Plague Inc. and Ebola: The Unsettling Realism of Epidemic Simulators

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<em>Plague Inc.</em> and Ebola: The Unsettling Realism of Epidemic Simulators

The first time I picked up Plague Inc. after the Ebola epidemic came to the United States, I immediately knew I made a mistake.

This wasn’t the first time I had played an infectious disease simulator. I had played the flash game Pandemic during high school lunch breaks in the library, named my disease something stupid like “butt crack,” and had discussions with others about how to get to Madagascar. I had participated in rounds of the board game Pandemic, where players had to work together to stop a disease (we usually failed). Plague Inc. is just another one of these simulators, expanding on the model set in Pandemic (the flash game), giving you the power over a disease you create by making it immune to certain environmental factors, postponing research efforts, and trying to kill off as much of the Earth’s population as you can with a larger degree of control.

It’s a simple concept, allowing the player to utilize strategy to most efficiently kill off the human race. It was in late 2014, when the outbreak was most prevalent in the media, that I decided I was going to boot up the abandoned app on my phone. I named my disease (something butt related), chose to start it in Africa, and began spreading, letting it mutate into something dangerous. I started off with a few subtle symptoms, hardly noticeable, made my disease infectious, allowing it to jump from person to person without stirring up a lot of anxiety, and then blowing it up all at once with disgusting, fatal syndromes. The international community freaked out, borders shut down, and countries began to turn red and die. I wasn’t able to touch isolated countries like Greenland or completely wipe out first-world nations like the United States, but I was able to completely wipe out many African countries. It’s the easiest strategy to utilize: to start off in a poor country with a large population and little governmental oversight. My plague was successful and out of control, only hindered by my overzealous choosing of symptoms that were visible, along with the constant mutations that only sought to make my disease more terrifying.

However, once I got the game over screen with my final score, I suddenly became nauseous. I shut down and immediately uninstalled the app. Sure, I had done well, wiped out and infected all but a couple of countries, but I had also killed millions.

I worked in local cable news during the beginning of the outbreak’s entrance into America. I got to see first hand the collective fear as people watched it get closer, as Dr. Kent Brantley, one of the first Americans diagnosed with Ebola, was transferred to a hospital in Georgia and brought the disease into our country. I saw the outrage grow as more people became infected and officials seemed to not be taking it seriously. I even got to see our audience become more anxious and annoyed over the coverage, of each new aid worker or nurse becoming infected or showing symptoms that turn out to be nothing. The death toll still continues to rise in Africa and while the media frenzy has—luckily—died down, the disease is still spreading. And around the time that coverage of the Ebola outbreak was most prevalent, and thousands had already died, Plague Inc. became very popular.

James Vaughan, the developer behind the game, said that in October, around the time media coverage of Ebola was at its peak, downloads of his game rose nearly 50 percent in two weeks. By early November, he said that nearly 35 million people had downloaded the game. Many players had even called their plagues “Ebola,” whether out of some morbid fascination of current events or a poor attempt of a joke. Vaughan used the game’s popularity to raise awareness about the disease on his website, encouraging visitors to give to charities that were fighting Ebola.

“This is the first time something in the real world has had an effect on the sales charts, especially since Ebola came over to America,” Vaughan told Polygon. “People are curious about it and want to know more about infectious diseases.”

However, Vaughan’s responses didn’t erase how uncomfortable I felt that people seemed to be even more into taking on the role of a deadly pathogen. There are no actual people represented in the game. Instead, you are cued into your effects with statistics and news headlines. At that point, that’s how I had been experiencing Ebola. Each day seemed to bring worse news. Soon, a man from Massachusetts, where I live, was diagnosed with the virus. A man in Texas died after a hospital initially turned him away despite a high fever. That man in turn infected two nurses, one of whom took a flight to Ohio. As information about the disease spread enough for people to become—comparatively—relaxed and more aware about how to prevent transmission, the fear seemed to die down. Regardless, there was a sense of unease surrounding Plague Inc.

This discomfort comes from an awareness of the realism of Plague Inc. and other similar simulators. Vaughan said he had done a lot of research when crafting the algorithms for the game in order to make it as realistic as possible.

This isn’t uncommon. What many people notice about epidemic simulators like Plague Inc. is how realistic they are, how they manage to use real-world logic and incorporate them into synthetic scenarios and, more importantly, how they can more accurately simulate human behaviors in the event of a plague. Epidemiologists, scientists that study infectious diseases and how they spread in various populations, have used videogames to experiment with certain behaviors. For instance, the “Corrupted Blood” incident in World of Warcraft—where a plague glitched and spread throughout the entire game, causing Blizzard to wipe the servers clean back in 2005—captured an environment that simulated how people behaved under risk. Nina Fefferman, an epidemiologist at Rutgers University, told WNYC’s New Tech City that the incident introduced a “curiosity” factor that had never been included before in models, where people would travel to the scene of an outbreak just to see what was going on. People would take on certain roles, such as a National Guard to protect quarantine zones, medical staff, or of those who wanted to take advantage of the chaos.

Fefferman said it had more accurately depicted human behaviors during a crisis than had been recorded before. EpiSIM, a software utilized by the CDC and other organizations, is epidemic simulation software that uses synthetic individuals that move around “realistically,” taking into account multiple factors when determining how diseases spread. It factors in geography and environment, along with social factors such as gender and class, to figure out how best to proceed in the event of a pandemic. However, experts say it has issues with exact human behaviors, something that Fefferman said the “Corrupted Blood” incident actually helped with, calling it a “petri dish.”

“So we’ve got the social set up that we need for the behaviors to be not, again, realistic for the real world but a little closer than just sitting down and thinking to yourself ‘huh, I wonder what I would do,’” Fefferman said.

Plague Inc. seems to also fall within the interest of epidemic professionals. Vaughan was invited to visit the Centers for Disease Control, which was interested in how the game could be used to raise public awareness about disease transmission. Fefferman, in regards to her interest in setting up controlled experiments in game worlds, said she wants to test new behaviors never before considered. The CDC could then use that data in simulations that can maybe help them to make precise predictions on where to send response teams in the event of an epidemic, which could therefore make us more prepared in the event of a larger-scale Ebola outbreak or other pandemic.

Of course, there are elements of Plague Inc. that manage to take you away from the dark, familiar undertones and remind you that you’re playing a game. As the pathogen, you can pop blue bubbles that emerge on the map to hinder research efforts—I’m sure viruses can’t directly attack research laboratories. But there are things that seem to linger even after the app is closed: The randomly mutating genes that veer humanity’s fight off course, the strategies that involve exploiting the weaknesses of certain disadvantaged regions, watching the disease spread unknowingly across ships and planes. Most chilling is the goal where players are encouraged to kill. In the board game Pandemic, you band together to try and eradicate the disease. In Plague Inc., you are the disease. You get to play the villain.

Regardless of whether my awkwardness with the game has to do with the role I play or the realistic aspects of it, there is something in that realism that should be explored, in how the games themselves can affect the science space. There is more that can be done with games like this. With the growing arms race against antibiotic-resistant superbugs, the continuing fight against Ebola, and the potential for more battles against whatever new disease shows up next, Plague Inc. will also continue to evolve, utilizing films about pandemics such as Dawn of the Planet of the Apes to add new content, and become more detailed. As these epidemic strategy games continue, scientists will also find ways to incorporate them into research, finding new ways to track disease across populations and new behaviors to factor into simulations. Like the diseases we are afraid of, we will also evolve.

Carli Velocci is a freelance journalist in Boston, Massachusetts. You can find her on Twitter @revierypone.