From a storytelling perspective, the zika virus presents an interesting twist on illness.

Much as is the case with melioidosis, which I covered in this space a couple of weeks back, zika is a disease which has made major headlines all over the world. This is simultaneously good and bad. On the one hand, the zika virus is clearly a major public health problem which deserves world attention and awareness. On the other hand, modern media being what it is, much of what’s being reported is scare-mongering and exaggeration, such that a lot of people think they know a lot about it, much of which is, in fact, misunderstood at best. In reality, for the vast majority of people alive at this precise moment, the zika virus is a very small threat; the best data available at the moment suggest that zika is a minor infection to anyone who isn’t actively pregnant when infected, and since it’s cleared from the body within a couple of weeks of infection, it probably poses few long-term risks to a woman who only intends to become pregnant in another 5 years. None of this is meant to minimize how scary the virus no doubt is to a woman who’s pregnant right now, but the fact is that most of the people who will ever read this text really have no reason to be very frightened. Aware, yes, and informed, certainly, but not frightened.

This being said, from a storytelling perspective, the zika virus presents an interesting twist on illness. When we talk about infections, we’re usually concerned with what’s happening now. Even in a fairly long-term campaign, most players (and most storytellers) focus on what things might be affecting characters right this moment. Storytellers who infect PCs with diseases like leprosy, which don’t start having in-game effects until potentially years after the campaign is over, rarely find that their players take it very seriously. Zika, in contrast, has a curious potential to change the shape of a game world in a way that other illnesses don’t. Consider the following plotline, and how it shapes an entirely different campaign depending what time point the players encounter it.

At “time 0,” a plague hits a region. Perhaps it’s a natural epidemic, just as the current zika outbreak is (presumably) the result of natural forces. Perhaps it’s spread by druids, who use their powers to encourage the spread and reproduction of mosquitos who carry the infection. Perhaps it’s spread by a wizard using the contagion spell or similar magic, although this is less likely in the case of zika, since in the real world it’s a disorder which doesn’t easily spread from human to human. Perhaps in this case, the virus isn’t carried by mosquitos at all, but rather by fleas, who are introduced into a town by rats, allowing the disease to spread in a region normally inhospitable to insects. In the short term, the disease has a fairly minor effect: most of the town is infected by the disease, and about one in four of them develop minor, flu-like symptoms. This might have important ramifications if, for example, weakening the town guard is step one of a plot by wererats to invade from below, or if an unscrupulous bard plans to spread fear of a pandemic to inflame public sentiment against the local government. Heroes who enter the storyline at this stage have to uncover why the plague is spreading while dealing with a minor health crisis, although a fearful public may not recognize that the disease itself isn’t dangerous.

One year later, we have a different situation. Now, the true horror of the zika outbreak becomes clear. Depending on the size of the infected region, there may now be a handful, or a few dozens, or thousands of children who have been born with “microcephaly,” a failure of brain development which can result if the zika virus infects a woman during pregnancy. These babies, who are now anywhere from a few months to almost a year old, have decreased intelligence, require more care, and perhaps most frightening to the medieval mind, look different from other babies. The region now faces a very different crisis: the population has a sudden influx of special-needs children to care for, which most societies in a fantasy setting are ill-equipped to handle. In a relatively modern setting, this may mean that a large proportion of the society’s resources are reallocated to help provide care, and the region’s workforce is reduced. In feudal societies, it likely means vastly increased infant mortality, with an impact on happiness of the population. In fiercely militaristic societies, like ancient Sparta, it means that all of these children are likely killed at birth for the crime of being abnormal, leaving an unprecedented hole in the population. In any case, heroes who encounter the storyline at this point find themselves in a region coping with a previously never imagined tragedy, which may mean that the region is in economic crisis or may mean that the region is in the midst of a violent and bloody inquisition seeking the “demons” who caused the calamity.

Finally, fifteen to twenty years later, we see a third stage in the evolution of the crisis. Now, all of the affected children have grown, or as is much more likely in a fantasy setting where people live at a subsistence level without much in the way of medical care, most of the affected children are long dead. Aside from all of the other, much more obvious impacts of a society to have last an unknown percentage of the workforce, what happens to a fantasy world if a generation of would-be adventurers disappears? Perhaps the entire outbreak was masterminded by a devil or some other ageless, endlessly patient creature, who has waited decades for the moment when there is a shortage of wizards capable of blocking its portals. Perhaps there was no mastermind, but when some dragon or lich or other monster-of-the-week rises from its eternal slumber the adventurers who were fated to thwart it died years earlier. Heroes who enter the storyline at this point may be outsiders who find a region under the sway of dark forces due to the lack of local heroes, or PCs might be horribly overworked adventurers who are struggling to defend a region which has traditionally been protected by five or six times their number of heroes. Perhaps some cataclysm which heroes would usually have prevented has already occurred, and now the PCs live in the ruins of civilization and struggle to understand why there was no chosen one or ring-bearer that one critical time.

All told, the zika virus isn’t necessarily one which is useful as a direct storytelling tool, but it’s particularly well-suited to be a MacGuffin of some sort, a cause or catalyst of some other set of circumstances. By the time that zika’s real impact on a storyline is obvious, the disease itself may be long gone. A storyteller looking at using infections in an atypical way may find interesting opportunities presenting themselves. 

More than four years ago, Dr. Eris Lis, M.D., began writing a series of brilliant and informative posts on RPGs through the eyes of a medical professional, and this is the one that appeared here on January 31, 2016. Lis is a physician, gamer, and author of the Skirmisher Publishing LLC OGL sourcebook Insults & Injuries, which is also available for the Pathfinder RPG system.