The Pathogen

## Overview

The Pathogen (yet to be named but for now will be referred to as "The Pathogen"), is the mysterious emergent infectious agent of unknown origin that became epidemic in the city of \_\_\_\_\_ during the events of OWW. In the US, it became known as **THE \_\_\_(city name)\_\_\_ INFECTION.**

Humans who are infected with the pathogen and ***turned*** (a term meaning the loss of mental faculties as the virus assumed control of the brain) manifest a diseased state where they consistently exhibit the general characteristics of violent aggression towards uninfected humans, the hunger and compulsion to consume human flesh, and the overall loss or severe degeneration of higher brain functions.

Thousands were unable to survive the disease process and died as a result of the infection itself, but the overwhelming majority of the infected population turned into vessels to the pathogen's spread - killing and infecting exponentially

and causing a large-scale disaster where law and order dissolved into widespread chaos. Many thousands died as a result of the chaos or being unable to survive the infection, but hundreds of thousands more that were infected manifested

A characteristic common in those infected with The Pathogen is losing the capability to experience fear, and so infected individuals will never falter or flee, even in the face of death.

The type the infected person will turn into largely depend on the symptoms they experience. The effects and experienced symptoms of the disease vary greatly from person to person.

The extremely long incubation period of the first strains (beginning at several weeks) was said to be the major reason why the world could not survive the pathogen. Infected persons were unknowingly spreading the infection to others before they had even began showing major symptoms through sharing drinks, kissing, sharing drug needles, and other saliva/blood-to-blood contact. Each individual may have been spreading the pathogen for several weeks even before they turned, and then they infect even more afterwards.

In addition to The Pathogen's virulence and contagiousness, no viable treatment for the disease was found before worldwide civil breakdown - antibiotics proved ineffective due to the pathogen's structure being different from a bacteria, and some antivirals worked only to suppress symptoms and prolong the time before turning. The world was unable to find a true cure before the collapse of global civilization.

Infected individuals close to turning will begin producing pheromones that will make other infected disregard them as prey. A human who is infected but not close to turning yet, however, will not produce such pheromones yet and other infected will still try to kill and eat them.

## History and Timeline:

The mysterious Pathogen that has plagued the city is of unknown origin. Because of the viciously virulent nature of the pathogen and the failure of authorities to contain the disease, it spread relatively fast in the city and was prevented from being examined thoroughly by scientists in the city, who either died or were not able to effectively study it in the ensuing chaos of the outbreak.

When the very first strains of the pathogen broke out, billions of people became infected over an unknown time period (estimated to be over several months) but the world was largely unaware. This was because symptoms of the disease were weak and were identical to the common cold or the flu. Almost everybody infected was seen to recover in full and the mortality rate was so miniscule that the CDC and other agencies were not alarmed. For a while, many assumed that it was a new, more potent strain of the flu, until it was much later (post-collapse) detected by scientists to be something completely different. Months after this initial spread, a new strain emerged and shook the globe.

When the world seemed like it was overcoming this minor pandemic and people slipped back into comfort, the pathogen evolved a new variant and became more virulent. Individuals who were young, fit, and healthy were still able to fight the disease off and recover - but the elderly, immunocompromised, and infants were beginning to fall severely ill to the disease. On the day of \_\_\_\_\_\_\_\_\_, the first infected person, an elderly man in \_\_\_\_, underwent turning. While not the true patient zero of the pathogen, this individual was titled as so because they were the first person to ***turn***. After turning, this patient went on to infect several others through bites and scratches, including a few of the police officers that detained him. Some of the individuals who were attacked were subsequently hospitalized, while others suffered minor wounds and did not think anything of it. They were released home and for several days they seemed normal - until they began showing signs of infection. Some were hospitalized again and some were not when they all eventually turned, but the contact they had with people (saliva & blood) meant that several other people had already been infected before these individuals turned. The infection spread out from here, but flew under the radar of most of the world's knowledge due to it beginning in a third-world country. Eventually, an infected person boarded a plane to the US and landed in the city of \_\_\_\_\_\_\_\_. This individual turned after a few weeks of being in the country, and subsequently infected a few others through bites and scratches.

