Plague Inc: What It Can Teach Us about the Coronavirus Outbreak in Wuhan, China

Please note that the current outbreak of novel Coronavirus (2019-nCoV) is a developing issue. However, I believe that there is a learning experience in everything. For up to date information (because there is no feasible way this article will remain up to date), please visit John Hopkins tracking map.

 
I am going to preface this article with a HUGE disclaimer that states that I am not and will never be a medical professional. Also, I’m still not sure if this is a PSA or a game review? Tell me what you think in the comments!

I am, however, very involved with communicable disease outbreaks and emergency preparedness in my line of work. Come hang out with me in the public sector one day and I’ll tell you all about the importance of vaccinations 🙂

THE CORONVIRUS BASICS

For those who may not know (or may have been hiding under a rock for the last week or so) there is a new type of the already existing virus known as coronavirus. Within the family of coronvirus are MERS-CoV and SARS-CoV. This new one doesn’t have a cool name yet, so it is referred to as 2019-nCoV (the “n” stands for novel). I won’t be getting too TECHNICAL in my writing today; otherwise we would be here all day/night/week and I just do not have the energy to do so. If you want more information or updates regarding the outbreak check out some reliable news and health sources.

So on that note, let’s take a look at what we can learn from a VERY popular game right now called Plague Inc.

Image 1: Plague Inc logo

PLAGUE INC. BASICS

Released in 2012 as a mobile game for Android and iOS, and then in 2016 with a modified name of “Plague Inc: Evolved” for Steam and other consoles, and since its release it has been brought up repeatedly in times of outbreaks. The CDC interviewed the creators back in 2013, and recently, CNET reported on January 25th, 2020 that in the wake of the new coronavirus outbreak, Plague Inc. had a huge spike in sales and downloads for the mobile game, making it the top selling app in China. It is important to remember that while the game is based on an epidemic model, the game does not replace the scientific understanding of the spread of disease. There are only so many scenarios loaded into the game, and even with fan made scenarios, it is virtually impossible to recreate a real world outbreak or epidemic.

OUR EXPERIMENTS

For fun, take a look at some of these fan made scenarios! And I wonder if there will be a 2019-nCoV scenario to come in the future.

Image 2: Screenshot of Custom Scenarios for Plague Inc: Evolved on Steam

In the game, you get to create your own disease. It’s very basic to begin with and the more you play, the more features you unlock. As the disease spreads, you earn DNA points to help it evolve. With DNA points you can have the disease develop new symptoms, make it better suited for a specific environment, and even make it harder to cure or develop antibiotic resistance. You can make it more infectious or more lethal or more severe depending on how you evolve the disease. That obviously isn’t how a real world virus works, but in the game you develop a strategy to basically infect the whole world.

Image 3: Select your disease start menu
Image 4: And the game begins
Image 5: An attempt to recreate the spread of 2019-nCoV

To attempt to recreate the spread of 2019-nCoV, I also began in China. In this run through, I played on Normal mode (in which about 2/3rd of the population wash their hands and a few other criteria that make disease easier to spread) and I have the virus present similar symptoms of fever, cough, and cold symptoms.

Image 6: Your information screen

Your information screen that shows you the total number of infection/healthy people, breaks down the map based off countries that are mostly or completely infected, and then a panel that explains the cure development. I accidentally killed about 5 million people because the virus evolved on its own (oops).

Image 7: Symptom Information
Image 8: Transmission information

Disclaimer: thinking back I should have made this as an animal source to be more reflective of 2019-nCoV. Airborne transmission indicates that the virus can live long outside the body in the air (such as Measles which can hang out in the air for 2-3 hours and infect people). Coronaviruses tend to spread through droplets that are created when people cough or sneeze and do not practice Proper. Hand. Hygiene! 2019-nCoV originated from an open air seafood market but the exact host has yet to be identified. For the sake of the game, this probably still worked pretty decently.

Image 9: The disease spread enough to get its own awareness day!
Image 10: Note this watch list alert.

