Contagion (2011)
Directed by
Steven Soderbergh
Produced by
Zakaria Alaoui...line producer: Casablanca
Chen On Chu...line producer: Hong Kong
Gregory Jacobs...producer
Jonathan King...executive producer
Michael Polaire...executive producer
Michael Shamberg...producer
Stacey Sher...producer
Jeff Skoll...executive producer
Ricky Strauss...executive producer
Written by
Scott Z. Burns
Starring
Marion Cotillard
Matt Damon
Laurence Fishburne
Jude Law
Gwyneth Paltrow
Kate Winslet
Music by
Cliff Martinez
Cinematography
Peter Andrews
Edited by
Stephen Mirrione
Production
company
Participant Media
Imagenation Abu Dhabi
Double Feature Films
Distributed by
Warner Bros. Pictures
Release date
Running time
106 minutes
Country
United States
United Arab Emirates
Language
English
Budget
$60 million
Box office
$135.5 million
Contagion is a 2011 American medical thriller-disaster film directed by Steven Soderbergh. The film features an ensemble cast that includes Marion Cotillard, Bryan Cranston, Matt Damon, Laurence Fishburne, Jude Law, Gwyneth Paltrow, Kate Winslet, and Jennifer Ehle. The plot of Contagion documents the spread of a virus transmitted by fomites, attempts by medical researchers and public health officials to identify and contain the disease, the loss of social order in a pandemic, and finally the introduction of a vaccine to halt its spread. To follow several interacting plot lines, the film makes use of the multi-narrative "hyperlink cinema" style, popularized in several of Soderbergh's films.
Soderbergh and screenwriter Scott Z. Burns had collaborated on The Informant! (2009). Following that film's release, Burns brought up the idea of producing a medical thriller film depicting the rapid spread of a virus, which was inspired by various pandemics such as the 2003 SARS epidemic and the 2009 flu pandemic. To devise an accurate perception of a pandemic event, Burns consulted with representatives of the World Health Organization as well as noted medical experts such as W. Ian Lipkin and Lawrence "Larry" Brilliant. Principal photography started in Hong Kong in September 2010, and continued in Chicago, Atlanta, London, Geneva, and San Francisco until February 2011.
Contagion premiered at the 68th Venice Film Festival in Venice, Italy on September 3, 2011, and went on general release on September 9. The film was well received by critics, who praised the narratives and the performances of various actors and actresses. It was also well received by scientists, who praised its accuracy. Commercially, the film was a box office success. Budgeted at $60 million, Contagion attained $135 million in box office revenue during its theatrical run.
Plot
Returning from a Hong Kong business trip, Beth Emhoff (Gwyneth Paltrow) has a layover in Chicago to rendezvous with a former lover before returning to her family in suburban Minneapolis. She appears to have contracted a cold during her trip. Her six-year-old son from a previous marriage, Clark, also becomes symptomatic and is sent home from school. Beth's condition worsens and two days later she collapses with severe seizures. Her husband, Mitch (Matt Damon), rushes her to the hospital, but she dies of an unknown cause.
Mitch returns home and finds that Clark has also died from a similar infection. Mitch is placed in isolation but seems to be immune to the disease. He is released and returns home to his teenaged daughter Jory, who had been living with Mitch's former wife and her husband and has decided to stay with Mitch since he's now all alone. As more and more persons become infected with no cure in sight, they face decaying social order and rampant looting of stores and homes. Mitch is unsure if Jory has inherited his immunity and he struggles with the frustration of quarantine, his desire to protect his daughter and learning that his wife was unfaithful to him immediately prior to both her death and that of his stepson.
In Atlanta, representatives of the Department of Homeland Security meet with Dr. Ellis Cheever (Laurence Fishburne) of the CDC and express fears that the disease is a bio weapon intended to cause terror over the Thanksgiving weekend. Dr. Cheever dispatches Dr. Erin Mears (Kate Winslet), an Epidemic Intelligence Service officer, to Minneapolis to begin investigating. Mears traces the outbreak back to Emhoff while negotiating with local bureaucrats initially reluctant to commit resources for a proper public health response to the virus. Dr. Mears later becomes infected and dies.
At the CDC, Dr. Ally Hextall (Jennifer Ehle) determines the virus is a mix of genetic material from pig and bat viruses. Work on a cure stalls because scientists cannot discover a cell culture within which to grow the newly identified Meningoencephalitis Virus One (MEV-1).
UCSF professor Dr. Ian Sussman (Elliott Gould) violates orders from Cheever (relayed through Hextall) to destroy his samples, and identifies a usable MEV-1 cell culture using bat cells. Hextall uses the breakthrough to work on a vaccine. Other scientists determine the virus is spread by fomites, with a basic reproduction number of four when the virus mutates, with projections of one in twelve of the population being infected, and a 25-30% mortality rate.
Conspiracy theorist Alan Krumwiede (Jude Law) posts videos about the virus on his popular blog. In one video, he shows himself sick and later claims he recovered using a homeopathic cure derived from forsythia. In a panic, people seeking forsythia overwhelm pharmacies, spreading and accelerating the contagion as the infected come into contact with healthy people.
Krumwiede's claims attract national attention. During a television interview he discloses that Dr. Cheever had secretly informed friends and family to leave Chicago just before the city was quarantined. Cheever is then informed the government will investigate and may charge him for leaking information. Later it is revealed Krumwiede had faked being infected by the virus in an attempt to increase profits for shareholders in companies producing and selling forsythia. Krumwiede is arrested for conspiracy and securities fraud, only to walk free when his many supporters successfully raise funds to provide for his bail.
Using an attenuated virus Dr. Hextall identifies a possible vaccine. To cut out the lengthy time it would take to obtain informed consent from infected patients, Dr. Hextall inoculates herself with the experimental vaccine and immediately visits her gravely ill father, who has been infected with MEV-1. The doctor does not contract MEV-1 and the vaccine is declared a success.
The vaccine's production is rapidly increased, but due to limited production, the CDC awards vaccinations by lottery based on birth date. Inoculations take place for one full year until every survivor is vaccinated. First responders, doctors and others designated by the government are declared exempt from the lottery. Dr. Cheever gives his fast-tracked MEV-1 vaccination to the son of Roger (John Hawkes), a CDC janitor who had overheard Dr. Cheever's phone call warning his girlfriend to leave Chicago.
Dr. Leonora Orantes (Marion Cotillard), a WHO epidemiologist, travels to Hong Kong to follow the Beth Emhoff lead. She collaborates with Sun Feng (Chin Han) and other local epidemiologists and public health officials; they identify Emhoff as patient zero. As the virus spreads, Feng kidnaps Orantes to use her as leverage to obtain MEV-1 vaccine doses for his village. Orantes spends months living with the villagers until the vaccine is announced. Feng exchanges Orantes for the vaccine doses. Her colleague mentions that the exchanged doses were placebos and Orantes rushes away to warn them.
The death toll reached 2.5 million in the U.S. and 26 million worldwide. Dr. Hextall places samples of MEV-1 in cryogenic storage, alongside samples of H1N1 and SARS.