Eventually, isolated incidences of "maulings and other random violent acts committed by sick people" began to occur in a pattern across several major cities of the US. The offenders were often killed in self-defense by other citizens or by police, rather than apprehended and taken into custody. The few that were apprehended were noticed to be in a completely altered mental state that doctors were unable to ascertain the cause of. They were ruled unfit to stand for trial. The first

It was only recognized in the hospital lab much after the infection had spread out considerably that the infective organism was in fact not the flu, but a new microorganism called The Pathogen, and that it had solidified into a blood-to-blood/saliva mode of transmission.

This led to overcrowded hospitals and

Several weeks into the outbreak in the city of \_\_\_\_\_\_, it was discovered by one of the \_\_\_\_\_ research teams that the properties of some antivirals help to slow the infection progression and suppress symptoms in infected (but not yet turned) individuals. These drugs were delivered via airdrops along with care packages of other supplies to healthy survivors in the city. **SPOILER AHEAD UNTIL NEXT PARAGRAPH:** Eventually, these airdrops stopped when the outbreak spread beyond the city walls and devastated the rest of the US.

## Microbiology:

The Pathogen's causative microbe/agent for infection seems to be of a structure unlike anything ever seen before on Earth and its genome is capable of rapid evolution faster than other microorganisms. It is not a bacterium in structure and is also completely unaffected by antibiotics. It is not structured like a true virus, either, but its pathogenesis resembles the progression of a viral infection. Many of the symptoms are similar to those caused by prion diseases (also known as transmissible spongiform encephalopathies, or TSEs), however the microbe is not a prion, either. The Pathogen is also not a parasite, as the causative organism does not need a living host to survive - it can live in dead bodies, inanimate objects, and on surfaces -at least for short periods of time. While the pathogen doesn't need a living host to survive, it does need one to replicate itself, much like a true virus does.

### Reservoir:

While the microbe can survive for short periods of time on fomites like doorknobs and other surfaces, its only natural reservoir are humans - it can only replicate itself using human cells. Food, water, animals, soil, insects, and other reservoirs can potentially harbor the microbe for limited amounts of time, but the pathogen can only multiply in humans. Vectors such as insects and rodents can potentially transmit the infection if contact with human infected fluids occur, however they are not true carriers, as the microbes cannot live longer than a short time on these animals, no different from any other non-human surface.

It has been studied that those contracting the infection from a fomite or other indirect transmission tend to suffer less severe symptoms than those that are directly infected by another human. It seems to be the case that the microbe becomes attenuated from being away from human cells.

### Portal of exit/entry:

Often, a pathogen's portal of exit is the same as a pathogen's portal of entry.

The pathogen's portal of exit was initially a droplet-based transmission for the early strains that weren't fatal or capable of causing turning.

The pathogen is not a contact-precautions disease, meaning spread through direct physical contact. This means that direct skin-to-skin contact with an infected person did not necessarily cause infection. It is a blood/fluid-borne pathogen, meaning it only spread through fluid transfer onto broken skin or wounds.

Eventually, the pathogen became primarily bloodborne, and respiratory transmission was no longer viable.

## Transmission:

The Pathogen's natural reservoir are humans, and so the disease is a primarily human-to-human infection that is spread through direct physical contact with an infected person's blood and saliva. A person exposed to infected fluids will only become infected if the fluids enter the person's bloodstream. Splatters on intact and unbroken skin do not cause infection. With biting attacks being the most common behavior and most utilized method of attack of all infected types, getting bit by an infected person becomes the most common cause of infection. Otherwise, infected saliva or blood splattering into or otherwise contaminating an open wound can also cause infection. Other bodily fluids seemed unable to harbor the microbes that cause the infection. Scratching and clawing attacks also are seen to be able to infect others, despite the fact that no body fluids are excreted from the nails and hands. The explanation for this is that infected individuals use their hands to eat, and their own saliva and blood contaminate their hands and get under their nails.

