Pandemic: How to Prevent an Outbreak

A documentary about the flu that is no longer just about the flu.

When something as alien as the COVID-19 pandemic has shaken up the world’s normality to its core, we want to know more about it. Normally, I don’t go out of my way to spend time with documentaries because I find them to be more didactic than entertaining. For me, anything on TV or the theater screen serves as a way to escape the real world. But every now and then, there is a certain reality that I just want to learn more about. Right now, we live in one of the most interesting times of human history and it deserves our undivided attention. As curiosity fuels our humanity, I chose to spend some time with a Netflix documentary that had an eerily timed release, Pandemic: How to Prevent an Outbreak.

Given our current predicament, it’s quite the ironical title. While Pandemic is not about COVID-19 at all, it does talk about a more prevalent disease that is rampant worldwide: the influenza. We treat it like an annoying pest that can be easily dealt with by drinking some honey and lemon tea. We think that the flu symptoms are trivial at best, all the while nurturing an overconfidence that we will easily recover from it. However, the same cannot be said in other parts of the world. According to WHO, there are up to 1 billion seasonal flu cases and 650,000 deaths worldwide every year, even while we believe to have suppressed it for years through proven vaccines. In fact, the other most recent pandemic said to have claimed up to 50 million people's lives worldwide was also caused by the flu, now known as The Spanish flu in 1918. Today, our world population has nearly quadrupled with global transportation much more common. So how much damage can a pandemic unleash today? Unthinkable. It's a not a matter of if, but when.

Over 6 episodes, this documentary (or docuseries) explores several perspectives involved in the war against the flu. However, it goes through them in a very back and forth manner. So I felt that each deserves its own section for the sake of being organized, with thoughtful quotes from real professionals to capture the spirit of their institutions.

Healthcare policy

“It just takes one person to start an outbreak.”

– Dr. Syra Madad, Special Pathogens Program in NYC

My sociology professor once told me that healthcare is perhaps the most complicated institution in modern society. And it's really not a ridiculous statement, especially if you dive into all of it. Let’s start with the fact that health encompasses more things than simply treating physical symptoms, but more so an interconnected web of social determinants as the documentary depicts. We see that optimizing health in the slums of Jaipur, India is a completely different game compared to urban healthcare in NYC. Moreover, there is just as much emphasis put on proactive medicine as there is reactive medicine. Vast amounts of efforts are put into optimizing response, educating the public, and strategizing with the government all to eliminate even a single chance of an outbreak happening.

Social movements are pervasive and healthcare is no stranger to them, (i.e. the anti-vaccine movement). The documentary takes an impartial stance on this issue, so it is fascinating to hear anti-vaccine families’ justifications and the amount of pushback that medical experts receive for their seemingly benevolent goals to protect people’s health. While anti-vaxxers claim to be deprived of their freedom of choice, they are also the same people who obey traffic lights. So watching this paradox unfold and the ethics of whether parents have the right to put their children at risk simply add onto the complexity of healthcare. It will be definitely be even more interesting how they will react when the first COVID-19 vaccine becomes available in the future.

Another aspect that comes into the limelight is political involvement. Sometimes, the feasibility of healthcare lies in the hands of the voting majority and state governors, who decides whether a program or a hospital receives the necessary funds to continue their operations. Therefore, the concerns of healthcare leaders are two-fold: medical and political. While politicians should understand the seriousness of a potential pandemic, the documentary’s narrative is that healthcare is still becoming less and less of a priority for the government. It serves as an important message especially to young people, whose votes have tangible the power to keep society healthy and are also next in line to inherit the principles of healthcare. If anything, the COVID-19 pandemic probably amplified this awareness.

Pharmaceuticals

“In venture capital, you either lose control of your company, or you lose control of your vision”

– Jacob Glanville, Founding Partner at Distributed Bio

There has always been a negative impression on the pharmaceutical industry from the general public. To them, a medical drug is a financial investment. They are, after all, a business that sells a product. There is "Wall Street" written all over these big pharmaceutical companies and our suspicions has reached the point where we believe they are hiding the cure for cancer from the world for financial motives. As the documentary shows, this industry is stuck in a fine-line between discreet science and the almighty dollar. Because of this, they also advance slowly and tend to be risk-averse, not daring to invest on new techniques.

