Plausibility Check: Post 1920s Pandemic

Although the idea has been sparsely used here, Fiction is crawling with the idea a serious plague can strike the World after the 1920s devestatingly, where 20%-90% of the population dies-off (like in The Stand for instance).

How plausible is this?

Pennicillin and antibiotics have certainly revolutionized medicine, and a better idea of the microbes causing the plights have helped stop many infections. On the other hand homogenization through travel and trade brought our diseases world wide.


IMO These diseases couldn't cause spectacular die-offs, reasons listed with them:

Ebola, AIDS, and Other Bloodbourne Diseases - Spreading through blood and some other bodily fluids is not really effective in transmission.
STDs - You are going to pick out promiscuous stragglers, making everyone watching their suffering puritanistic, which creates a lack of bodies for the disease.
Smallpox and Polio - Both are declining naturally (Smalllpox was simply helped by Vaccination regimes)

So Who would you think would be good canidates, and how plausible would it be?
 
90% is unlikely for a natural plague. The Black Death killed about a third of the population in a Europe that was already immunocompromised due to widespread malnutrition.

The introduction of smallpox, TB and other Old World infections to the Americas resulted in multiple devastating plagues. We're not really sure how much each one killed, but the worst were probably in the range of 50%. (Note that at that level, there are significant secondary deaths -- people who survive the plague but starve because the fields aren't worked, small children whose parents have been taken, etc.) The 90%+ dieoffs recorded by some Native American populations were probably the result of multiple pandemics combined with secondary deaths. So "around 50%" is probably a reasonable high end for a natural pandemic.

Note also that if you're considering a worldwide pandemic, there's a tremendous amount of immune system variation among populations. So you'd likely see differential results across regions. Fractally differential, with subpopulations and sub-subpopulations responding quite differently.

Candidates? Antibiotics narrow the field less than you'd think. They don't touch viruses or parasites, and then within a few decades you get resistant strains -- google MDR-TB and its disturbing child, XDR-TB. (XDR-TB would be a good candidate for a pandemic except that the BCG vaccine gives better than 50% resistance.)

Something like a pneumonic variant of AIDS or a vaccine-resistant smallpox might do. (Smallpox was truly fucking terrifying. It's just a merciful accident of history that it happened to be utterly vulnerable to a cheap, simple vaccine.)

A malaria variant that tolerates cold weather could wreak some major havoc, especially if it were cerebral malaria. Its effectiveness as a pandemic would be limited by its need for an insect vector, though -- spraying and sanitation measures would shut it down fairly soon.

Then there's influenza. The pandemic of 1918-19 would have been almost as deadly 50 years later, and a major flu outbreak of a new, unrecorded strain would still be seriously bad news. It takes about six months to develop a vaccine for a new strain, and about two weeks after injection for it to take effect, and even then a flu virus can mutate around it with surprising speed. That's why the WHO and other public health authorities are so twitch about new flu strains. There's no foolproof treatment for influenza even today; even antivirals work sometimes, but not always.

So, King was probably right to choose "superflu" for his pandemic; of the stuff that's currently out there, it's probably at or near the top of the list. Virus, spreads easily, highly infective, and mutates like mad; what's not to like?



Doug M.
 
As Doug M. pointed out, influenza would have to be high on the list of any possible pandemics. Anything else which goes airborne would be another good candidate, particularly if it has a decent incubation period to allow it to spread further.

Another possibility is a virus which makes the jump from animals to humans in a form which leads to a pandemic. There are a host of animal-borne viruses around which are capable of infecting and killing humans. In their current state, most such viruses are not capable of using human-to-human transmission, but it's always a possibility that a particular virus can make that jump. That is, after all, how most human epidemic viral diseases got their start.

Bat-borne virus are, for some reason, particularly capable of becoming infectious to other mammal species (including humans). SARS is a recent epidemic which almost became a pandemic, but was fortunately contained in time. The SARS virus originated in bats, and was spread to humans either directly or via civets. Ebola, one of the nastiest pieces of work around, is also spread via bats, as are a number of other viruses.

Perhaps the nastiest candidate for a bat-borne virus which evolves into a human pandemic is Nipah virus. This is a particularly ugly virus in its effects, which first came to major attention in 1999, when it caused an outbreak of encephalitis and respiratory disease in Malaysia, killing over 100 people and leading to the culling of millions of pigs.

Nipah virus has a natural reservoir in fruit bats (flying foxes), and its is easily capable of making the jump to humans. Since 1999, there have been eight further significant outbreaks causing multiple human fatalities, concentrated in Bangladesh and India, and a variety of other isolated cases. The virus has rather a high mortality rate; up to 90% in some outbreaks, although varying strains seem to have different mortality rates. In at least one of these epidemics, the virus is known to have turned into a airborne form transmitted from person to person.