The source of the virus is revealed to viewers. A bulldozer (coincidently, operating for the company Emhoff worked for) knocks down a palm tree disturbing some bats, with one finding shelter and food in a banana tree. That bat then flies over a pig pen, dropping a chunk of banana from its mouth, which is then eaten by a piglet. Chinese chefs later collect pigs from the pen and take them to a Hong Kong casino. A chef is called away from his preparations of a piglet, and casually wipes his hands on his apron. The chef then shakes hands with Beth Emhoff, giving her the mix of bat and pig viruses that makes her patient zero and the origin of the MEV-1 virus.
Cast and characterizations
Matt Damon, a frequent collaborator of Soderbergh's, was chosen to portray Mitch Emhoff.
Kate Winslet traveled to the Centers for Disease Control and Prevention, where she met with many of the employees to research her character.
Conception and writing
There's a scene in The Informant! where Matt (Damon) is watching Scott Bakula's character talk on the phone and Scott coughs on the phone, and there's this whole rant that Matt goes off on of 'Oh, great, now what happens? He gets sick and then I'm going to get it, my kids are going to get it.' I've always been fascinated by transmissibility, so I said to Steven, 'I want to do an interesting thriller version of a pandemic movie' and he said, 'Great! Let's do that instead.'
“
”
Scott Z. Burns.
Concerted efforts to devise Contagion coincided with Burns' collaboration with Soderbergh in The Informant! (2009). The duo had initially planned to create a biographical film on Leni Riefenstahl, a trailblazer in German cinema during the 1930s and a figure in the rise of the Nazi Party. Soderbergh later contacted Burns to cancel the project, as he thought that a film about Riefenstahl would struggle to attract an audience. Intrigued with the field of transmission, Burns suggested that they instead create a film that centered on a pandemic situation—"an interesting thriller version of a pandemic movie". His main objective was to construct a medical thriller that "really felt like what could happen".
Burns consulted with Lawrence "Larry" Brilliant, renowned for his work in eradicating smallpox, to develop an accurate perception of a pandemic event. He had seen one of Brilliant's TED presentations, which he was fascinated by, and realized that "the point of view of people within that field isn't 'If this is going to happen', it's 'When is this going to happen?'"Brilliant introduced Burns to another specialist, W. Ian Lipkin. With the aid of these physicians, the producers were able to obtain additional perspectives from representatives of the World Health Organization. Burns also met with the author of The Coming Plague, Laurie Garrett. Her 1995 book helped Burns consider a variety of potential plots for the film. He wanted to feature an official from the CDC, and ultimately decided to use an epidemiologist, since that role requires interacting with people while tracking the disease.
Although he had done research on pandemics six months prior to the 2009 flu pandemic, the outbreak was "really helpful" to his studies, because it provided a glimpse of the societal apparatus following the onset stages of a pandemic. To him, it was not solely the virus itself that one had to be concerned about, but how society handles the situation. "I saw them come to life", Burns said, "and I saw issues about, 'Well, do you close the schools and if you close the schools, then who stays home with the kids? And will everyone keep their kids at home?' Things happening online, which is where the Jude Law character came from, that there's going to be information that comes out online where people want to be ahead of the curve, so some people will write things about anti-virals or different treatment protocols, and so there's always going to be an information and that information also has sort of a viral pulse."
Filming
In conjunction with overseeing the directing process, Soderbergh functioned as a cinematographer for Contagion. The film was wholly shot using Red Digital Cinema Camera Company's RED One MX digital camera, which uses ambient light and has a 4.5K image resolution. Since he hoped for the premise to be authentic and "as realistic as possible", Soderbergh opted not to film in the studio. "There's, to me, nothing more satisfying occasionally than making someplace look like someplace else on film and having nobody know the difference." For choosing cities, Soderbergh felt that they couldn't "go anywhere where one of our characters hasn't been", since he wanted to portray an "epic", yet "intimate" scenario. He explained,
We can't cut to a city or a group of extras that we've never been to that we don’t know personally. That was our rule. And that’s a pretty significant rule to adhere to in a movie in which you're trying to give a sense of something that’s happening on a large scale, but we felt that all of the elements that we had issues with prior, when we see any kind of disaster film, we're centered around that idea.
Principal photography started in Hong Kong in September 2010, and continued for approximately two weeks. Soderbergh was originally hoping to also film in mainland China, though Moviefone journalist David Ehrlich believed that permission from the Chinese government was unlikely to be forthcoming. Although producers also intended to establish a filming location in one of the many casinos in Macau, the Jumbo Floating Restaurant in Hong Kong's Aberdeen Harbour was used instead for the casino setting, as filming within the vicinity of a gambling establishment is prohibited by law. To move the equipment for the casino scenes to the on-the-water location, producers hired a number of locals to carry out the task, as they were accustomed to "using sampans like trucks". Additional locations included the Hong Kong International Airport, InterContinental Hong Kong, and the Princess Margaret Hospital.
Some of Chicago's landscape provided for the setting of Minneapolis and Atlanta.
Principal photography relocated in the following month to Chicago, Illinois, which served as the nexus for production. Much of the cityscape and its surrounding suburbs were used to emulate Minneapolis, Minnesota, and Atlanta, Georgia, in addition to serving as backdrop for Chicago itself. Since principal photography occurred during the winter months, snowfall was a prerequisite in simulating a "persistent coldness" that encompassed "a hypersensitive kind of glare".Within the city limits, filming locations were installed at the Shedd Aquarium, O'Hare International Airport, and the Midway Airport. Arguably the largest sets were at the General Jones Armory, which was converted into an infirmary, and a major location shoot occurred in Waukegan, where a portion of the Amstutz Expressway was used to simulate the Dan Ryan Expressway. Production also took place at Sherman Hospital in Elgin and Central Elementary School in Wilmette, and also in Downtown Western Springs, where the grocery store scene was filmed.
Filming moved once again in January 2011 to the Druid Hills quadrant of Atlanta, which contains the headquarters of the Centers for Disease Control and Prevention. The restricted nature of the CDC campus meant that producers were only allowed to shoot exterior scenes of the area, as well as within the parking garage and reception area for the CDC's museum onsite. Principal photography then proceeded into Atlanta's central business district and Decatur, before advancing to London, Geneva, and lastly San Francisco, California, in the ensuing month. The San Francisco Film Commission charged filmmakers $300 per day for production within the city limits. In the North Beach and Potrero Hill sections of the city, production designer Howard Cummings scattered trash and discarded clothing on the ground to depict the rapid decline of civilization. For the Civic Center set, over 2,000 extras were sought for in background roles; actors who were a part of the Screen Actors Guild were paid $139 per day, while nonunion workers received $64 per day for their work. Other filming locations were established at Golden Gate Park, Chinatown, and Candlestick Park; it cost $60,000 to rent the football stadium for six days.