The timeframe between infection and turning seems to depend on several factors:

* The location of the infection site on the body is one factor - the infected person is expected to turn incredibly quickly if the neck, head, or face is the infection site. The timeframe is slightly longer if the torso is the infection site, but is longest when it is a limb that is an infection site. Generally, the further the site is from the brain, the more time the individual has before symptoms begin and they eventually transform/turn.
* The severity of the wound/contamination - a small scratch or scrape that has become contaminated may take days before symptoms show up, but a large bite or infected blood splatter into a gaping wound will hasten the infection process considerably. Additionally, multiple infection sites (for example, several bites on different parts of the body) also speeds up the timeframe before turning.
* The specific strain of the pathogen - the first strains (the strains that caused wasters) were at first not extremely virulent and so infected people didn't turn until several weeks or months after infection. The runner variant and subsequent strains caused people to turn within hours to a few days at maximum.

It was studied and ruled that the Pathogen is, in fact, not airborne. The pathogen did not evolve to gain airborne capabilities, for reasons unknown. It is also shown that other animals, such as dogs and cats, are able to contract the infection, but will not develop a diseased state/illness - asymptomatic carriers/reservoirs of the pathogen.

## Infection progression/Symptoms:

Information given on this disease is considering the scenario of the longest known time before turning. There have been cases where somebody has turned within hours or even minutes after getting bit.

The progression of infection as well as symptoms experienced by the host can vary heavily, depending on the specific strain of the pathogen that the individual was infected with and any factors that can possibly cause mutations. Otherwise, symptoms of infection from the same strain remain consistent and may only vary minimally between individuals.

Below are the lists of differing symptoms experienced by people infected with different strains of the pathogen.

### **First strain:**

*These symptoms are experienced by those who have been infected by the embryonic, or initial strain of the pathogen. This strain was the infection that created the waster-type and was the most communicable of all the strains. Timeframes given for symptom onset reflect the strongest and latest walker strain - the first of the walker strains may have taken weeks or months for the subject to succumb to the infection. Physical symptoms are overall degenerative and are similar to those of influenza and Ebola.*

###### Initial symptoms:

*Initial symptoms are the symptoms that occur after first getting infected. These are experienced by, and can be observed in, an infected person who **HASN'T** turned yet.*

* Cachexia - aka "Wasting Syndrome" - end stage of emaciation, progressive loss of muscle mass and weight over disease process. Fatigue and weakness/loss of strength are common.
* Bulging, discolored veins first starting at local site of infection, and gradually spreading outwards in all directions to areas like the neck, face, arms, and legs - begins minutes or so after infection, and the pallid skin symptom makes this more noticeable
* Local area of bite or infection will rapidly become inflamed, painful, dark green or blue, and occasionally throbbing
* Epistaxis (nosebleed) - often one of the first symptoms to appear, used as an indicator that the infection has made it to systemic circulation, and that amputation of infected limb can no longer save the individual
* Random, powerful hallucinatory episodes/delirium that can begin even just minutes after infection
* Random moments of syncope (fainting) - can begin happening several hours after infection
* Random bouts of violent tonic-clonic (grand-mal) seizures - can begin happening several hours after infection
* Photophobia, dizziness, & migraines caused by sensitivity to and discomfort in bright lights - can start minutes after infection, as nothing more than a small inconvenience, but steadily grows more severe until moment of turning
* Lack of appetite, nausea, & vomiting - can begin within several hours after infection, these are simply common responses of the body to being sick. Vomit becomes bloody (hematemesis) around the time the bloody cough symptom begins.
* Skin becoming paler - beginning several hours after infection and worsens over time
* Coughing up blood - some measure of internal hemorrhaging happens as a result of the infection, and coughing up blood (hemoptysis) is one of the most distinguishable signs of someone being infected. Usually begins a half-day after infection, before fever onset
* Gingival bleeding - the gums may bleed easily and spontaneously, even if no wound is present. This symptom is another giveaway for infection, and is the source of paranoia for uninfected survivors, only because someone bleeding from the mouth bears a striking resemblance to an infected who has been consuming human flesh.
* Chills & worsening fever usually the day after infection
* Cold sweats/excessive sweating usually the day after infection (can lead to dehydration)
* Weakness, fatigue, & muscle aches usually the day after infection
* Yellowed sclera of the eyes resembling that of jaundice (however not caused in the same manner) - begins the day after infection and is a dead giveaway sign that someone is infected (with the walker strain in particular).
* Yellowing of the fingernails and toenails & hair growing brittle over the course of days
* Osteomalacia - bones soften and weaken over the course of days and continue to deteriorate after turning
* People that are infected may experience anxiety, depression, bouts of anger and panic attacks, suicidal thoughts, hopelessness, paranoia - all not TRUE symptoms of the disease but rather a common psychological reaction to being aware of their infected condition
* Irritability - infected individuals may become increasingly irritable or "on edge". Their emotions are labile, but tend towards anger and despair
* Coma - the coma is the final symptom before turning. The infected person falls unconscious, becomes unresponsive, and their heart rate and breathing slows significantly. It can last several hours or even days and during this time the subject begins releasing pheromones that signal that they are no longer uninfected. Due to this, other infected will leave the comatose body alone. Once they wake, they are turned.

