ethnic enclave or the ghetto, as well as nodes of communication such as points of entry, train stations, and quarantine spaces. The particular association of those spaces with immigrants in the United States intensified nativism and anti-Semitism, as preventive measures disproportionately and inequitably targeted Eastern European Jews. The theories and models of the urban sociologists conceptualized a spacialization of the social and the pathological that would play a great role in the outbreak narrative.

Cold War stories

The outbreak narrative is also heir to the stories of viral invasion, threats to the national body, and monstrous creatures from outer space that shaped the imaginaries of the Cold War. The insights of virology were central to those stories. New technologies of visualization implanted on the public the image of a virus attacking a healthy cell and destroying the host through a weakening of the immune system. Viruses unsettled traditional definitions of life and human existence. Unlike parasites, they did not simply gain nutrients from host cells but actually harnessed the cell’s apparatus to duplicate themselves. Neither living nor dead, they offered a convenient trope for science-fiction horror stories envisioning the invasion of the earth by “body snatchers” that transformed their human hosts into insentient beings of walking dead. These stories were suffused with the anxieties of the times: the inflated threat of Communism, the paranoia fueled by McCarthyism, research into biological warfare or mind control, the atomization of society, emerging visions of an ecological catastrophe, as well as the unsettling of racial and gender boundaries. Americans were inundated with stories and images of a cunning enemy waiting to infiltrate the deepest recesses of their being. Conceptual changes into science and politics commingled, and narrative fictions in turn influenced the new discipline of virology, marking the conjunction of art and science. Priscilla Ward describes these changes through an analysis of the avant-garde work of William S. Burroughs, who developed a fascination with virology, as well as popular fictions such as Jack Finney’s bestselling 1955 novel The Body Snatchers and its cinematic adaptations.

The metamorphosis of infected people into superspreaders is a convention of the outbreak narrative. In the case of HIV/AIDS, epidemiology mixed with moral judgments and social conventions to shape popular perceptions and influence scientific hypotheses. Medical doctors, journalists, and the general public found the sexuality of the early AIDS patients too compelling to ignore. In 1987, Randy Shilts’s controversial bestseller And the Band Played On brought the story of the early years of the HIV/AIDS epidemic to a mainstream audience and contributed significantly to an emerging narrative of HIV/AIDS. Particularly contentious was the story of the French Canadian airline steward Gaetan Dugas, launched into notoriety as “Patient Zero” and who reported hundreds of sexual partners per year. In retrospect, Shilts regretted that “630 pages of serious AIDS policy reporting” were reduced to the most sensational aspects of the epidemic, and offered an apology for the harm he may have done. Considering the lack of scientific validity of the “Patient Zero” hypothesis, it is difficult not to see the identification of this epidemiological index case and its transformation into a story character as primarily a narrative device. The earliest narratives of any new disease always reflect assumptions about the location, population, and circumstances in which it is first identified. In the case of HIV/AIDS, the earlier focus on homosexuals, and also on Haitians, intravenous drug users, and hemophiliacs, was an integral part of the viral equation, while origin theories associating the virus with the primordial spaces of African rainforests reproduced earlier tropes of Africa as a continent of evil and darkness. Modern stories of “supergerms” developing antibiotic resistance in the unregulated spaces of the Third World and threatening to turn Western hospitals into nineteenth-century hotbeds of nosocomial infection fuel on the same anxieties.

The narrative bias

The outbreak narrative introduces several biases in our treatment of global health crises, a lesson that is made only too obvious in the international response to Covid-19. It focuses on the emergence of the disease, often bringing scientific expertise into view; but it treats the widespread diffusion of the virus along conventional lines, and has almost nothing to say about the closure or end-game of the epidemic. It is cast in distinctly national terms, and only envisages national responses to a global threat. It presents public health as first and foremost a national responsibility, and treats international cooperation as secondary or even as nefarious. As countries engage in a “war of narratives,” the reality of global interdependence is made into a threat, not a solution. The exclusive focus on discourse and narratives overlooks the importance of social processes and material outcomes. Priscilla Ward’s book reflects many of the biases she otherwise denounces. It is America-centric and focuses solely on fictions produced in the United States. It exhibits a narrative bias that is shared by politicians and journalists who think problems can be solved by addressing them at the discursive level. It neglects the material artifacts that play a key role in the spread and containment of infectious diseases: the protection mask, the test kit, the hospital ventilator, and the vaccine shot are as much part of the Covid-19 story as debates about the outbreak and zoonotic origins of the disease. Priscilla Ward’s Contagious concludes with a vigorous plea to “revise the outbreak narrative, to tell the story of disease emergence and human connection in the language of social justice rather than of susceptibility.” But fictions alone cannot solve the problem of modern epidemics. In times like ours, leaders are tested not by the stories they tell, but by the actions they take and the results they achieve.