Soundtrack
Cliff Martinez composed the film's soundtrack, which was his first score for Soderbergh since Solaris in 2002. Given that the pacing of the music was one of Soderbergh's biggest concerns, Martinez needed to maintain a brisk pace throughout the soundtrack, while also conveying fear and hope within the music. "I tried to create the sound of anxiety. And at key, strategic moments I tried to use the music to conjure up the sense of tragedy and loss." Martinez incorporated orchestral elements, and fused them with the predominantly electronic sounds of the score. He noted that the "sound palette for Contagion came by way of combining three very different approaches Steven went through as he was cutting the film." Martinez received a rough cut for the film in October 2010, which contained music that was imbued with elements of The French Connection (1971) and Marathon Man (1976). He "loved" those two soundtracks, and composed a few pieces in their style. A few months later, he acquired a new cut, which included music influenced by German electronic group Tangerine Dream. Toward the end, Soderbergh changed again and used contemporary soundtrack music that was "more energetic and more rhythmic". Ultimately, Martinez used aspects of all three approaches: "I reasoned that combining them would not only be effective but would give the score a style all its own."
Themes
An electron microscope image of the H1N1 influenza virus. The 2009 flu epidemic was a key influence on the creation of Contagion.
An electron microscope image of the SARS virus. The 2003 SARS outbreak was also an inspiration and influence of Contagion.
Steven Soderbergh was motivated to make an "ultra-realistic" film about the public health and scientific response to a pandemic.The movie touches on a variety of themes, including the factors which drive mass panic and collapse of social order, the scientific process for characterizing and containing a novel pathogen, balancing personal motives against professional responsibilities and rules in the face of an existential threat, the limitations and consequences of public health responses, and the pervasiveness of interpersonal connections which can serve as vectors to spread disease. Soderbergh acknowledged the salience of these post-apocalyptic themes is heightened by reactions to the September 11 attacks and Hurricane Katrina.The movie was intended to realistically convey the "intense" and "unnerving" social and scientific reactions to a pandemic. The recent real-life epidemics such as the 2003 SARS epidemic and the 2009 flu pandemic have been inspirations and influences in the film. The chain of contagion involving bats and pigs is reminiscent of the trail of the Nipah virus that originated in Malaysia in 1997, which similarly involved the disturbance of a bat colony by deforestation.
The film presents examples of crowd psychology and collective behavior which can lead to mass hysteria and the loss of social order. The bafflement, outrage, and helplessness associated with the lack of information, combined with new media such as blogs, allow conspiracy theorists like Krumwiede to spread disinformation and fear, which become dangerous contagions themselves. Dr. Cheever must balance the need for full disclosure but avoid a panic and allow the time to characterize and respond to an unknown virus. The movie indirectly critiques the greed, selfishness, and hypocrisy of isolated acts in contemporary culture and the unintended consequences they can have in the context of a pandemic. For example, the Centers for Disease Control and Prevention recommends social distancing by forcibly isolating the healthy to limit the spread of the disease, which stands in stark opposition to contemporary demands for social networking. Responding to the pandemic presents a paradox, as the contagiousness and lethality of the virus instills deep distrust of others but surviving and limiting the spread of the disease also requires individuals to work together.
Against this existential threat and fraying social order, the film also explores how individual characters bend or break existing rules for both selfish and selfless reasons.[28] Dr. Hextall violates protocols by testing a potential vaccine on herself, Dr. Sussman continues experiments on a cell line despite orders to destroy his samples, Dr. Cheever notifies his fiancé to leave the city before a public quarantine is imposed, Sun Feng kidnaps Dr. Orantes to secure vaccine supplies for his village, Dr. Mears continues her containment work despite contracting the virus, and Krumwiede is paid to use his blog to peddle snake oil cures so as to drive demand and profit for investors in Alternative Medicine. Soderbergh repeatedly uses the cinematographic style of lingering and focusing on the items and objects which are touched by the infected and become vectors (fomites) to infect other people. These objects link characters together and reinforce the multi-narrative hyperlink cinema style which Soderbergh developed in Traffic (2000) and Syriana (2005), which he produced.
The story also highlights examples of political cronyism (a plane to evacuate Dr. Mears from Minneapolis is instead diverted to evacuate a Congressman), platitudes and rigid thinking (public health officials consider postponing the closing of shopping malls until after the Thanksgiving shopping season), federal responders trying to navigate 50 separate state-level public health policies, and the heroism of Federal bureaucrats.Soderbergh does not use type-cast pharmaceutical executives or politicians as villains,but instead portrays bloggers such as Krumwiede in a negative light. Social media plays a role in Krumwiede's accusations against Dr. Cheever and in Emhoff's daughter's attempts to carry on a relationship with her boyfriend through text messaging. Other responses in the movie, such as Emhoff's appropriating a shotgun from a friend's abandoned house to protect his home from looters, imposition of federal quarantines and curfews, the allocation of vaccines by lottery, inadequate federal preparation and responses, and use of bar-coded wristbands to identify the inoculated highlight the complex tensions between freedom and order in responding to a pandemic. Soderbergh uses Emhoff to illustrate the micro-effects of macro-level decisions.
Reception
Release and box office
Contagion premiered on September 3, 2011 at the 68th Venice Film Festival in Venice, Italy, and a wider release followed on September 9. In the United States and Canada, Contagion was shown in 3,222 theaters, of which 254 screenings occurred at IMAX venues.Various American commercial analysts anticipated that the film would have ticket sales of between $20 million and $25 million during its opening weekend, which it did, grossing $8 million on its first day, and $23.1M for the entire weekend. Of that total, ten percent ($2.3M) of the gross came from IMAX screenings. By outgrossing competitor The Help ($8.7M), Contagion became the highest-grossing film of the week. Demographically, the opening audience was evenly divided among gender, according to Warner Bros., while eighty percent of spectators were of the age of 25 and over.Contagion did well the following weekend, generating a $14.5M box office, but came in second to the re-release of The Lion King (1994). The third week saw the box office drop by forty percent, for a total gross of $8.7M. By the fourth week, Contagion had dropped to ninth place at the box office with $5M, and the number of theaters narrowed to 2,744. The film completed its theatrical run on December 15, 2011, at which point its total domestic gross was $75.6M.
Contagion made its international debut in six foreign markets the same weekend as its American release, including Italy, where it achieved $663,000 from 309 theaters. The first week saw Contagion acquire $2.1M from 553 establishments—a per-theater average of $3,797. Foreign grosses for Contagion would remain relatively stagnant up until the weekend of October 14–16, 2011, when the film expanded into several additional European markets. Out of the $3.9M that was generated from 1,100 venues during that weekend, nearly 40% of the gross originated from Spain, where the film earned $1.5M from 325 theaters. With the growing expansion of the film in seven additional markets, the weekend of October 21–23, 2011 saw Contagion take in $9.8M from 2,505 locations, increasing the international gross to $22.9M.In the United Kingdom, one of the film's significant international releases, Contagion opened in third place at the box office with $2.3M from 398 theaters;it subsequently garnered the highest debut gross of a Soderbergh film since Ocean's Thirteen (2007).International grosses for Contagion stand at $59.8M.
