What's Right and What's Wrong with Outbreak

The 1995 film, Outbreak, follows the story of a viral hemorrhagic fever that originated in a remote African river valley suddenly making a catastrophic appearance in a rural California town. While there are certainly elements within the movie to be lauded for their accuracy, there is a lot more that goes off the rails. Let’s dive in.

THE VIRUS

The virus chosen for Outbreak, a virus called Motaba, is essentially a stand in for Ebolavirus. As such, most of the comparisons to real-world accuracy will focus on Zaire Ebolavirus. 

First, the way in which the Motaba was discovered and named mimicked what actually happened with Ebolavirus. Both the fictitious Motaba and Ebolavirus were discovered and named after the river in Zaire (now the Democratic Republic of the Congo) where it was first discovered. Further, even the species of virus responsible for the largest outbreaks, Zaire Ebolavirus, is named for the country it was found in, the above referenced Zaire (now the Democratic Republic of the Congo). However, the practice of naming a virus after its place of discovery is longer an acceptable practice. In 2015, the World Health Organization (WHO) released new best practices for naming diseases, including not naming the disease for their places of origin. The reasoning for this is that naming a disease for its place of origin creates a stigma around that place and its peoples as diseased. This can lead to discrimination and racism from others who fear the disease.

Next, the ways in which Motaba and Ebolavirus attack the host are similar. Motaba and Ebolavirus are both hemorrhagic fevers. There are over a dozen viral hemorrhagic fevers that affect humans including Ebolavirus, Hantavirus, and Marburg. Hemorrhagic fevers are named for their ability to make your blood vessels leaky and cause bleeding from various places, specifically mucous membranes. Fever and fatigue eventually give way to more dire symptoms such as kidney and liver impairment and severe bleeding. These things are well documented in the film and can be viewed as accurate.

However, things begin to fall apart when it comes to mode of transmission. Motaba begins the film as a virus that is only spread from very close contact: touching the skin or fluids of an infected person. As Cedar Creek, California begins to fall ill, however, it is discovered that the disease has made the sudden jump to an airborne disease. This means that it could be spread like the flu.

While this kind of change can occur in reality (called a gain-of-function mutation), even the movie seems confused as to what has actually occurred. At first, Dustin Hoffman calls it a mutation. This would mean that during the virus’s reproductive cycle a mistake was made accidentally imbuing the virus with a new ability. Due to the nature and rate of viral reproduction, mutations happen all the time, though they are more often inconsequential or detrimental in how the virus behaves. However, moments later the scientists begin to behave as if there were actually 2 strains of the virus all along. This new version of events implies that the virus mutated while still in its host animal (the monkey) instead of during the Cedar Creek outbreak. They flip-flop on this terminology for the remainder of the film. 

The team of scientists are able to tell the difference between these strains by simply looking at a photo of the viruses side by side, which is virtually impossible. In fact, with one exception, viruses are too small to see with an ordinary microscope, instead requiring a much more high-tech piece of equipment called an electron microscope. It seems unlikely that the mobile lab would come equipped with one of these, especially in 1995.  As a treat, the image they use for the Motaba virus is a real photo of Ebolavirus obtained by an electron microscope.

The likelihood of multiple strains of Motaba is real. There are, in fact, six species of Ebolavirus. Four of the six are known to be able to infect humans but none of those are transmissible through the air. Ebolavirus builds up in the blood, not the lungs, and only affects the lungs if the body is completely saturated. And while there is some evidence that a person in the very late stages of infection could spread the disease through respiratory droplets like a sneeze, it is incredibly uncommon. 

The mortality rate of Motaba is what originally draws the attention of the attention of health officials. In Zaire, the virus is shown to have a 100% mortality rate. When it jumps into the Cedar Creek population, however, this seems to change. The population certainly becomes gravely ill, but they don’t appear to die at the staggering rate laid out in the beginning of the film. This, however, isn’t necessarily an error. The various outbreaks of Ebolavirus have had widely varied mortality rates over the years. In 2014, the average risk of death was 50%, however there have certainly been outbreaks with mortalities far higher, reaching up to 90%.

Finally, the vectors of Motaba and Ebolavirus are different. The capuchin monkey, arguably the best actor in Outbreak, is the vector for Motaba. Unfortunately for the Outbreak casting team, capuchin monkey actually lives in South America and not Africa.  Ebolavirus, on the other hand, is believed to have a natural reservoir in fruit bats and some antelope, although it has never been conclusively proven.

TREATMENT

The biggest difference between Motaba and Ebolavirus is how it is treated. In the 44 years since Ebolavirus was discovered, there has never been a treatment discovered or synthesized to fight it. Ebola is treated entirely with supportive care, meaning doctors treat the worst symptoms and try to keep the patient alive long enough for their body to fight it off naturally. Fortunately, there is a vaccine (rVSV-ZEBOV) being tested in Africa. Less fortunately, vaccines are entirely preventative and would be of no use to someone who is already infected.

By the end of the film, both forms of Motaba are completely treatable. The government has a treatment of the first strain of Motaba (the direct contact strain) in storage. It’s called E1101 and it was developed sometime in the 28 years between the opening and the main plot of the movie. This is because the Army wanted to use Motaba as a bioweapon, which isn’t completely outside the realm of possibility in our own world. We’ll look a little more at that later.

Cuba Gooding Jr. also creates a treatment for the second strain of Motaba (the airborne strain) at a speed completely impossible even by today’s standards. In a matter of minutes, Cuba Gooding Jr. is able to isolate the antibodies in the monkey’s blood that protect it from Motaba, then use those antibodies to generate an antiserum, and somehow mass produce it for the patients.

In the best of circumstances, it takes months, if not years, to do this level of work.

THE US MILITARY

The last area that Outbreak leans more into fiction than reality is the US Military’s response to the Motaba. Outbreak posits that in 1967 Morgan Freeman and Donald Sutherland took samples of Motaba and turned it into a bioweapon for the US Military. This is feasible as it was not until 1969 that Richard Nixon committed the United States to destroying all stores of biological weapons. 

However, by May 1972, the government had completed its destruction of all of its stores of biological weapons. So, even if Sutherland had procured Motaba as a weapon, the program would certainly have been ended by 1995, when the bulk of the movie is supposed to take place.

Additionally, the US Army is dispatched to Cedar Creek to enforce a quarantine on the town, including the use of a military helicopter to blow up a jeep full of people trying to escape. Obviously, the writers of Outbreak have not read the Posse Comitatus and Insurrection Acts. 

These parts of the US Code prohibit the military from being deployed on American soil. It specifically pertains to the Army. If this had been the National Guard, nothing would have been amiss, except for maybe an excessive force charge against the helicopter pilot. However, the movie makes sure you know that Dustin Hoffman and Morgan Freeman are in the Army.

Interestingly, this scenario would have been completely legal for 2 years in 2006 and 2007. In an odd twist of fate, George W. Bush repealed parts of the Insurrection Act to allow for the armed forces to deploy on US soil to keep peace in the event of a natural disaster, epidemic, or other public health emergency. This change was repealed in 2008, and the act was returned to its original text.

CONCLUSION

While Outbreak gets a lot right when it comes to the symptoms and structure of the virus, it gets much more wrong. In the end, it seems like only a small amount of research went into the crafting of this movie. Although it’s possible that the research that was done was thrown out in the editing process in favor of writing conveniences, drama, and helicopter fights.