The Problem with TNT’s The Last Ship

There’s nothing like a good TV show about a virus running amok especially with the largest Ebola outbreak EVER in history happening to make it even more realistic.

I’ll update you with the story line if you’re not familiar with the show. Be warned, this post will contain spoilers.

A deadly virus is wiping out much of the earth’s population. It’s swift, but supposedly not airborne, which may present the first issue with the theory behind the show.

One U.S. Navy vessel was sent to Antarctica under the guise of military exercises. On board, a research scientist tagged along and spent a lot of time on the ice. It was only later disclosed that she was trying to find the “primordial strain” to help her develop a vaccine. She was able to find the strain needed. What her mission truly entailed was developing a vaccine for the disease. Essentially, the crew has had to stay away from civilization until this was developed.

It’s actually a very good set-up. Of course, what generally trips a show up is those pesky medical details and I want to highlight the biggest violation here today.

Of course, this research scientist develops a vaccine but she needs to test it out before she can truly say it works. Six volunteers are picked from the crew that meet certain age, race, and gender requirements.

First, this group of six gets the vaccine and then fairly immediately– gets dosed with the pathogen.

Sure.

What’s misleading here is the time it takes for a person to develop immunity. It’s never mere minutes. Generally, it takes weeks to months. The flu vaccine (which I hope all of your are planning on getting) takes about two weeks for immunity. This link from the CDC states it takes 4-5 weeks for seroconversion for the MMR vaccine.

Needless to say, it’s unrealistic to portray a vaccine working in mere moments. This is also the reason for multiples injections– some people gain immunity only after a couple of doses. You can read more about that from the above link.

The kicker is– I actually don’t think it would have destroyed their story line in any way. There’s plenty of drama to be had with a deadly virus killing off the majority of the world’s population. Whoever owns the cure, rules the world.

Overall, I liked this show but there wasn’t a need to cheat on the medical details.

News Stories for Authors: The Black Death Returns

Rats. Cute, right? Unless you think about the diseases they help to transmit. Here’s a short list here.

Evidently, the Black Death or Plague has not died. Well, perhaps it never did but a curious thing is that it disappears for years on end and then . . . it . . . comes . . . back.

Which always makes for a good medical thriller.

But now, it seems that the Black Death is popping up on the West Coast. Some interesting points from this article.

1. In LA county, a squirrel tested positive for bubonic plague or The Black Death. It is genetically similar to the organism that killed 200 million people in the 14th century.

2. Plague is spread from fleas, to rodents and then to humans. You can read further about transmission here.

3. There have been almost 1,000 cases of plague in the US. New Mexico sees almost half of these cases.

4. The pathogen responsible for bubonic plague is Yersinia pestis. It can be successfully treated with antibiotics. It’s death rate is around 11%.

5. There is a season for plague (just like flu and some other viruses) that runs from late spring to early fall. My guess is because that’s when rodents are active and not hiding in the snow during winter.

6. Untreated, the bacteria will spread through the body in one to six days. When it reaches the lungs– it can then become airborne and is then called pneumonic plague which is why some think it would make a good biological weapon.

7. Death can occur in as short as three days.

The question is– why does it disappear? What factors cause this to happen? Do you think there could be a true pandemic of The Black Death again?

Has the Black Death returned? Click to Tweet.

Fungal Fright: Sprial by Paul McEuen

I wish I could say exactly how I discovered Spiral by Paul McEuen. I want to say it was a Goodreads review and I’m always looking for new medical thriller authors– particularly ones that can back it up with good sound expertise.

Paul is a professor at Cornell University and has received the Agilent Technologies Europhysics Prize, a Packard Fellowship, and a Presidential Young Investigator Award as listed in his bio. I am just guessing he’s one really smart dude.

This debut medical thriller also won the International Thriller Writer’s Debut Category for 2012. Strong work, Paul– as I like to say.

Spiral begins the first part of the book in the past– specifically a close examination of two war ships in the ocean– of a few men in a raft– and the large gun ship swiftly disposing of them because they want to come aboard.

The reason they aren’t rescued– and actually murdered– is because of the fear that they have been infected with a deadly fungus named Uzumaki.

The early scenes of the novel– from the terror realized as the infection manifests, to the other ship trying to “quarantine” the fungus in the middle of the ocean until one stray bird lands on the infected vessel . . . and then takes off. . . 

I never thought a bird landing on a ship would lead to heart palpitations– seriously.