Directed by
Steven Soderbergh
Produced by
Zakaria Alaoui...line producer: Casablanca
Chen On Chu...line producer: Hong Kong
Gregory Jacobs...producer
Jonathan King...executive producer
Michael Polaire...executive producer
Michael Shamberg...producer
Stacey Sher...producer
Jeff Skoll...executive producer
Ricky Strauss...executive producer
Written by
Scott Z. Burns
Starring
Marion Cotillard
Matt Damon
Laurence Fishburne
Jude Law
Gwyneth Paltrow
Kate Winslet
Music by
Cliff Martinez
Cinematography
Peter Andrews
Edited by
Stephen Mirrione
Production
company
Participant Media
Imagenation Abu Dhabi
Double Feature Films
Distributed by
Warner Bros. Pictures
Release date
- September 3, 2011(Venice Film Festival)
- September 9, 2011
Running time
106 minutes
Country
United States
United Arab Emirates
Language
English
Budget
$60 million
Box office
$135.5 million
Contagion is a 2011 American medical thriller-disaster film directed by Steven Soderbergh. The film features an ensemble cast that includes Marion Cotillard, Bryan Cranston, Matt Damon, Laurence Fishburne, Jude Law, Gwyneth Paltrow, Kate Winslet, and Jennifer Ehle. The plot of Contagion documents the spread of a virus transmitted by fomites, attempts by medical researchers and public health officials to identify and contain the disease, the loss of social order in a pandemic, and finally the introduction of a vaccine to halt its spread. To follow several interacting plot lines, the film makes use of the multi-narrative "hyperlink cinema" style, popularized in several of Soderbergh's films.
Soderbergh and screenwriter Scott Z. Burns had collaborated on The Informant! (2009). Following that film's release, Burns brought up the idea of producing a medical thriller film depicting the rapid spread of a virus, which was inspired by various pandemics such as the 2003 SARS epidemic and the 2009 flu pandemic. To devise an accurate perception of a pandemic event, Burns consulted with representatives of the World Health Organization as well as noted medical experts such as W. Ian Lipkin and Lawrence "Larry" Brilliant. Principal photography started in Hong Kong in September 2010, and continued in Chicago, Atlanta, London, Geneva, and San Francisco until February 2011.
Contagion premiered at the 68th Venice Film Festival in Venice, Italy on September 3, 2011, and went on general release on September 9. The film was well received by critics, who praised the narratives and the performances of various actors and actresses. It was also well received by scientists, who praised its accuracy. Commercially, the film was a box office success. Budgeted at $60 million, Contagion attained $135 million in box office revenue during its theatrical run.
Plot
Returning from a Hong Kong business trip, Beth Emhoff (Gwyneth Paltrow) has a layover in Chicago to rendezvous with a former lover before returning to her family in suburban Minneapolis. She appears to have contracted a cold during her trip. Her six-year-old son from a previous marriage, Clark, also becomes symptomatic and is sent home from school. Beth's condition worsens and two days later she collapses with severe seizures. Her husband, Mitch (Matt Damon), rushes her to the hospital, but she dies of an unknown cause.
Mitch returns home and finds that Clark has also died from a similar infection. Mitch is placed in isolation but seems to be immune to the disease. He is released and returns home to his teenaged daughter Jory, who had been living with Mitch's former wife and her husband and has decided to stay with Mitch since he's now all alone. As more and more persons become infected with no cure in sight, they face decaying social order and rampant looting of stores and homes. Mitch is unsure if Jory has inherited his immunity and he struggles with the frustration of quarantine, his desire to protect his daughter and learning that his wife was unfaithful to him immediately prior to both her death and that of his stepson.
In Atlanta, representatives of the Department of Homeland Security meet with Dr. Ellis Cheever (Laurence Fishburne) of the CDC and express fears that the disease is a bio weapon intended to cause terror over the Thanksgiving weekend. Dr. Cheever dispatches Dr. Erin Mears (Kate Winslet), an Epidemic Intelligence Service officer, to Minneapolis to begin investigating. Mears traces the outbreak back to Emhoff while negotiating with local bureaucrats initially reluctant to commit resources for a proper public health response to the virus. Dr. Mears later becomes infected and dies.
At the CDC, Dr. Ally Hextall (Jennifer Ehle) determines the virus is a mix of genetic material from pig and bat viruses. Work on a cure stalls because scientists cannot discover a cell culture within which to grow the newly identified Meningoencephalitis Virus One (MEV-1).
UCSF professor Dr. Ian Sussman (Elliott Gould) violates orders from Cheever (relayed through Hextall) to destroy his samples, and identifies a usable MEV-1 cell culture using bat cells. Hextall uses the breakthrough to work on a vaccine. Other scientists determine the virus is spread by fomites, with a basic reproduction number of four when the virus mutates, with projections of one in twelve of the population being infected, and a 25-30% mortality rate.
Conspiracy theorist Alan Krumwiede (Jude Law) posts videos about the virus on his popular blog. In one video, he shows himself sick and later claims he recovered using a homeopathic cure derived from forsythia. In a panic, people seeking forsythia overwhelm pharmacies, spreading and accelerating the contagion as the infected come into contact with healthy people.
Krumwiede's claims attract national attention. During a television interview he discloses that Dr. Cheever had secretly informed friends and family to leave Chicago just before the city was quarantined. Cheever is then informed the government will investigate and may charge him for leaking information. Later it is revealed Krumwiede had faked being infected by the virus in an attempt to increase profits for shareholders in companies producing and selling forsythia. Krumwiede is arrested for conspiracy and securities fraud, only to walk free when his many supporters successfully raise funds to provide for his bail.
Using an attenuated virus Dr. Hextall identifies a possible vaccine. To cut out the lengthy time it would take to obtain informed consent from infected patients, Dr. Hextall inoculates herself with the experimental vaccine and immediately visits her gravely ill father, who has been infected with MEV-1. The doctor does not contract MEV-1 and the vaccine is declared a success.
The vaccine's production is rapidly increased, but due to limited production, the CDC awards vaccinations by lottery based on birth date. Inoculations take place for one full year until every survivor is vaccinated. First responders, doctors and others designated by the government are declared exempt from the lottery. Dr. Cheever gives his fast-tracked MEV-1 vaccination to the son of Roger (John Hawkes), a CDC janitor who had overheard Dr. Cheever's phone call warning his girlfriend to leave Chicago.
Dr. Leonora Orantes (Marion Cotillard), a WHO epidemiologist, travels to Hong Kong to follow the Beth Emhoff lead. She collaborates with Sun Feng (Chin Han) and other local epidemiologists and public health officials; they identify Emhoff as patient zero. As the virus spreads, Feng kidnaps Orantes to use her as leverage to obtain MEV-1 vaccine doses for his village. Orantes spends months living with the villagers until the vaccine is announced. Feng exchanges Orantes for the vaccine doses. Her colleague mentions that the exchanged doses were placebos and Orantes rushes away to warn them.
The death toll reached 2.5 million in the U.S. and 26 million worldwide. Dr. Hextall places samples of MEV-1 in cryogenic storage, alongside samples of H1N1 and SARS.
The source of the virus is revealed to viewers. A bulldozer (coincidently, operating for the company Emhoff worked for) knocks down a palm tree disturbing some bats, with one finding shelter and food in a banana tree. That bat then flies over a pig pen, dropping a chunk of banana from its mouth, which is then eaten by a piglet. Chinese chefs later collect pigs from the pen and take them to a Hong Kong casino. A chef is called away from his preparations of a piglet, and casually wipes his hands on his apron. The chef then shakes hands with Beth Emhoff, giving her the mix of bat and pig viruses that makes her patient zero and the origin of the MEV-1 virus.
