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[ANON POST] Epidemic To Order
Inara
orange_fell wrote in little_details
Searched: pneumonia and flu epidemic, found lots of stuff on the Spanish Flu in 1918, but it's not quite relevant to what I'm looking for.

Setting: dystopian near-future London in December. About 50 or so survivors are living in a Tube station.

What I'm looking for is an easily foreseeable, easily treatable (if they had access to hospitals or antibiotics, which they don't) epidemic with potentially devastating consequences. Basically they've just had a narrow escape, think they're relatively safe, and then people start getting sick. It should be something pretty obvious—one of the characters, who has no medical training, spots it immediately.

I do want most—but not all—of the characters to survive, so it has to be something that isn't necessarily fatal but could easily be, particularly for a malnourished population.

What would the first signs be? What would people try to do about it (beyond, in this case, going up to the surface for help, which is the point of this whole plot point).

Thanks in advance!

Strep throat, aka "scarlet fever". It's very common even today among children, so lots of people are intimately familiar with the symptoms, and most people know that scarlet fever was a big killer in the past. It's a bacterial illness, so you can get it again and again, too.

As for what they'd do, that depends on whether their knowledge is more medical or historical. If the first, same as any other disease - hydrate, try to keep a fever down, try to keep the infected away from the healthy as much as possible. If the latter, they may attempt to control the infection by destroying anything the infected had touched or used. This is pointless.

Edited at 2013-11-28 04:09 am (UTC)

Scarlet fever is actually a sequelae to strep throat. You get the sore throat, then as you start to feel better your chest and throat (outside this time) turn bright read and your fever heads back up. It doesn't happen all the time. I've had several cases of strep but never had scarlet fever, my sister got it twice.

That's what I thought of too.

You can treat it with Oral Rehydration Therapy. An old approximation was to give the victim water with sea salt and molasses, which might indeed help.

Even just plain water will work, though it must be boiled and clean.

Really? I would have thought there was danger of electrolyte imbalance.

That's certainly why ORT is better, but if you can't manage that then you can make do with water.

I was thinking cholera but they'd already be boiling water.

Measles or mumps. The anti-vaccine crowd has raised the number of cases already, and without vaccines at all the numbers would only go up. Depending on how recent your apocalypse was, older people might remember it/have had it.

The apocalypse is limited in scale and they've been underground for three years, so the generation that's around now would have been vaccinated long before Jenny McCarthy began her misinformation campaign. Very small children wouldn't have been, obviously, but there aren't many of those, and I'm not sure if that's enough to start an epidemic.

How about the plain old flu? Flu epidemics have been big killers in the past and peoplein western countries still die from it. A real flu epidemic can decimate malnourished populations pretty thoroughly.

My thought exactly - the scenario reads as if it was written for it.

That's the scenario I was envisioning (the more mundane, the better, because the idea is "we could easily prevent this except we can't"); just trying to figure out how realistic it is.

You don't want the Spanish Flu then, that was a real killer. Just an ordinary flu. (Especially since that one killed the healthy adults disproportionately, whereas ordinary ones tend to kill the children and aged.

Consider the amount of deaths we had a few years ago just from H1N1. Also consider that the prevalence of flu shots and such is something fairly routine (even though not everyone gets them, a lot do)... that's something your group likely wouldn't have, nor would they have the medical care for the really bad cases. We tend to consider the flu pretty minor, but it's not. (IME, if you refer to it as influenza vs. the flu, people actually take it more seriously as an illness, too. People just shrug off "the flu", so this may be something you want to consider using.)

Ah, you do realize that 284,500 reported deaths (the highest number I could find) is less that 1% of the 61,000,000reported cases ? http://www.cdc.gov/h1n1flu/yearinreview/yir5.htm

I believe the OP is looking for something that has a bit higher than 1% probability of death.

Scarlet Fever runs around 2% fatality rate.
cholera is about 2.5%.