But perhaps we are now reliant on the pharmaceutical industry more than ever for a coveted vaccine. It seems that discreet science must make a big return in order to quite literally save the world. In the documentary, we get to watch how scientists from their own start-up company called Distributed Bio follow their humanitarian vision of creating a universal vaccine for the flu, named Centivax. It is an appropriate place shine the spotlight on because the characteristics of big pharmas versus start-ups are polar opposites. To investors, the idea of opening easy access to a single shot that can eradicate the flu forever is low on the priority list. It sounds risky, naïve, and even impossible.

But as the story progresses, we observe that the pharmaceutical environment is where the integrity of science must be sanctified for success. Therefore, if the data supports it, it is possible, even for an utopian and dreamy ambition like a flu panacea. Contrast to the flu outbreak, however, battling COVID-19 is an extreme race against time, driven by very different motives. It’s safe to say that only a vaccine will stop this miserable quarantine in the short term. Of course, there are many ways to creating this treatment, where the same interviewee from Distributed Bio is aiming to engineer an antibody instead of a vaccine, apparently because its effects kick in faster and can go through clinical trials faster. As a result, the dynamics within the pharmaceutical industry is no doubt flipped upside down during these times, compared to what is shown in the documentary. During COVID-19, the dollar is no longer almighty. Your personal visions are irrelevant. We cannot fake it until we make it. Science just has to work. As far as preventing an outbreak goes, the pharmaceutical industry is probably what society will rely on the most. It’s helpful to watch a documentary disclosing how this pivotal industry works behind-the-scenes and why the discreet science needs to trump the almighty dollar.

International & Global Health

“You don’t wait for an outbreak to infect humans. You find it and fight it before it ever infects a person.”

– Dr. Dennis Carroll, U.S. Agency for International Development

A pandemic is defined as the worldwide spread of a new disease. Although the influenza virus may be a century-old enemy of human health, the greater problem lies in the emergence of new strains from anywhere around the world. This is a risk that is right around the corner everyday but is, as the documentary shows, constantly monitored and suppressed by public health experts from the World Health Organization (WHO). To this very day, international organizations are involved in controlling zoonotic spillovers from agriculture and livestock. Then appropriately, the question you might have is "where did we go wrong in this COVID-19 pandemic?". A fair question that will probably will not be answered for a long time, but will keep our healthcare institutions wondering for years.

In the documentary, the Ebola virus makes a return. It's most likely the second most recent viral outbreak other than COVID-19 that has caused worldwide panic. Although it did not reach to the levels of a pandemic, over 3000 Ebola cases still remain with 67% mortality rate in the Democratic Republic of Congo, where most of the story takes place in the documentary. You cannot help but acknowledge the fact that an outbreak is a long-term battle, almost like World War 3. While many of us may move onto new things on the media 5 years from now, the virus is counting numbers in the background, Ebola or COVID-19 alike. And the ones out in the battlefield risking their lives will be these international health officials.

The more interesting aspect of the international/global dynamic during a pandemic, however, is the fact traversing to new societies can unveil new problems. In certain Africa countries, the name of the game can be as serious as holding off the zealous militia and calming negative perceptions of foreigners. As a result, health officials not only have defend themselves from pathogens, but also from all these other unpredictable dangers that may not be purely biological. In a way, the world is experiencing the same social symptoms from a virus within the realms of economy, mental health, and education. As such, the documentary shows only a sliver of negative outcomes in one country, and now they have manifested into much worse and has spread around every single country. There is no doubt that the pandemic will change global health for decades to come.

Rural Medicine

“If you have to travel an hour to get healthcare, people are going to say... I’d rather not.”