Cast and characterizations
- Marion Cotillard as Dr. Leonora Orantes
Matt Damon, a frequent collaborator of Soderbergh's, was chosen to portray Mitch Emhoff.
- Matt Damon as Mitch Emhoff
- Laurence Fishburne as Dr. Ellis Cheever
- Jude Law as Alan Krumwiede
- Gwyneth Paltrow as Elizabeth "Beth" Emhoff
Kate Winslet traveled to the Centers for Disease Control and Prevention, where she met with many of the employees to research her character.
- Kate Winslet as Dr. Erin Mears
- Jennifer Ehle as Dr. Ally Hextall
- Elliott Gould as Dr. Ian Sussman
- Chin Han as Sun Feng
- Bryan Cranston as Rear Admiral Lyle Haggerty, United States Public Health Service Commissioned Corps
- John Hawkes as Roger, CDC custodian and acquaintance of Dr. Cheever
- Anna Jacoby-Heron as Jory Emhoff, daughter of Mitch Emoff
- Josie Ho as Li Fai's sister
- Sanaa Lathan as Aubrey Cheever, fiancée of Dr. Cheever
- Demetri Martin as Dr. David Eisenberg, CDC colleague of Dr. Hextall
- Armin Rohde as Damian Leopold, a WHO official
- Enrico Colantoni as Dennis French, a Department of Homeland Security official
- Larry Clarke as Dave, a Minnesota health official working with Dr. Mears
- Monique Gabriela Curnen as Lorraine Vasquez, a print journalist in San Francisco
- Amr Waked as Rafik
- Matt Motyka as Minnesota Body Burial Worker
Conception and writing
There's a scene in The Informant! where Matt (Damon) is watching Scott Bakula's character talk on the phone and Scott coughs on the phone, and there's this whole rant that Matt goes off on of 'Oh, great, now what happens? He gets sick and then I'm going to get it, my kids are going to get it.' I've always been fascinated by transmissibility, so I said to Steven, 'I want to do an interesting thriller version of a pandemic movie' and he said, 'Great! Let's do that instead.'
“
”
Scott Z. Burns.
Concerted efforts to devise Contagion coincided with Burns' collaboration with Soderbergh in The Informant! (2009). The duo had initially planned to create a biographical film on Leni Riefenstahl, a trailblazer in German cinema during the 1930s and a figure in the rise of the Nazi Party. Soderbergh later contacted Burns to cancel the project, as he thought that a film about Riefenstahl would struggle to attract an audience. Intrigued with the field of transmission, Burns suggested that they instead create a film that centered on a pandemic situation—"an interesting thriller version of a pandemic movie". His main objective was to construct a medical thriller that "really felt like what could happen".
Burns consulted with Lawrence "Larry" Brilliant, renowned for his work in eradicating smallpox, to develop an accurate perception of a pandemic event. He had seen one of Brilliant's TED presentations, which he was fascinated by, and realized that "the point of view of people within that field isn't 'If this is going to happen', it's 'When is this going to happen?'"Brilliant introduced Burns to another specialist, W. Ian Lipkin. With the aid of these physicians, the producers were able to obtain additional perspectives from representatives of the World Health Organization. Burns also met with the author of The Coming Plague, Laurie Garrett. Her 1995 book helped Burns consider a variety of potential plots for the film. He wanted to feature an official from the CDC, and ultimately decided to use an epidemiologist, since that role requires interacting with people while tracking the disease.
Although he had done research on pandemics six months prior to the 2009 flu pandemic, the outbreak was "really helpful" to his studies, because it provided a glimpse of the societal apparatus following the onset stages of a pandemic. To him, it was not solely the virus itself that one had to be concerned about, but how society handles the situation. "I saw them come to life", Burns said, "and I saw issues about, 'Well, do you close the schools and if you close the schools, then who stays home with the kids? And will everyone keep their kids at home?' Things happening online, which is where the Jude Law character came from, that there's going to be information that comes out online where people want to be ahead of the curve, so some people will write things about anti-virals or different treatment protocols, and so there's always going to be an information and that information also has sort of a viral pulse."
Filming
In conjunction with overseeing the directing process, Soderbergh functioned as a cinematographer for Contagion. The film was wholly shot using Red Digital Cinema Camera Company's RED One MX digital camera, which uses ambient light and has a 4.5K image resolution. Since he hoped for the premise to be authentic and "as realistic as possible", Soderbergh opted not to film in the studio. "There's, to me, nothing more satisfying occasionally than making someplace look like someplace else on film and having nobody know the difference." For choosing cities, Soderbergh felt that they couldn't "go anywhere where one of our characters hasn't been", since he wanted to portray an "epic", yet "intimate" scenario. He explained,
We can't cut to a city or a group of extras that we've never been to that we don’t know personally. That was our rule. And that’s a pretty significant rule to adhere to in a movie in which you're trying to give a sense of something that’s happening on a large scale, but we felt that all of the elements that we had issues with prior, when we see any kind of disaster film, we're centered around that idea.
Principal photography started in Hong Kong in September 2010, and continued for approximately two weeks. Soderbergh was originally hoping to also film in mainland China, though Moviefone journalist David Ehrlich believed that permission from the Chinese government was unlikely to be forthcoming. Although producers also intended to establish a filming location in one of the many casinos in Macau, the Jumbo Floating Restaurant in Hong Kong's Aberdeen Harbour was used instead for the casino setting, as filming within the vicinity of a gambling establishment is prohibited by law. To move the equipment for the casino scenes to the on-the-water location, producers hired a number of locals to carry out the task, as they were accustomed to "using sampans like trucks". Additional locations included the Hong Kong International Airport, InterContinental Hong Kong, and the Princess Margaret Hospital.
Some of Chicago's landscape provided for the setting of Minneapolis and Atlanta.
Principal photography relocated in the following month to Chicago, Illinois, which served as the nexus for production. Much of the cityscape and its surrounding suburbs were used to emulate Minneapolis, Minnesota, and Atlanta, Georgia, in addition to serving as backdrop for Chicago itself. Since principal photography occurred during the winter months, snowfall was a prerequisite in simulating a "persistent coldness" that encompassed "a hypersensitive kind of glare".Within the city limits, filming locations were installed at the Shedd Aquarium, O'Hare International Airport, and the Midway Airport. Arguably the largest sets were at the General Jones Armory, which was converted into an infirmary, and a major location shoot occurred in Waukegan, where a portion of the Amstutz Expressway was used to simulate the Dan Ryan Expressway. Production also took place at Sherman Hospital in Elgin and Central Elementary School in Wilmette, and also in Downtown Western Springs, where the grocery store scene was filmed.
Filming moved once again in January 2011 to the Druid Hills quadrant of Atlanta, which contains the headquarters of the Centers for Disease Control and Prevention. The restricted nature of the CDC campus meant that producers were only allowed to shoot exterior scenes of the area, as well as within the parking garage and reception area for the CDC's museum onsite. Principal photography then proceeded into Atlanta's central business district and Decatur, before advancing to London, Geneva, and lastly San Francisco, California, in the ensuing month. The San Francisco Film Commission charged filmmakers $300 per day for production within the city limits. In the North Beach and Potrero Hill sections of the city, production designer Howard Cummings scattered trash and discarded clothing on the ground to depict the rapid decline of civilization. For the Civic Center set, over 2,000 extras were sought for in background roles; actors who were a part of the Screen Actors Guild were paid $139 per day, while nonunion workers received $64 per day for their work. Other filming locations were established at Golden Gate Park, Chinatown, and Candlestick Park; it cost $60,000 to rent the football stadium for six days.
