Could a 'The Last of Us' pandemic really be the last of us?

So I was on the train the other day, and there was an announcement telling people who felt sick to get off and seek medical attention, and I thought, ‘Thank you, Ebola; not only are you killing thousands of innocent people, you’re also making millions paranoid about that cold that they’re coming down with.’

But is it any surprise that people are paranoid? Ebola is, after all, a terrible disease and one that most people know next to nothing about. Pop culture is full of end-of-the-world scenarios, almost all of which centre around a small group of remarkably photogenic survivors fighting to survive in a world stripped of its civilised trappings (I find this particularly disturbing; when Armageddon comes, I may not be good looking enough to make the cut), forced to confront animals, the elements and the dark, vicious nature of the human soul. Even video games, the last great bastion of the nerds, aren’t immune from this outbreak ephemera – The Last of Us, The Division, Resident Evil – all deal with worlds where little bugs have caused big problems.

But are these scenarios in any way realistic? Or is this a case of all cough and no cold? (Sorry, that was terrible.) Oddly enough, I don’t start this article with my usual brand of misguided ignorance. In the real world I actually have a couple of degrees in this stuff. Epidemiology, the study of disease outbreaks is what I’ve spent most of the last decade training in, and so I’m at least partially qualified to assess the whys and wherefores of these apocalypses (am I the only one who feels that should be apocalyspsi?).

Let’s focus on The Last of Us – a game where a global pandemic (an epidemic that’s circled the globe), has killed 60% of the human population. So, is it even possible? Could an infectious agent really have such an impact?

The simple answer is yes; in fact, it’s happened before. In 1918, the Spanish flu infected a third of the world’s population – killing 100 million people (more than the whole of WW1), many of whom were young and healthy (through an awesomely named process called the cytokine storm).

‘But that was years ago,’ says the voice in my head that I choose to believe represents my audience, ‘they didn’t even have antibiotics in 1918; it was practically the Stone Age!’ That’s certainly true; antibiotics weren’t known about until 1928 (when Alexander Fleming discovered penicillin), but viruses like the flu don’t respond to antibiotics. The best defence against them is vaccination, a topic you’ll see a lot of people up in arms about today. For proof, look no further than our current pandemic, that of HIV.

Another virus with worldwide distribution and massive infection rates (up to 25% in some parts of southern Africa), HIV has been classed as a pandemic since the 80’s – a tragedy affecting millions of people that’s been going on so long that the western media rarely bothers to mention it (incidentally, you can donate here).

But the pathogen in The Last of Us is a fungi, not a virus – an important point that might actually make things worse. To explain why, here is one of my patented bad metaphors:

Think about your computer, about how you love it and worship it and how it’s sitting in front of you right now. Think about all the ways that it could go wrong. A virus is like a computer virus; errant bits of coding that stuff up the programming and make the computer behave the way the virus wants it to behave (note: my knowledge of how computer viruses work is somewhat shady). Bacteria are like a corrosive dust that’s been sucked up by the fan – physical objects that can interfere physically and chemically with the operation of the parts within. Fungi, by this (very inaccurate) definition, would be mice somehow sneaking in and chewing on the motherboards.

Now assume that you couldn’t physically reach in to remove the mice; assume that your only recourse was to poison them.

Of the three, getting rid of the rodents would be the most hazardous, because whatever you used would almost certainly hurt you (or your computer). It’s the same with antifungal medication – because fungi are closer to us on the evolutionary tree, drugs that can hurt them but have no negative effect on us are rare. Finding a medication that could target the fungal cordyceps in less than the two days it takes for someone to become a face-eating loon would be a difficult process, especially if the Cordyceps fungus has (as the wiki says) been mutated by a virus.

So yes, if there was a fungus that acted as quickly as The Last of Us’ does (most are much slower to propagate), then finding a treatment would be a huge pain in the whatever. Vaccines might help, but you’d need to create, manufacture and distribute them to every person left on Earth (assuming the anti-vaxxers had gotten over it) – a worthwhile goal, but given the mess that civilisation seems to have become, a bit of a difficult one.

But would we even get that far? As an epidemiologist there’s a couple of things that make me think we wouldn’t have made it to the cannibalistic paedophile stage, and none of them have to do with my faith in the power of the human spirit (because I don’t have any).

The first, and this is the thing that bugged me for the entire game, is that no one even mentions using fire. Yes, I’ll admit there are Molotov cocktails, and a couple of explosions about the place, but at no point does anyone say, “Hey, you know that building that all the infected are coming from, the one that’s probably swimming in spores? Let’s give up on all this gas mask shit and just burn that fucker down!”

Fire is, while crude, a form of infection control that’s been used since antiquity. In the Middle Ages, whole villages were scorched to prevent the spread of the Plague – and these were people who thought the Black Death could be thwarted by a nice floral arrangement. The idea that in the decades since the first outbreak (during which everyone presumably got a primer titled ‘What to expect when your wife’s infected’), no one floated the idea of napalming infected areas seems to me ridiculous. Agent Orange side effects may suck, but at least no one tries to chew your arm off.

The second is slightly more technical – it has to do with incubation and latency. The incubation of a disease is the length of time between exposure and the onset of symptoms, and the latency is the interval between infection and infectiveness (between when you’re exposed to a disease and when you can pass it on). From what I saw in the game, the incubation of the Cordyceps fungi is less than 24 hours, and at that point you’re fully capable of infecting others. This means that even if the latency is very short (say an hour after you’re infected) you only have 23 symptom-free hours when you’re infectious, but the people around you aren’t going to know about it. Bear in mind that the only way you can infect people during this time is to bite them; there’s no airborne transmission without the (fairly visible) spores, which don’t even show up unless your head has exploded.

This short incubation period and the very obvious behavioural changes from the disease also make picking up who’s infected a cinch. All the authorities have to do is hold someone in isolation for 24 hours – if they’re infected, they’ll show symptoms and they can burn their arse down.

Thirdly, is that while losing 60% of the population would be devastating – it doesn’t necessarily mean that society as a whole is over. In the Middle Ages, Europe lost 40-50% of its population over four years (75-80% in some areas), and yet here we are, 700 years later, arguing over a video game. Even more jarring, the Native American population took (by some estimates) 90% casualties after being exposed to all those European germs, but Pocahontas was still around to sing about the beauty of nature and whatever else she did. What I’m saying is that humans, like the fungus we’re talking about, are very good at hanging on. A 60% death rate is still a 40% survival rate, which means that yeah, life will certainly be rougher, and a lot of the amenities we take for granted would no longer exist, but we’ve lived through worse.

Now yes, I could be wrong about a lot of this, I am speculating about a made-up disease in a made-up universe (one which probably wouldn’t be so emotionally jarring if everyone had followed decent infection control protocols), but personally I’m not losing a lot of sleep over it. Not while there are so many real diseases to get worked up about.

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