When I was 16 weeks pregnant with my son I caught a nasty head cold. Unable to take any of the traditional over the counter cold medications (because, pregnancy), I was forced to ride it out in misery on the couch praying for my own swift demise. The cold knocked me down hard and by the second or third day of misery on the couch I had binged watched just about everything I could binge watch.
Then I came across The Walking Dead on Netflix. Now, I had very particularly avoided watching the show because my fellow #publichealthnerd colleagues had pressured me to watch it, and urging me to do something is the best way to get me to not do that thing. I’d also avoided watching it because I’m not a fan of horror. Blood and guts are not my preferred form of entertainment. Sure, give me intrigue, drama, suspense and I will eat it up (hello House of Cards and Mad Men) but toss in zombies or vampires? I’m out.
But it was a few days before Hallowe’en* and I was 16 weeks pregnant, miserable, and out of binge-worthy TV. I decided to give the first episode a watch…and I haven’t looked back since. Well, except during the really gory scenes. Where I literally look backwards.
As a public health nerd, I can say that there have been times where from a public health standpoint the show has been laughable. The season one finale where our group of survivors winds up at the CDC?(OH COME ON!) Nothing that the show depicted about the CDC’s facilities in Atlanta is even remotely accurate. Even the evidence the CDC researcher claims to have (as in, shooting someone while in an MRI machine? OH COME ON!!) was preposterous.
Don’t even get me started on the idea that the CDC somehow, somewhere, has billions of dollars squirreled away for a state-of-the-art underground command center. Please show me the line item for that in the annual congressional allocation. I’m sure if Congress did earmark funds for a Dr. Evil-like underground lair, there would be a deafening outcry from both within and without the CDC for the desperate need for that funding to go towards more pressing public health concerns. Like anything not secret-underground-lair-ish.
When the announcement came early this year that there would be a spin-off show of The Walking Dead, detailing the beginnings of the zombie apocalypse, I was intrigued, if not concerned. After the complete media fail that was the news coverage for Ebola in America I was suspicious about how the show would portray public health infrastructure, and to be frank after the premiere I still am, but the premiere gave me much to be hopeful about.
*** WARNING, VERY MILD SPOILERS BELOW ***
The premiere episode does do a great job of highlighting the world as it currently is. We have made accommodations, and in fact are comfortable with, symbols of fear in our daily lives against things like violence (metal detectors in high schools, bars on the windows of homes, police activity). Likewise, we’re somewhat oblivious to more insidious threats like drug abuse and infectious disease.
What the show does get right in terms of science in its first episode is the emergence of the Walking Dead’s infamous zombie virus in an intravenous drug using population. A variety of infectious diseases have presented first or early among members of this group, including HIV/AIDS and numerous bacterial infections.
The reason for this is simply because of the behaviors associated with the practice; needles are often shared, and blood and other bodily fluids are exchanged,making it the perfect scenario for bacteria and viruses to replicate and mutate.
The demographics of IV drug users also interferes with what public health nerds call epidemiological surveillance. Epidemiological surveillance is how public health officials monitor what viruses, infections, and diseases are prevalent in a given population. The most common form of this surveillance is through passive surveillance, which is when an individual reports to their health care provider with an illness or concern and its documented, instead of public health officials actively seeking out cases.
If this sounds a little creepy, it’s actually not. Typically, and depending on the disease, your doctor or hospital isn’t reporting to the CDC that you, Jane Doe, born on this date, had the flu. What they’re reporting are generalities, so that public health officials can assess where resources would be best allocated. What your doctor or hospital reports is that a female, in this age range had this strain of flu at this time.
But the fatal flaw in passive surveillance is that it requires people to actually go to their health care provider. Unfortunately IV drug users tend to lack the means to seek out timely medical care. In many cases, a lack of a regular income, health insurance, fear of being reported to the police, or simply fear of judgment means that people often wait until an illness has reached a crisis point before they seek medical care. This means that illnesses can circulate undetected in the population for a longer period of time than they would in a population without similar barriers to accessing health care.
When looking for their son, whom they fear has fled hospital to score heroin, the main characters of Fear The Walking Dead drive through several rough neighborhoods where “Missing” posters have gone up on walls and fences. The implication the audience is meant to intone from these posters is that there is a massive outbreak underway that the powers-that-be are not yet aware of, because of who the missing (we know to be zombified) individuals are.
The genesis of the zombie virus in an intravenous drug using population was something I wasn’t expecting from the show, but something I find completely plausible (as plausible as a zombie virus can be). I was concerned considering the show’s previous ridiculous portrayal of the federal public health infrastructure, that the writers would go in the direction of a government-engineered virus released on an innocent and unsuspecting public. If they’d done that, I would have been out immediately and I have to admit, it probably would have ruined the original Walking Dead series for me as well.
I have to say, Fear the Walking Dead has stepped up its game in terms of scientific accuracy, which I greatly applaud. But I’m obviously not watching it for that – or maybe just partially. As my husband can tell you, I’ve spent a good chunk of time watching The Walking Dead yelling at Rick and his crew “FOR THE LOVE OF GOD, HOW HAS NO ONE DIED OF A STAPH INFECTION YET?!” Robert Kirkman, if you’re listening, someone on the show needs to step on a rusty nail and die of tetanus.
*I’m Canadian, so I spell Hallowe’en with an apostrophe