Soundtrack
Cliff Martinez composed the film's soundtrack, which was his first score for Soderbergh since Solaris in 2002. Given that the pacing of the music was one of Soderbergh's biggest concerns, Martinez needed to maintain a brisk pace throughout the soundtrack, while also conveying fear and hope within the music. "I tried to create the sound of anxiety. And at key, strategic moments I tried to use the music to conjure up the sense of tragedy and loss." Martinez incorporated orchestral elements, and fused them with the predominantly electronic sounds of the score. He noted that the "sound palette for Contagion came by way of combining three very different approaches Steven went through as he was cutting the film." Martinez received a rough cut for the film in October 2010, which contained music that was imbued with elements of The French Connection (1971) and Marathon Man (1976). He "loved" those two soundtracks, and composed a few pieces in their style. A few months later, he acquired a new cut, which included music influenced by German electronic group Tangerine Dream. Toward the end, Soderbergh changed again and used contemporary soundtrack music that was "more energetic and more rhythmic". Ultimately, Martinez used aspects of all three approaches: "I reasoned that combining them would not only be effective but would give the score a style all its own."
Themes
An electron microscope image of the H1N1 influenza virus. The 2009 flu epidemic was a key influence on the creation of Contagion.
An electron microscope image of the SARS virus. The 2003 SARS outbreak was also an inspiration and influence of Contagion.
Steven Soderbergh was motivated to make an "ultra-realistic" film about the public health and scientific response to a pandemic.The movie touches on a variety of themes, including the factors which drive mass panic and collapse of social order, the scientific process for characterizing and containing a novel pathogen, balancing personal motives against professional responsibilities and rules in the face of an existential threat, the limitations and consequences of public health responses, and the pervasiveness of interpersonal connections which can serve as vectors to spread disease. Soderbergh acknowledged the salience of these post-apocalyptic themes is heightened by reactions to the September 11 attacks and Hurricane Katrina.The movie was intended to realistically convey the "intense" and "unnerving" social and scientific reactions to a pandemic. The recent real-life epidemics such as the 2003 SARS epidemic and the 2009 flu pandemic have been inspirations and influences in the film. The chain of contagion involving bats and pigs is reminiscent of the trail of the Nipah virus that originated in Malaysia in 1997, which similarly involved the disturbance of a bat colony by deforestation.
The film presents examples of crowd psychology and collective behavior which can lead to mass hysteria and the loss of social order. The bafflement, outrage, and helplessness associated with the lack of information, combined with new media such as blogs, allow conspiracy theorists like Krumwiede to spread disinformation and fear, which become dangerous contagions themselves. Dr. Cheever must balance the need for full disclosure but avoid a panic and allow the time to characterize and respond to an unknown virus. The movie indirectly critiques the greed, selfishness, and hypocrisy of isolated acts in contemporary culture and the unintended consequences they can have in the context of a pandemic. For example, the Centers for Disease Control and Prevention recommends social distancing by forcibly isolating the healthy to limit the spread of the disease, which stands in stark opposition to contemporary demands for social networking. Responding to the pandemic presents a paradox, as the contagiousness and lethality of the virus instills deep distrust of others but surviving and limiting the spread of the disease also requires individuals to work together.
Against this existential threat and fraying social order, the film also explores how individual characters bend or break existing rules for both selfish and selfless reasons.[28] Dr. Hextall violates protocols by testing a potential vaccine on herself, Dr. Sussman continues experiments on a cell line despite orders to destroy his samples, Dr. Cheever notifies his fiancé to leave the city before a public quarantine is imposed, Sun Feng kidnaps Dr. Orantes to secure vaccine supplies for his village, Dr. Mears continues her containment work despite contracting the virus, and Krumwiede is paid to use his blog to peddle snake oil cures so as to drive demand and profit for investors in Alternative Medicine. Soderbergh repeatedly uses the cinematographic style of lingering and focusing on the items and objects which are touched by the infected and become vectors (fomites) to infect other people. These objects link characters together and reinforce the multi-narrative hyperlink cinema style which Soderbergh developed in Traffic (2000) and Syriana (2005), which he produced.
The story also highlights examples of political cronyism (a plane to evacuate Dr. Mears from Minneapolis is instead diverted to evacuate a Congressman), platitudes and rigid thinking (public health officials consider postponing the closing of shopping malls until after the Thanksgiving shopping season), federal responders trying to navigate 50 separate state-level public health policies, and the heroism of Federal bureaucrats.Soderbergh does not use type-cast pharmaceutical executives or politicians as villains,but instead portrays bloggers such as Krumwiede in a negative light. Social media plays a role in Krumwiede's accusations against Dr. Cheever and in Emhoff's daughter's attempts to carry on a relationship with her boyfriend through text messaging. Other responses in the movie, such as Emhoff's appropriating a shotgun from a friend's abandoned house to protect his home from looters, imposition of federal quarantines and curfews, the allocation of vaccines by lottery, inadequate federal preparation and responses, and use of bar-coded wristbands to identify the inoculated highlight the complex tensions between freedom and order in responding to a pandemic. Soderbergh uses Emhoff to illustrate the micro-effects of macro-level decisions.
Reception
Release and box office
Contagion premiered on September 3, 2011 at the 68th Venice Film Festival in Venice, Italy, and a wider release followed on September 9. In the United States and Canada, Contagion was shown in 3,222 theaters, of which 254 screenings occurred at IMAX venues.Various American commercial analysts anticipated that the film would have ticket sales of between $20 million and $25 million during its opening weekend, which it did, grossing $8 million on its first day, and $23.1M for the entire weekend. Of that total, ten percent ($2.3M) of the gross came from IMAX screenings. By outgrossing competitor The Help ($8.7M), Contagion became the highest-grossing film of the week. Demographically, the opening audience was evenly divided among gender, according to Warner Bros., while eighty percent of spectators were of the age of 25 and over.Contagion did well the following weekend, generating a $14.5M box office, but came in second to the re-release of The Lion King (1994). The third week saw the box office drop by forty percent, for a total gross of $8.7M. By the fourth week, Contagion had dropped to ninth place at the box office with $5M, and the number of theaters narrowed to 2,744. The film completed its theatrical run on December 15, 2011, at which point its total domestic gross was $75.6M.
Contagion made its international debut in six foreign markets the same weekend as its American release, including Italy, where it achieved $663,000 from 309 theaters. The first week saw Contagion acquire $2.1M from 553 establishments—a per-theater average of $3,797. Foreign grosses for Contagion would remain relatively stagnant up until the weekend of October 14–16, 2011, when the film expanded into several additional European markets. Out of the $3.9M that was generated from 1,100 venues during that weekend, nearly 40% of the gross originated from Spain, where the film earned $1.5M from 325 theaters. With the growing expansion of the film in seven additional markets, the weekend of October 21–23, 2011 saw Contagion take in $9.8M from 2,505 locations, increasing the international gross to $22.9M.In the United Kingdom, one of the film's significant international releases, Contagion opened in third place at the box office with $2.3M from 398 theaters;it subsequently garnered the highest debut gross of a Soderbergh film since Ocean's Thirteen (2007).International grosses for Contagion stand at $59.8M.