Nipah virus symptoms are mostly respiratory and nervous system infections. It causes fever, headaches, severe coughing, blurred vision, and can send people comatose where they need mechanical ventilation to survive (if even that works).

It can also cause long-term encephalitis (nervous system infection); one person suffered from relapse encephalitis over 4 years after the original infection. There is no cure whatsoever for the relapse encephalitis, only treatment of symptoms [1]. It is not yet clear whether the virus in its encephalitic form is capable of reinfecting other people (hopefully not; if it does, then quarantine will become virtually impossible in the event of a pandemic).

Given that Nipah virus is already capable of evolving into a form where it jumps from person to person, all that it really needs to turn into a pandemic would really be a form where it is slightly less lethal. Its mortality rate is high enough that it probably kills people too quickly to spread far. But given that there are a variety of strains with varying mortality rate, all it takes is one that evolves a slightly longer incubation period, and you have the makings of a very nasty pandemic indeed.

This idea is one which I've toyed with writing a WI thread about, because the effects would be... bad. (But also rather morbid, which is why I've never turned it into a full thread.) It would be perfectly possible for Nipah virus to evolve into a pandemic which kills more than 20% of the global population, if it's not caught in time.

[1] This probably sounds familiar to anyone who's read Lands of Red and Gold. With good reason; that TL's Marnitja virus is based on an ATL version of Hendra virus and Nipah virus, one that emerged long enough ago in an urbanised society so that it could mutate into a major killer.
 
Go with Mega-Flu.

Bird-Flu and Pig-Flu are bad, SARS was much, much worse...

http://en.wikipedia.org/wiki/Severe_acute_respiratory_syndrome

That death-rate was despite the numbers staying low enough to allow full-on, high-dependency treatment for many victims. Had it 'gone viral', and overwhelmed the hospitals, you'd have a situation where people all around you are literally dropping dead within a couple of days of infection...

Now, set SARS in the Roaring 20s...
 
Perhaps the nastiest candidate for a bat-borne virus which evolves into a human pandemic is Nipah virus. This is a particularly ugly virus in its effects, which first came to major attention in 1999, when it caused an outbreak of encephalitis and respiratory disease in Malaysia, killing over 100 people and leading to the culling of millions of pigs.

Nipah virus has a natural reservoir in fruit bats (flying foxes), and its is easily capable of making the jump to humans. Since 1999, there have been eight further significant outbreaks causing multiple human fatalities, concentrated in Bangladesh and India, and a variety of other isolated cases. The virus has rather a high mortality rate; up to 90% in some outbreaks, although varying strains seem to have different mortality rates. In at least one of these epidemics, the virus is known to have turned into a airborne form transmitted from person to person.

Nipah virus symptoms are mostly respiratory and nervous system infections. It causes fever, headaches, severe coughing, blurred vision, and can send people comatose where they need mechanical ventilation to survive (if even that works).

It can also cause long-term encephalitis (nervous system infection); one person suffered from relapse encephalitis over 4 years after the original infection. There is no cure whatsoever for the relapse encephalitis, only treatment of symptoms [1]. It is not yet clear whether the virus in its encephalitic form is capable of reinfecting other people (hopefully not; if it does, then quarantine will become virtually impossible in the event of a pandemic).

Given that Nipah virus is already capable of evolving into a form where it jumps from person to person, all that it really needs to turn into a pandemic would really be a form where it is slightly less lethal. Its mortality rate is high enough that it probably kills people too quickly to spread far. But given that there are a variety of strains with varying mortality rate, all it takes is one that evolves a slightly longer incubation period, and you have the makings of a very nasty pandemic indeed.

This idea is one which I've toyed with writing a WI thread about, because the effects would be... bad. (But also rather morbid, which is why I've never turned it into a full thread.) It would be perfectly possible for Nipah virus to evolve into a pandemic which kills more than 20% of the global population, if it's not caught in time.

Nipah Virus, Measles, and Influenza. Danke, Jared.
 
Already done

Go, pick up "Last Centurion" by John Ringo. _explictly_ what you're talking about, set in the "very near future" (has an date of 2018 or so) about the bird flu making the jump. It's Alt History now, given an few things, but describes _excatly_ what you're talking about, and putting aside the political aspects (I'm sure people have discussed Ringo's hard on for the Democratic party before, even though honeslty, I can't _blame_ him, I just think he's waaaaaaaaaaay over the line) has an intresting discussion of several of the impacts (trade, civilization cohesion, etc, etc. Ironically while it's _very_ much an "rah rah rah Anglo conservative vaules" he points out several other nations that make the cut. Futher, has some fun discussions about 'military' force, and 'vaules', plus personal space.

IF you can stand his rants about political issues, the information inside it, is -very- intresting.

A.
 
Addtional; Ironically, while it doesn't fit the concept here, it's still good information for what you need.

A.
 
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