(Spoilers. And things.)

After the start of season 4 of the Walking Dead and the introduction of a new nemesis: a fast-spreading, deadly infectious disease that seems to be a strain of influenza, I was looking forward to the plot arc of this season.

And then episode 3, “Isolation”, happened. From an infectious disease standpoint, I say, bah.

At the end of the previous episode, “Infected”, the group had decided to lock up anyone who was showing signs of the infectious disease within the death row cellblock, so that they would not further spread the disease, and to put the children and elderly (as the most vulnerable population) in another area to keep them safe from the infection. Quickly it was seen that this wasn’t working well, as people were becoming sick all over and more and more were moving into the isolation cellblock.

So, a council meeting was called of the leaders of the group. One of the decisions which was made, on the advice of Hershel the veterinarian, was to try to scavenge supplies from a college of veterinary medicine approximately 50 miles away from their location at the prison. What supplies?

ANTIBIOTICS.

For the micro people reading, you’ll see why my rage started boiling a bit at this point. Hershel was the one who’d suggested this was an influenza outbreak (and therefore, caused by a virus) in the prior episode. He is familiar with the disease (and there is another physician, Dr. Subramanian, who has been treating the ill and has seen the rapid course of the disease–of course, he is now sick himself). It is true that influenza can be complicated by a secondary bacterial infection: that those sick with the flu could develop pneumonia due to Staphylococcus aureus or other bacteria, and that these bacterial infections would respond to antibiotic treatment. But, when the course of disease is as rapid as it appears to be during this outbreak, it’s more likely that people are dying from primary influenza infections, which are most certainly NOT treatable with antibiotics. There are antiviral drugs that can treat influenza infections if given early in the disease course (such as oseltamivir or zanamivir ), but I think the odds of those being stocked at a veterinary school would be pretty slim.

So, rather than at least try for some kind of medically plausible scenario (is that really too much to ask?), Daryl, Michonne, Tyreese and Bob the medic take off in search of completely ineffective antibiotics,and run into an enormous zombie horde on the way. Hershel, in the interim, leaves the relative safety of the prison (he was ensconced with the children as a “high risk” individual) and wanders out into the woods to pick berries and leaves to brew elderberry tea. A folk remedy, there are a few peer-reviewed publications which suggest that elderberries or elder flower might have some properties that do work to treat influenza, so at least here Hershel is, well, sucking somewhat less here when it comes to proposing medical interventions to help those suffering than he did with his terrible antibiotics idea.

Hershel does end up with his tea, taking it into the isolation cell block and distributing it to the infected. This includes Dr. Subramanian, who repays the favor by coughing bloody sputum all over Hershel’s face. (Seriously, he doesn’t even know how to cough into his elbow? Even the little girl talking to Carol did that correctly).

From the previews of next week’s episode, “Indifference”, it appears there will be more searches for drugs, while presumably the horde advances toward the prison. I anticipate a miracle cure of some kind for Glenn at the least, but remain annoyed that the writers are touting antibiotics for a viral infection when flu season is upon us.

See also:

Part I: the microbiology of zombies

Part III: “We’re all infected”

Part IV: hidden infections

Comments

  1. #1 jane
    October 28, 2013

    Elderberry and elderflower are antiviral and the former has been shown to inhibit the ability of influenza viruses to enter human cells. Elder leaf is somewhat toxic and was mostly used, historically, as a purgative. If the show actually showed this guy mixing leaf and berry, you know what kind of side effects that’s going to have.

  2. #2 Kultakutri
    October 31, 2013

    I don’t know whether elder works as an antivirotic but both flowers and berries are edible and tasty. At least if we’re talking the common elder, Sambucus nigra. Sambucus racemosa has red berries that make excellent jam but one has to strain it as the seeds are somewhat rich in saponins and glycosides that make some people sick.

  3. #3 TJ
    November 1, 2013

    Ha! While on vacation with a non-science-inclined friend I caught my first ep of TWD in years and it was this one. My friend was filling me in on the background of this outbreak and I kept saying pretty much exactly what you outlined here, but stressing the antibiotics weren’t going to help, especially with such a fast mortality rate. She kept calling me unreasonable. Not because I was expecting reality, but because I should give the ab’s a chance. I told her she continued to cement why she would never be on Team Me during a zombie apocalypse.

  4. #4 Vesta
    November 2, 2013

    Looking for antibiotics is a subplot in the series , soon they will discover that the antibiotics don’t work. Either someone will survive and they can use the blood for a serum or the use of herbs will indicate a path.

  5. […] UPDATE2: Just found this, an excellent post by Dr Tara Smith (@aetiology) actual microbiologist: “The microbiology of zombies, part II: ineffective treatments and how not to survive the apocalypse“. […]

  6. #6 Bob
    November 6, 2013

    It’s a series about zombies and you expect realism?
    With these kinds of stories, disengage your brain first.

  7. […] Getting Your Microbes Analyzed Raises Big Privacy Issues Why I Choose to Submit to Journals with Low Impact Factors Linnaeus’s Asian elephant was wrong species New antimicrobials discovered in wild mushrooms A bad taste in my mouth for overselling the microbiome The microbiology of zombies, part II: ineffective treatments and how not to survive the apocalypse […]

  8. #8 jemand
    November 7, 2013

    Elderberry LEAVES however, are toxic and high in cyanide! say what you will about the berries (and even that isn’t given…) but eating the stems, leaves, or roots of elderberry is an AWFUL idea, AWFUL.

  9. #9 Hermenauta
    November 9, 2013

    #6 “With these kinds of stories, disengage your brain first”

    Ha! Filthy zombie covering as human. Forget it, Bob, if you want my brain you´ll have to take it from my cold, dead hands first!

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