Superbug C. auris identified in 122 people across 7 states, CDC saysBy Susan Scutti, CNN
Updated 8:54 PM ET, Thu May 18, 2017
JUST WATCHEDHow bugs become superbugs
Story highlights
The fungus, Candida auris, can cause severe illness with high mortality, especially among high-risk patients, including those in intensive care units, those with a central venous catheter and those who have received antibiotics or antifungal medications.
"It seems to affect the sickest of the sick patients, particularly those in hospitals and nursing homes with other medical problems," said Sharon Tsay, lead author and an Epidemic Intelligence Service officer at the CDC.A total of 77 US clinical (in hospitals) cases of C. auris were reported in seven states. After the patients' close contacts were screened, an additional 45 cases were identified, resulting in 122 US patients with the fungal infection as of May 12. Among the 77 clinical cases, the patients' average age was 70, and more than half, 55%, were men.
CDC identifies first US cases of drug-resistant fungal infection
None of the infections reported in the US was resistant to all available antifungals, Tsay said.
Paige Armstrong, an Epidemic Intelligence Service officer for the CDC, said the multidrug-resistant fungus has been causing outbreaks in health care facilities worldwide.
"This is a fungus that's acting a lot like some super bacteria that we've seen previously," she said.'Very concerning'
The CDC issued its first alert in June of last year, telling US hospitals to be aware of this fungus based on reports of spreading infections in health care facilities around the world.
The clinical cases, all identified through cultures taken as part of routine patient care, occurred in New York (53 cases), New Jersey (16), Illinois (four) and one each in Indiana, Maryland, Massachusetts and Oklahoma.
The patients who were identified by screening because they were contacts of the initial cases, though colonized with the fungus, do not show any symptoms of an infection. Most of these people were patients on the same ward in health care facilities.
"Most cases of C. auris that have been reported have been from the blood," Tsay wrote in an email, though she noted that it has also been seen in urine, the respiratory tract, wounds, bile fluid and the ear.
Why NASA sent a superbug to the space station
"The fact that it has been found in other sites may also reflect its ability to persist on a patient's body and be spread in the environment around them -- one of (the) reasons that C. auris is causing outbreaks," Tsay said.
First identified in Japan in 2009, C. auris has now been named as the cause of reported infections in more than a dozen countries. In August, the CDC described the first seven cases of infection in the US, most dating to the previous year and one in 2013.
Some strains of C. auris are resistant to all three major classes of antifungal drugs. But most cases that have been seen in the US have been treatable with antifungal drugs.
Armstrong recently investigated an outbreak in Colombia, working with health authorities there to learn more about how C. auris spreads.
The fact that this fungus is showing resistance to the existing three classes of antifungal drugs, "leaving no medication to treat" patients, is "obviously very concerning," Armstrong said. Multidrug resistance has not been seen in other species of Candida.
"The fact that it's causing outbreaks in hospitals and other health care settings (is) something we typically don't see with fungus," Armstrong said.
Another concern is that testing of patients' rooms identified C. auris on mattresses, beds, windowsills, chairs, infusion pumps and countertops. This ability to linger on the surfaces of health care environments and spread between patients is unlike most of the other 20 species of Candida that cause infections in humans.Invasive infections
"Typically, fungus and particularly candida species are commensal organisms or organisms that live within us, that live within our guts," Armstrong said.
Infections can occur due to overgrowth, known as candidiasis. If it develops in the mouth or throat, it is called thrush. If it develops in the vagina, it is commonly referred to as a yeast infection. And if the Candida species enters the bloodstream and spreads through the body, this is an invasive candidiasis.
It is possible, though not likely, for an invasive infection to occur at times of surgery, prolonged hospitalization, an ICU stay or while taking a high number of antibiotics, Armstrong said.
Research highlights Americans' vulnerability to infectious diseases
"With C. auris, we're actually seeing this happen," she said, and not only among high-risk people.
"We're also seeing it in some patients that don't always fit all those characteristics, and then additionally, we're seeing it spread from person to person or the environment to people, and that's kind of the impetus for the reason why it's causing these outbreaks."
"The reason this is happening, the reason it's causing outbreaks, is because it's colonizing the skin at levels we don't typically see with most other species of Candida," Armstrong said.
Nicole Kirgan, a spokeswoman for the New Jersey Department of Health, said it is tracking cases throughout the state, performing ongoing investigations at some health care facilities, while working with the CDC and remaining "in close correspondence" with New York state.
"Risk factors include recent surgery, diabetes, broad-spectrum antibiotic and antifungal use (broad-spectrum means they protect against a wide variety of bacteria or fungus), and central venous catheter use," Kirgan wrote in an email.
"Infections have been found in patients of all ages, from pre-term infants to the elderly," she said. "The majority of patients identified with C. auris infections have had weakened immune systems."
What patients can do to prevent surgical site infections
Cases in New York have been concentrated among hospital patients and nursing home residents in the New York City area, with a single patient in Rochester who'd been treated in a New York City facility, according to a statewide health advisory issued May 5 by New York State Health Commissioner Dr. Howard Zucker.
Among New York state's 71 total cases -- 53 clinical cases, with an additional 18 screening cases -- 20 deaths have occurred as of May 5. Since all the patients had serious underlying medical conditions, it is difficult to attribute any deaths specifically to C. auris.
"It is important for New Yorkers to understand C. auris poses no risk to the general public," Zucker said. "C. auris is an opportunistic infection which primarily impacts patients who are already ill for other reasons."Origins and prevention
Armstrong said that "whether or not it started in one place and spread to other countries" is of interest to the CDC, which used whole genome sequencing to determine the origins of the fungus causing infections in US patients. Based on the gene data, CDC scientists say, the fungus didn't "look like it started in one place and moved around."
"There are four different families or groups that emerged simultaneously ... and independently," Armstrong said.
WHO: These 12 bacteria pose greatest risk to human health
Fungus samples in each state were highly related, the new CDC report indicates. All the New York cases, with one exception (plus a related screening case), came from the same genetic group as samples from South Asia. Though distinct from samples in New York, the New Jersey fungal infections were also related to those found in South Asia. Illinois cases showed a relationship to those found in South America.
"Resistance has also varied within those groups. We don't think it's necessarily spreading around the world, so to speak, but at the same time, when it does emerge somewhere, there's obviously concern that it will spread within the health care facilities or person to person," Armstrong said.
Join the conversationSee the latest news and share your comments with CNN Health on Facebook and Twitter.
Prevention is often a matter of good infection control and standard precautions, including good hand washing and hygiene, and personal protective equipment.
After a thorough cleaning with a sodium hypochlorite-based disinfectant, the fungus could not be found in the rooms of patients infected with C. auris.
