OVERVIEW

While pandemic disease has long been a threat to human societies, the combination of frequent global travel, increased population density, and extreme environmental conditions have made the rise of global pandemic over-determined. The early warnings of the Quarantine superthreat can be found in the SARS outbreak in 2002, and the sporadic outbreaks of H5N1 Avian Flu throughout the past two decades. We currently face a global pandemic of Respiratory Distress Syndrome, or ReDS. As bad as ReDS is, however, the WorldRun simulations suggest that it's only the first of a wave of successive global health threats.

The Quarantine superthreat encompasses both the broader health impacts of pandemic disease and the social impact--including political and economic implications. Traditional measures for controlling local disease outbreaks can be less effective, even counter-productive, when applied at the national or global scale. Isolation is often imposed in discriminatory ways; information overload lessens attention paid to warnings, while information limits heighten fears of being misled; immunization, when possible, is costly and happens unevenly, often increasing likelihood that the disease will spread; fears about disease transmission disrupt economic behavior, from workplace interactions to travel.

A larger issue, however, is the manner in which pandemics can serve as a catalyst for the breakdown of social trust. The emergence of pandemic disease can magnify existing dissatisfaction or disputes, whether with the government or between rival communities. Disease, more than almost any other kind of threat, elicits primal fears about the safety of oneself and one's family. Institutions or groups that undermine such safety can trigger strong emotions and, all too often, violence.

We've seen examples of all these reactions in the response to the ReDS pandemic over the past two years.

  • • Across the globe, healthcare professionals have seen restricted travel, demands to provide all services for free, even accusations of being the cause of the ReDS pandemic.
  • • Slums from Bangalore to Nairobi to Rio have seen sporadic lockdowns, often killing thousands from hunger, thirst, or untreated non-ReDS diseases.
  • • Brazil has canceled all Carnival celebrations until further notice, with the consequence of undermining national identity and crippling communities held together by such face-to-face social processes.
  • • Schools in Southeast Asia have been targeted as breeding grounds for ReDS, leading to waves of school closings.
  • • Quarantines and outbreaks have triggered widespread depression and mental health disorders, as coping mechanisms break down.
  • • n more than one quarantined community, fearful citizens have engaged freelance soldiers in enforcing a quarantine, usually with resulting violence.

RESPIRATORY DISTRESS SYNDROME (ReDS)

ReDS is thought to be caused by Mycobacteria borelliasis, a bacterial strain carrying genes similar to the bacteria causing tuberculosis and the bacteria causing Lyme disease. Current theory holds that this is a new species arising from an extreme case of Horizontal Gene Transfer. This combination, as well as antibiotic resistance common to many bacteria, make ReDS immune to existing treatments for both tuberculosis and Lyme; there is, as yet, no known cure.

At present, over 25 million people worldwide are known to be infected with ReDS; the World Health Organization estimates that another 5 million are likely to be in the early stages of the disease. Some 3 million people have died from ReDS and its related health effects. Although ReDS is not technically considered to be immunosuppressive, victims of full-blown ReDS have a much higher likelihood of acquiring opportunistic diseases.

ReDS is spread both by insect bites and airborne droplets (from coughing, laughing, spitting, etc.). The incubation period is typically one week; although the victim is asymptomatic during this period, she or he is highly infectious. Early signs of infection include high fever and flu-like symptoms, typically including lumps under the arms. The bacteria then settles into the lungs, nervous system, and/or digestive system, where it becomes chronic, with coughing, bloody mucous, pain in the extremities, chronic diarrhea, weight loss, and wasting. For people with seriously compromised immune systems, it can be fatal within a few weeks of contraction; about 10 percent of the people who contract it can expect to be dead within 5 years; the long-term morbidity rate remains unknown.

The first known case of ReDS appeared in Cuba in 2016, spreading initially to Central America and Europe, then globally. Early rumors that ReDS was an engineered bioweapon appear to be mistaken; the rumors continue to persist, however, in both low-information and information-overloaded populations. Syndrome, or ReDS. As bad as ReDS is, however, the WorldRun simulations suggest that it's only the first of a wave of successive global health threats.

COMING PANDEMICS

In isolation, ReDS should be controllable within the next five years, according to GEAS projections. Two factors make this unlikely, however: the combinatorial effect with other superthreats (see below) and the rise of other pandemic diseases reducing resources available to fight ReDS.

The WorldRun/bio simulations forecast two major rival pandemic diseases, and one wildcard disease, within the 25-year horizon.

The first is a viral outbreak. One candidate is the mutation of an Avian flu (probably H5N1) to human-to-human transmissible form; GEAS estimates a mortality total of 20-50 million people worldwide over the course of the outbreak. Another candidate is a non-influenza viral infection, akin to SARS or similar coronaviruses, causing widespread pneumonia-like symptoms. Mortality rates would be lower, at approximately 1-5 million.

The second potential pandemic is the emergence of a known bacterial disease with full-spectrum antibiotic resistance. High on the list of candidates is CA-MRSA--community-acquired Methicillin-resistant Staphylococcus aureus. Symptoms include necrotizing pneumonia, severe sepsis and necrotizing fasciitis.

The wild card pandemic is the emergence of a high-mortality pathogen with simple transmission vectors, such as an aerosolized form of hemorrhagic fever (e.g., Ebola, Marburg, or Hanta virus). This scenario is an example of a phase-change event, a potential trigger for extinction under superthreat conditions.

POINTS OF IMPACT

Areas hardest-hit by ReDS are largely--but not exclusively--in the tropical and subtropical regions of the planet. Temperate and even Boreal zones are not immune, however, as the outbreak in Stockholm demonstrates. (Stockholm is somewhat of an outlier, however, in that the current rate of infection seems to correlate with the initially very high number of volunteers for ReDS Relief work.)

The Quarantine superthreat is likely to be felt most strongly in locations that have some mix of the following characteristics:

  • • High population density
  • • High population mobility
  • • High levels of transnational migration
  • • High proportion of elderly or very young population
  • • Limited access to preventative healthcare
  • • Limited healthcare knowledge
  • • Limited access to information resources
  • • Compromised political stability
  • • Strong community rivalries

CONNECTIONS

The Quarantine superthreat interacts with the four other superthreats in the following ways:

Ravenous: Starvation exacerbates existing health crises, increasing mortality rates; pandemic disease disrupts food distribution, workforce productivity, and overall healthcare capacity.

Outlaw Planet: Piracy and griefing reduces access to and reliability of medicines; the spread of monitoring and sensor technologies improve capacity to watch crisis zones; in turn, the spread of disease increases demand for public monitoring.

Power Struggle: Energy costs, limitations on infrastructure, and increased demand for scientific research & development all limit resources available to fight pandemic; disease disrupts workforce productivity, reducing available economic resources for alternative energy development.

Generation Exile: Disaporas can serve as disease vectors; migration makes control of pandemic harder; migratory groups serve as ready scapegoats for outbreaks; pandemic can serve as trigger for expulsion of or violence against minorities.