Fast forward and the young military fungal specialist is now a well-acclaimed university professor specializing in fungus and one of the few who know about Uzumaki– and now others want the fungus born again for nefarious reasons.

What I really liked about this novel was it reminded me of the early Robin Cook books. Take a medical concept and take it to the worst case scenario. Or take something theoretical, somewhat expiramental and think about the way it can run amok on humanity. I think that’s what makes a medical thriller— well– thrilling!

I liked learning about fungi and the tiny robots called microcrawlers (and how deadly they can be!) In fact, I wanted to look up some of these concepts to see how “true to life” they really were. I also liked the examination of how prevalent antibiotic usage can be detrimental.

I would have enjoyed more of the fungus unleashed on humanity. Instead, there were only a few infected people. The story centered more on the family and how the secret of the fungus was kept hidden.

Overall, a good read for medical thriller fans. I’ll be excited to read this author’s future works.   

Fungal Fright: Killer Spores

In preparation for Thursday’s post– I did a quick Google University search for “deadly fungus” and up came Cryptococcus– again. I first blogged about this fungus here.

The interesting thing about fungal infections is that they are like the unwanted orphans of pathogens. Their infections can take a while to manifest and be equally as difficult to treat– often requiring months of anti-fungal therapy.

I first blogged about Cryptococcus two years ago but have you even heard of it? The reason bacteria and viral infections get much more press is that they tend to spread and manifest much more quickly– thereby meeting our need for instant gratification. We’ll know, likely within a few weeks, whether you’re going to live or die.

Not so much with a fungal infection.

A person gets infected by cryptococcus by directly inhaling the spores. There are two species that are responsible for MOST human infections. C. neoformans, found in the soil, generally infects people with weakened immune systems like those with the HIV virus. The other, C. gattii, affects more healthy populations.

What’s interesting is that these fungus spores are continuing to spread along the western sea board. Compared to when I first wrote about this infection, the death rate has risen to about 33% from 25%. What’s more interesting is that the same fungal infection for Canadians only has a death rate of about 10%.

It makes me wonder if the difference in geography plays into the host, the fungus, and/or the ability to fight the infection. All good plot points for a medical thriller.

Treatment is antifungal medications for many months but if these prove inneffective then surgery may be required.

What about you? Have you heard of this deadly spore?

You can check out the following links if you want to read more about Cryptococcus and these links are also where I got the information for this post.

http://www.realclearscience.com/articles/2013/05/28/cryptococcus_spread_of_a_deadly_fungus_106543.html

http://www.cdc.gov/fungal/cryptococcosis-gattii/

http://www.ncbi.nlm.nih.gov/pubmed/20570552

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2669189/

Primer on Pathogens: Part 3/3

Sometimes you need to take a silly quiz to learn a point.

That’s why I like The Ultimate Zombie Apocalypse Survival Quiz. Now, of course, the quiz is in jest but it brings up several important points when we talk about pathogens and your susceptibility to them. How are zombies often made– by an infectious disease process– at least in books and movies.

But it also examines survival techniques. Have you thought through aspects of survival in your mind? The more you rehearse emergencies– the more apt you are to act. This is one reason why we practice “mock codes” in the hospital setting. Thinking through your response on a mannequin several times makes it less scary when a real person is involved. 

Let’s look at several of these factors.

Your age. Typically the ends of the spectrum are more susceptible to illness. The very old and young for instance. This is why we are super cautious in pediatrics during an infant’s first 30 days of life. A very low temp (anything 100.4 or greater) is concerning and will likely buy the infant a septic work-up. You can read a post I did about newborn septic work-ups here and why babies in their first two months of life should be sheltered in– particularly in the winter.

Where you live. People living more close together have the opportunity to spread disease more easily. This is why when school season starts we see an increase in illness– things like strep throat and meningitis. Because you’re lumping 20-30 (or more) kids in a classroom. Close contact=ease of transmission.

Your general state of health: Obviously, someone who has a healthy immune system and good general health will be able to fight off infection more easily.

Your occupation: When I first started working in pediatrics they warned me about the “Children’s Crud.” It’s not unusual for healthcare workers (those working taking care of people with infectious disease) to get sick a lot in their first couple of months. Suddenly, their immune system is exposed to LOTS of new bugs it hasn’t seen before. Now, I don’t get sick very often because my immune system has been primed for several different types of pathogens. However, my husband came down with a very common pediatric infectious illness from one of our daughters. “Why didn’t you get sick?” he asked. It’s simple– my immune system has seen this bug literally hundreds of times and it laughs it off now.