"C. auris is still relatively rare in the United States and CDC is working hard to contain its spread," said Tsay, who noted that most people are at low risk of getting infected. "One of the best ways to prevent the spread of germs like C. auris in healthcare settings is good hand hygiene."
Updated 8:54 PM ET, Thu May 18, 2017
JUST WATCHEDHow bugs become superbugs
Story highlights
- C. auris has spread through hospitals and nursing homes, especially those already sick
- The first US cases of the fungal infection occurred in 2013 but weren't identified at the time
- None of the infections reported in the US has been resistant to all medicines
The fungus, Candida auris, can cause severe illness with high mortality, especially among high-risk patients, including those in intensive care units, those with a central venous catheter and those who have received antibiotics or antifungal medications.
"It seems to affect the sickest of the sick patients, particularly those in hospitals and nursing homes with other medical problems," said Sharon Tsay, lead author and an Epidemic Intelligence Service officer at the CDC.A total of 77 US clinical (in hospitals) cases of C. auris were reported in seven states. After the patients' close contacts were screened, an additional 45 cases were identified, resulting in 122 US patients with the fungal infection as of May 12. Among the 77 clinical cases, the patients' average age was 70, and more than half, 55%, were men.
CDC identifies first US cases of drug-resistant fungal infection
None of the infections reported in the US was resistant to all available antifungals, Tsay said.
Paige Armstrong, an Epidemic Intelligence Service officer for the CDC, said the multidrug-resistant fungus has been causing outbreaks in health care facilities worldwide.
"This is a fungus that's acting a lot like some super bacteria that we've seen previously," she said.'Very concerning'
The CDC issued its first alert in June of last year, telling US hospitals to be aware of this fungus based on reports of spreading infections in health care facilities around the world.
The clinical cases, all identified through cultures taken as part of routine patient care, occurred in New York (53 cases), New Jersey (16), Illinois (four) and one each in Indiana, Maryland, Massachusetts and Oklahoma.
The patients who were identified by screening because they were contacts of the initial cases, though colonized with the fungus, do not show any symptoms of an infection. Most of these people were patients on the same ward in health care facilities.
"Most cases of C. auris that have been reported have been from the blood," Tsay wrote in an email, though she noted that it has also been seen in urine, the respiratory tract, wounds, bile fluid and the ear.
Why NASA sent a superbug to the space station
"The fact that it has been found in other sites may also reflect its ability to persist on a patient's body and be spread in the environment around them -- one of (the) reasons that C. auris is causing outbreaks," Tsay said.
First identified in Japan in 2009, C. auris has now been named as the cause of reported infections in more than a dozen countries. In August, the CDC described the first seven cases of infection in the US, most dating to the previous year and one in 2013.
Some strains of C. auris are resistant to all three major classes of antifungal drugs. But most cases that have been seen in the US have been treatable with antifungal drugs.
Armstrong recently investigated an outbreak in Colombia, working with health authorities there to learn more about how C. auris spreads.
The fact that this fungus is showing resistance to the existing three classes of antifungal drugs, "leaving no medication to treat" patients, is "obviously very concerning," Armstrong said. Multidrug resistance has not been seen in other species of Candida.
"The fact that it's causing outbreaks in hospitals and other health care settings (is) something we typically don't see with fungus," Armstrong said.
Another concern is that testing of patients' rooms identified C. auris on mattresses, beds, windowsills, chairs, infusion pumps and countertops. This ability to linger on the surfaces of health care environments and spread between patients is unlike most of the other 20 species of Candida that cause infections in humans.Invasive infections
"Typically, fungus and particularly candida species are commensal organisms or organisms that live within us, that live within our guts," Armstrong said.
Infections can occur due to overgrowth, known as candidiasis. If it develops in the mouth or throat, it is called thrush. If it develops in the vagina, it is commonly referred to as a yeast infection. And if the Candida species enters the bloodstream and spreads through the body, this is an invasive candidiasis.
It is possible, though not likely, for an invasive infection to occur at times of surgery, prolonged hospitalization, an ICU stay or while taking a high number of antibiotics, Armstrong said.
Research highlights Americans' vulnerability to infectious diseases
"With C. auris, we're actually seeing this happen," she said, and not only among high-risk people.
"We're also seeing it in some patients that don't always fit all those characteristics, and then additionally, we're seeing it spread from person to person or the environment to people, and that's kind of the impetus for the reason why it's causing these outbreaks."
"The reason this is happening, the reason it's causing outbreaks, is because it's colonizing the skin at levels we don't typically see with most other species of Candida," Armstrong said.
Nicole Kirgan, a spokeswoman for the New Jersey Department of Health, said it is tracking cases throughout the state, performing ongoing investigations at some health care facilities, while working with the CDC and remaining "in close correspondence" with New York state.
"Risk factors include recent surgery, diabetes, broad-spectrum antibiotic and antifungal use (broad-spectrum means they protect against a wide variety of bacteria or fungus), and central venous catheter use," Kirgan wrote in an email.
"Infections have been found in patients of all ages, from pre-term infants to the elderly," she said. "The majority of patients identified with C. auris infections have had weakened immune systems."
What patients can do to prevent surgical site infections
Cases in New York have been concentrated among hospital patients and nursing home residents in the New York City area, with a single patient in Rochester who'd been treated in a New York City facility, according to a statewide health advisory issued May 5 by New York State Health Commissioner Dr. Howard Zucker.
Among New York state's 71 total cases -- 53 clinical cases, with an additional 18 screening cases -- 20 deaths have occurred as of May 5. Since all the patients had serious underlying medical conditions, it is difficult to attribute any deaths specifically to C. auris.
"It is important for New Yorkers to understand C. auris poses no risk to the general public," Zucker said. "C. auris is an opportunistic infection which primarily impacts patients who are already ill for other reasons."Origins and prevention
Armstrong said that "whether or not it started in one place and spread to other countries" is of interest to the CDC, which used whole genome sequencing to determine the origins of the fungus causing infections in US patients. Based on the gene data, CDC scientists say, the fungus didn't "look like it started in one place and moved around."
"There are four different families or groups that emerged simultaneously ... and independently," Armstrong said.
WHO: These 12 bacteria pose greatest risk to human health
Fungus samples in each state were highly related, the new CDC report indicates. All the New York cases, with one exception (plus a related screening case), came from the same genetic group as samples from South Asia. Though distinct from samples in New York, the New Jersey fungal infections were also related to those found in South Asia. Illinois cases showed a relationship to those found in South America.
"Resistance has also varied within those groups. We don't think it's necessarily spreading around the world, so to speak, but at the same time, when it does emerge somewhere, there's obviously concern that it will spread within the health care facilities or person to person," Armstrong said.
Join the conversationSee the latest news and share your comments with CNN Health on Facebook and Twitter.
Prevention is often a matter of good infection control and standard precautions, including good hand washing and hygiene, and personal protective equipment.
After a thorough cleaning with a sodium hypochlorite-based disinfectant, the fungus could not be found in the rooms of patients infected with C. auris.
"C. auris is still relatively rare in the United States and CDC is working hard to contain its spread," said Tsay, who noted that most people are at low risk of getting infected. "One of the best ways to prevent the spread of germs like C. auris in healthcare settings is good hand hygiene."