Plague: The Apocalypse App

If you thought the world wasn’t full enough already with apocalypse themed gags, think again. Let me be your own personal version of the crackpot with a cardboard sign and introduce you to Plague: the iPhone user’s guide to bioterrorism.

Plague, Inc., an app by Ndemic Creations (one guy, his three friends and his MacBook) allows you the unique experience of being a microvillainous biological organism that infects the entire world.

You begin the game as a bacteria infecting one person in one country of your choice. You can play casual, normal or brutal levels of difficulty, the latter being for “strategic geniuses living in concrete bunkers.” As you infect more people, you acquire DNA points and transmission points allowing you to purchase traits that increase transmission, aggravate, and create symptoms or other abilities unique to the type of pathogen you choose to be.

What is fascinating about this app is the way that it incorporates real genetic and microbiological information. Real pathogens like MERS and SARS, chicken pox and herpes, require a unique set of traits that help them move from person to person and survive. Epidemiologists characterize the transmission ability of a pathogen by analyzing the Ro value or the basic reproduction number which denotes the number of cases an infection generates during the infectious period. If Ro > 1, the infection is likely to survive. The greater it is, the harder it becomes to control.

But if a pathogen has a high infection rate and a high mortality rate, it kills off its host before the host has a chance to transmit the disease and is not a successful plague. (This is actually the reason you shouldn’t be afraid of Ebola).* Pathogens evolve all the time and these evolutions confer or detract abilities that increase their R0 or decrease them. Thus, the specific set of abilities you endow your pathogen with are incredibly important to ensuring whether your plague is successful or not.

As you travel the globe and continue infecting more people, you become noticed and doctors begin to work on a cure. Depending on how infectious you are or how freaked out scientists are, the race to the cure can be fast or painfully slow. Regardless, your job is to infect the entire world and kill them, before the cure is completed. Miss one person and game over.

Interestingly, Greenland proves the biggest roadblock. The game assumes all Greenlanders are antisocial agoraphobes who refuse to be infected. Actually, the general rule is, if you can go ice-fishing there, your organism is unlikely to be successful. Nevertheless, you can surpass this by decking out your plague with abilities like “cold resistance.”

After winning the game, you move on the better, brighter, more difficult organisms like virus, fungus, parasite, prion, nano-virus and the tour de force, bio-weapon. Each organism confers a special set of pros and cons. The use of DNA points is an intriguing way to model evolutionary capabilities of a pathogen; pathogens that are more likely to evolve garner more DNA points than others and for organisms that mutate rapidly, it costs DNA points to remove traits. For example, viruses mutate faster than bacteria and evolve more traits, but they can be hard to control and fungal spores have trouble traveling over large distances and bodies of water. Even exceptionally lethal bio-weapons have one major flaw; humans created them and know how to disable them and thus the cure is nearly completed before the game even begins.

Plague is modeled using realistic, complex variables and software that is actually used to predict outbreaks. It thinks about pathogens and how they interact with their environment in interesting ways. The disease spreads between countries in the game by airplane, ship and border crossing, but also is limited by the number of flights going to a country, the availability of modern medicine in the country and whether certain regions have enough people interactions.

Basically, Plague shows some of the challenges of evolution: if you spend DNA points to get mosquito transmission and make yourself more infectious in tropical regions, you might not have enough DNA points to spend on cold resistance. It is also very good at being realistic about the limitations of healthcare. One of the major problems with tropical diseases is that for certain diseases that only affect a small/poor portion of the world’s population, cure-research is hard to fund. Plague actually gets at the heart of that inequality; for a pathogen discovered in Central America, cure research goes much slower than it would in the United States.

This is kind of every microbiologist’s wet dream. Science gets really lonely working in a lab waiting for electrophoreses gels to run—why wouldn’t you want to kill off the entire world in your spare time? Sounds like a successful experiment, and science definitely does not have enough of that.

Not to mention, Plague has some funny quirks. During the game, (since it’s based on real life) news articles pop up like CNN alerts with useful headlines like “New malaria drug in testing” “New filters in airplanes reduce disease transmission” and other choice pieces like “Tsunami hits Germany” “Dictator demands solar eclipse on his birthday” “Lemur fur toilet paper ‘inhumane.’”

I guess if all else fails, the writers of Plague would get pretty clutch jobs at the Onion.

Nevertheless, I think the most interesting thing about Plague is that it is such a useful tool for public health education. In an age where perhaps bio-terrorists are a real threat, a game like Plague helps you grasp the severity and potentially gruesome reality of a bioterrorism attack. And it does it in a way that might be fundamentally more effective than other modes like Dan Brown’s recent novel Inferno or Michael Crichton, BioShock or Outbreak because it teaches you the complex set of variables pathogens need to survive and take over the world, and tries not to spend too much time on other distractions.

Even the movie Contagion actually didn’t spend all that much time on the science and focused more on the societal response to a pandemic. Other watchers may have been distracted as I was by Marion Cotillard’s beauty, Matt Damon thinking ‘I’d rather be doing a Bourne movie’ or the fact that certain main characters (who I will not name) died way earlier than the trailer led you to believe. Maybe all you gleaned from that movie was finally learning what the WHO stood for. Plague, on the other hand, encourages you to understand the science, to theorize and strategize, and to get behind the scenes.

It also offers assurance of the limitations of a potential plague. It reinforces the idea that humans are resilient creatures. In fact, beating the cure is the hardest part about the game because once doctors figure out the cure, the WHO becomes very good at controlling the spread, hand washing becomes compulsive and doctors work round the clock. (There are real-life examples to back this up: smallpox, SARS.) Not to mention, the luck it takes for a microorganism to emerge naturally and literally infect the entire world without anyone noticing and, on top of that, spontaneously evolve into deadly strains is astronomically large. Plague is a challenging game even for expert strategists and one of the take-away messages is it will be very difficult for any microorganism to eradicate humanity— especially with games that make players aware of all of the different ways we need to protect ourselves (Provided that we don’t all turn into bio-hazard suit wearing agoraphobes).

And when would this information be useful? Plague isn’t just important for understanding how to protect yourself at the onset of an epidemic like Influenza, the principles apply to most pathogenic diseases, even common ones like Herpes and Mono.

Now I wouldn’t play this game all the time. It can be time-consuming and energy intensive, and I suppose I would get tired and start watching Walking Dead after a couple rounds. All things said, however, Plague has had tremendous success. It won Game of the year - the first year it came out (2012) and numerous accolades from the CDC. And it has the potential to be a fantastic public health education tool. Can you imagine a class where homework was to destroy the world?

Perhaps (when iPhones take over the world) this app will be at its side. All it takes is one patient zero.

* My apologies to Biology majors for whom these comments may seem incredibly reductive or common knowledge.