I’ll give him the benefit of the doubt...it looks like he is grinning, but it is sometimes hard to distinguish in some cultures between grinning and grimacing, especially with that picture.
I would guess, having seen the progression of the disease, and seeing what it does, he is probably grimacing as she spits up blood, because he knows what happens next.
Still...one has to say to one’s self...”Why are those people wearing hazmat suits? Should I be wearing one, or standing further away?”
“Gee, I don’t understand what is going on here. Why are these people in hazmat suits? I guess I’ll just STAND RIGHT HERE.”