– Dr. Holly Goracke, Jefferson County Hospital

The heart of medicine is most appreciated in this is the part of the documentary. Here, we follow the life of the only licensed doctor in a county in Oklahoma who, by herself, has to care for every flu patient that walks into the door. Rural medicine is therefore another challenging issue with its own set of problems and features, with the general idea being inaccessible healthcare. Thus, 72-hour shifts for rural doctors is not uncommon. You can practically feel the exasperation in their eyes and tone during the documentary. You cannot help but respect the doctor’s determination because they know that to the people of the county, they is their everything.

The rural environment is presented as a tight-knit community, where there are several interesting relationships that the doctor has with her family, patients, county residents, and mayor’s office. Basically, everyone in town knows who the doctor is. But the problem comes in balancing a career that requires consistent 72-hour shifts with family time, battling for state funds to prevent hospital site closures in rural areas, and being well-equipped to treat patients on the spot. The only thing keeping the leftover county hospitals afloat are the votes of the people in the community. As such, the documentary highlights that rural medicine simply needs more support from the people and the government For me, it was perhaps the most enlightening part of the documentary given my personal lack of knowledge about rural healthcare and its serious conditions.

Humanity

“The sadness I feel when I lose a patient is more than the happiness of saving ten.”

– Dr. Dinesh Vijay, Pulmonologist

When everybody runs away from the virus, doctors run towards it. In the day, they are superheroes. And in the evening, they are regular human beings with a regular family. This is the side of healthcare professionals that we rarely see, given how we have viewed them as the know-it-alls and headstrong in stressful environments. In addition to professional work, the documentary spends a great deal of time exploring each individual’s personal lives, mainly on how they spend time with family and their relatable upbringings. Putting this altogether, there is also a healthy representation of these stories in terms of gender, ethnicity, religion, and country.

The personal stories being told by each profession instills a level of humanity into the dynamics of a viral outbreak. These people are not without struggles. Doctors have to accept the fact that not every patient will live. Disease experts must carry the mental pressure of protecting entire cities like the dense NYC. And health advocates must fight for a cause that not everyone will follow. Yet in the face of unprecedented stress, they manage to sustain their level of positivity and never forget their purposes. When I come across TikTok videos of nurses dancing in the workplace, while some people may berate them for negligence, I remind myself with this documentary and acknowledge their humanity. While we may label them by their profession, we often forget that they are humans too. No more. No less. They need others’ support and they have their own struggles. Naturally, this applies to everyone in the world at any given time, where behind a mask that we wear in front of others, we tuck away a great deal of our identity that allows us to empathize with each other. For that, I am thankful to have experienced this part of the documentary.

Final Thoughts

The flu is a ticking time-bomb that is one false move away from exploding into a global catastrophe, as the documentary depicts. In recent history, this is the only instance where the extravagant narrative of film entertainment has nailed it right on the head. Before that, many were dismissing the impending severity of COVID-19 by pointing towards the deaths from influenza, treating it like a media farce. To a point, we still do it now. But even with all the prior preparations and vigilance, we seem to have much to straighten up, namely everything that was discussed previously but perhaps more importantly, our mindset and values.

As an aspiring healthcare practitioner, the thought of being out in the front-lines as we speak is downright frightening. When I watch these interviewees from all realms endure multi-day shifts, risks of infection, and deaths upon deaths, it makes me question my own convictions. Is this really something I want to do? Do I have the capacity to bear this chaos? Mostly during these several months of the pandemic, I came to acknowledge that medical school is no longer a career. As this documentary points out, pursuing to work in healthcare is upholding a sacred virtue. Especially during these times, it is paramount that the years of practice and experience comes down to one thing, and that is to save lives. Money, prestige, connections, none of it matters when it is a matter of life and death, which is the endgame for many healthcare practitioners.

For 6 hours, I had the chance to reflect upon this further with friends that I never met before on television. I got to learn about what they do at work everyday. I got to meet their friends and family. And more importantly, we got to share moments of struggle together. As what I am experiencing in real life will last in my memories forever, there is no better time to experience these furrow of thoughts and emotions. As such, this is not just a documentary about the flu. It's everything that everyone needs during the most significant juncture of modern history.

*All images on this post are legally owned by XG Productions, Netflix, and Zero Point Zero Productions Inc.