So, I feel like it is important to note this watch list alert. Already over 5 million people have died in the game, and just now in the real world there is an alert from the World Health Organization (WHO). The WHO declared 2019-nCoV a public health emergency on January 28th when there were roughly 170 people who had died and I feel like that speaks volumes of our current day awareness and preparedness to deal with a potential outbreak crisis. Shortly following this, the US and UK also declared the outbreak an emergency.

Image 11: Developing a cure.

Once a certain number of people are infected in the game, research begins to develop a cure. You can do things in the game to prevent the cure research from progressing, but I did not do much of that because I didn’t see it as being realistic. So eventually the cure was completed and everyone who was infected was treated and cured. So probably the equivalent of Tamiflu? Coronaviruses are what they are – viruses. And do you know what doesn’t work on viruses? Antibiotics. There has been some talk that certain antivirals may be able to treat 2019-CoV, but for the most part supportive care such as rest and fluids seems to be the best medicine.

Image 12: And I lost. Yay.

So brief breakdown of the run through: Normal mode; roughly 5 million people died. About 75% of the population was infected. Cured by the end of 2022 (about a 15 minute game/ 2 years of game play). No borders closed, all airlines and shipping carriers continued to work as normal. Really no change in day to day life.

To up the ante, I decided to see what would happen in “brutal mode.” In this scenario, everyone compulsively washes their hands and doctors do not go home (or in my interpretation there is always a hospital or urgent care center to go to if needed).

Image 13: It begins!
Image 14: And to no surprise, USA shuts down airports.
Image 15: And almost nothing happened in this scenario.

And almost nothing happened in this scenario. It was about a year and a half if you track the game play, almost 3 million were infected, and no one died. Some airports and shipping ports were shut down but it was so quick that some countries did not have time. As of now, 2019-nCoV has been around for roughly 6 weeks. For comparison, SARS-CoV began in February 2003 and was contained by December 2003 (about 11 months) and MERS-CoV began in June 2012 and is a disease that is still closely monitored by the CDC even though there are no current outbreaks of it.

Image 16: Defeated again!

So I do not doubt that 2019-nCoV is a warranted public health emergency and as many precautions as necessary should be taken. A huge reason why it is considered an emergency is because a lot of information is not known yet about the virus, and that lack of information can lead to misinformation. So let’s look at something I think might be a bit more infectious and dangerous than the 2019-nCoV – mass hysteria, fear,and racism.

There are scenarios in Plague Inc. that are not related to the spread of disease and instead are about the spread of information (or the spread of Santa Claus presents, because that was an update that came out a bit before December). So for my third run through I am going to see what happens in the Fake News scenario.

Image 17: Fake news

I created a scenario based on medical misinformation and racism that resulted in increasing reports of xenophobic behavior.

Image 18: Medical Fake News spread similar to a virus and can “mutate” as well to spread easier.
Image 19: You know what’s good to do? Believe doctors and vaccinate your children.
Image 20: And easier than both other runs through, I am able to deceive everyone on Earth.
Image 21: Yikes Victory!

And after about just 10 minutes of play in the Fake New scenario, my medical misinformation was able to deceive everyone on earth with the use of social media, news outlets, and a distrust of what once were medically ethical sources.

Overall (and I hope I won’t eat my words), the 2019-nCoV strain of coronavirus remains to be a threat but is no more threatening than the seasonal flu. The CDC estimates that since flu season began in October, there have been between 19,000,000 to26,000,000 flu illnesses, 180,000 to 310,000 flu related hospitalizations, and 10,000 to 25,000 flu deaths. The reason these are wide estimates is because the flu often goes unreported, which is a possibility for 2019-nCoV since some people may only experience mild symptoms. Our risk of contracting the flu remains much higher than contracting a coronavirus, so please go get your flu shot if you haven’t already! And cover your cough! And also, don’t be a jerk.

Michelle Lynn
About Michelle Lynn 2 Articles
Mother of Lizards. Occasionally Unburnt when she remembers to wear oven mitts. Also, a public health representative working in communicable disease investigations.