When I first took the Zombie Survival quiz– I answered fairly honestly with my current state of health. My chances of surviving a zombie apocalypse was 78.8%. 

When I took it a second time– making my health and survival knowledge much worse my score was 35.7%

How about you? How well is your body at fighting off infection? How well do you think you’d survive a Zombie Apocalypse?

If you take the quiz and post your score– there will be a chance to win one copy of either Proof or Poison— your choice. Winner announced Monday, July 29th! Must live in the USA.

Primer on Pathogens: Part 2/3

I remember a few years back when H1N1 (the swine flu) hit. Our ED volumes were through the roof. H1N1 affected middle and high school aged kids more than older populations. It was one time that perhaps the elderly were not as affected (perhaps because of years and years of flu shots and being exposed to other viruses.)

I was working with a PICU intensivist who was moonlighting in the ER. These are doctors who work in the Pediatric ICU. He was wicked smart, managed ED volumes well, had an awesome bedside personality and was great with the nursing staff. If you work in healthcare you’d realize these things ALL together in one physician are rare.

H1N1 Influenza Virus

There was becoming a concern about resources. If H1N1 hit as bad as was thought– this is what he said, “There won’t be enough ventilators to take care of everyone.”

That’s not funny.

Have you heard of coronavirus or the one that’s in the news a lot lately: MERS-CoV that’s affecting people near and around Saudi Arabia.

So far there has been 81 confirmed cases and 45 deaths— that’s about a 56% death rate.

That’s high. In medical terms, this would be considered a highly virulent bug. Imagine you’re told you have this virus and you have more than a 50% chance of dying.

MERS-CoV is a member of the coronavirus family. If you remember SARS from a few years back that affected South China and Hong Kong — this is a member of the same family. Consider it a cousin. Death rate from SARS was around 10%.

See what I mean?

Transmission of MERS is from close contact. This generally means you have to be within six feet of someone for prolonged periods of time to contract the bug– like living in the same household or being a medical person caring for a patient.

People present with symptoms of a URI (upper respiratory infection) which would be fever, cough and shortness of breath.

Thus far– there have been no cases in the US.

However, coronaviruses are common but usually not fatal. In fact, the CDC website says most people will be infected at some point in their life.  They were first identified in the 1960s.

Interestingly, the SARS virus mentioned above hasn’t been seen since 2004. Where is it hiding? Will it come back?

The coronavirus family is a good example of the gamut viruses can run that are related. From mild infection to death.

Have you heard of the Saudi Arabian MERS virus? Did you know it had such a high death rate?

To read more about MERS: check out this post.

Here is Part I of the series.

Primer on Pathogens: Part 1/3

There’s nothing like a good pathogen story line for medical thriller authors. It might be considered a mandatory novel requirement if you’re in the genre. Hmm . . . guess I better start developing a virus-run-amok story line.

Great examples would be Robin Cook’s Outbreak and the unrelated movie Outbreak that starred Dustin Hoffman. Recent film examples would be Contagion.

I was talking with a physician co-worker of mine after the movie Contagion was released and she said she’d applied for work at the CDC but they were overwhelmed by applications as a result of the movie. Personally, that movie would have quelled my desire to study virulent pathogens up close and personal but I guess if you like to hang over the edge of the cliff like that go right ahead . . . I’d rather write books.

When picking a pathogen there’re a couple of principles to keep in mind when you choose your microorganism of destruction.

First– what is a pathogen? A pathogen is a microorganism that causes disease. It can be one of four things: bacteria, virus, fungus or prion. Each has a different level of virulence.

Virulence is how deadly a pathogen is. Generally– medical thrillers pick bugs that have high virulence (hence the dramatic part.) This is the concern with the new SARS like virus (MERS-CoV) in Saudi Arabia that has a death rate of 60%. That’s scary. I’ll blog about that later this week.

Next thing to consider is how will the pathogen spread or what is its route of transmission? If you’re talking medical thriller– airborne transmission is generally preferred because of it’s ease and spread of transmission.

Pathogens can be spread person to person through touch (common cold), contaminated blood (HIV, Hepatitis C), saliva (rabies), and air (measles.)

Pathogens can also be spread through food, water, insects and fomites (non-living objects such counter tops).

Another thing to consider is the incubation period which is the time between exposure and development of symptoms and surprisingly they vary widely depending on what agent is involved. For instance, Mad Cow disease could have up to a 30 year incubation period whereas a staph infection can have an incubation period as short as one hour.

Here a list to peruse of different pathogens and some of these principles.