What about Small Pox? It nearly wiped out some of the Native American tribes. Estimated between 15-20% of all patients die. Believe to have been eradicated, we no longer stock the vaccine. A mutated form could serve your purpose.

Yes, I know the statistics. I'm also considering the differences with a malnourished populace without access to standard medical care, the death rate is likely to be higher... and it also sounded like the OP was looking for a small amount of deaths, since they mentioned wanting most of the characters to survive.

Yeah, I'm going for small scale, as there are only around 50 people to begin with, and some of them need to live. Mundane and predictable over unpredictable and exotic, and preferably something that would hit the weakest members of the group first. Only one of the major characters is affected; the rest need to be still running around and doing stuff.

Yup. Agreed good old flu or maybe norovirus or another gastric type problem. Is easy enough for people to die from dehydration etc if not treated

If they are a remnant, and living that isolated, what are their chances of actual exposure to something viral? I would think something related to poor hygiene, vermin, or tainted water would be much more realistic.

That's partially what I'm wondering.

They're not entirely isolated, though; there are people living on the surface, and some people do go back and forth, but those tend to be the most healthy people. (Whereas I want the epidemic to mostly endanger the weaker people.) So they've definitely come in contact with a larger population—and up until quite recently, were a much larger population—but tainted water or rats could also be a possibility.

Dysentry - similar treatment to cholera, less likely to kill everyone if they take reasonable precautions.

You say "isn't necessarily fatal but could easily be". There are a number of illnesses that could fit your description. I would suggest you start with determining just how big of an impact are you wanting to have on your group.

2% of your fifty people is 1 person. (minor, may be overlooked as a natural death)
5% would be 2 people (still minor, most people would not consider the illness serious.)
10% would be 5 people. (mild to moderate impact, people will start to consider the disease serious.)
20% would be 10 people. (moderate, and by now people would be getting scared)
30% would be 15 people. (bordering on serious. Panic would be setting in. Anyone with the disease might be outcast in a primitive society.)
After that, you're looking at serious impact. ;-)


Hadn't thought of it in those terms, because plot-wise, it doesn't get that far. Essentially the scenario is that they've just escaped an attack that's decimated their original population, which has an even greater impact on the people on the surface, who are a broader, civilian demographic (as opposed to the folks underground, who have some older people and children but are disproportionately around 20-50 years old and are used to rough conditions by now). One or more of the surface people are contagious.

MC draws everyone's attention to the fact that hey, the epidemic is inevitably going to be more of a problem than anything else they've dealt with. A few people die. The group does its best to isolate the sick people, but there's panic, and a handful of the other uninfected characters end up taking drastic actions in order to stop everyone (and the MC in particular) from dying.

So working this out in my head, it doesn't kill that many people; if it kills 5-10 and incapacitates a number of others, that would be enough to have the right impact.

RE: water- or food-bourne illness, if they've survived for 3 years, they're doing a darn good job of keeping things clean and boiling their water to prevent cholera and dysentery and e coli food poisoning. You don't say what sources they're using, how they're scavenging on the surface from existing buildings or obtaining their water. Urban water sources are generally pumped from distant sources, and fail very rapidly without maintenance. I think the series "After Us" (or something like that name) was discussing how (if we abandoned New York) soon things like pumps fail for storm water drainage. Pumps from water treatment facilities would fail very soon too, possibly with months. I know there were quite a few historical rivers draining under the current urban London, and possibly they might be tapping that. Perhaps something else happened to endanger their water or food sources--a broken sewer pipe or something.
Current new influenza strains have been developing most rapidly from contact between pigs, chickens, wild birds, and people in places like China and Southeast Asia. But you could imagine that if people in the UK are also living above ground on farms, and newly exposed by raising different breeds of livestock from the current factory farms, when some of those people had never mucked out stalls before, then a whole new group of people would be exposed to bird flu in strange new circumstances and develop novel strains of flu.