##### Uncommon initial symptoms:

* External hemorrhaging/Bleeding from all orifices - a very important sign that the infected person will mutate into something much, much more dangerous later on. Bleeding from eyes is the most noticeable of these symptoms, but bleeding from the nose, ears, mouth, urethra, anus, and genitalia openings are also common.
* Twitches and tremors within hours after getting bit - a less common symptom only experienced by a select few. Observed to be a signal that the infected will mutate into a \_\_\_\_\_ later on.
* Excessive fluid discharge - some fluid discharge happens as a symptom of the infection, but excessive discharge from the nose, ears, eyes, mouth, anus, and even genitalia is correlated with a possible future mutation...

###### Turned symptoms:

*These symptoms are experienced in those who have undergone turning into a walker and woken up from the coma.*

* Dilated pupils - an infected person's pupils should be constricted due to the photophobia symptom. So when inspecting an infected person in coma, severely dilated pupils signals they are close to turning. They remain dilated after turning.
* Severe lethargy - on top of the body having fought the infection for a prolonged period of time, wasters do not sleep, nor do they eat for nourishment, only getting miniscule amounts of energy from the sun to continue functioning. This puts them in a perpetual state of lethargy and sluggishness. Their weakened and wasted bodies have little muscle mass to support vigorous functions.
* Fading of irises - regardless of their original color before turning, the irises of all wasters will fade to a pale grey color eventually, but this takes place over many weeks or months. Freshly turned wasters will still show their original eye color.
* Vomiting - though the infected has turned and the pathogen has gained neurological control, it doesn't mean that the host body has stopped fighting the infection. The vagal response is still active and the pathogen irritating the gut cells will cause vomiting, especially during short periods of host consciousness where they become aware that they have consumed human flesh.

### **Second strain:**

*These symptoms are experienced by those who have been infected by the second strain of the pathogen. This strain was the infection that caused the runner-type infected. Some of the symptoms are similar to the first strain, but most of the degenerative symptoms are now absent, due to the extremely brief period between infection & turning - ranging from a few hours to 2 days after infection. Symptoms resemble those of rabies and encephalopathy.*

###### Initial symptoms:

*Initial symptoms are the symptoms that occur after first getting infected. These are experienced by, and can be observed in, an infected person who **HASN'T** turned yet.*

* Bloodshot eyes - begins within hours after infection. A telltale sign that a person is infected with the runner strain and not the waster strain is that the whites of their eyes turn bloodshot, rather than yellowish and jaundiced.
* Bulging, discolored veins first starting at local site of infection, and gradually spreading outwards in all directions to areas like the neck, face, arms, and legs - begins minutes or so after infection at the local infection site, and the pallid skin symptom makes this more noticeable. Local area of bite or infection will become inflamed, painful, dark green or blue, and occasionally throbbing
* Epistaxis (nosebleed) - often one of the first symptoms to appear, used as an indicator that the infection has made it to systemic circulation, and that amputation of infected limb can no longer save the individual
* Random, powerful hallucinatory episodes/delirium that can begin even just minutes after infection
* Random moments of syncope (fainting) - can begin happening several hours after infection
* Random bouts of violent tonic-clonic (grand-mal) seizures - can begin happening several hours after infection
* Photophobia, dizziness, & migraines caused by sensitivity to and discomfort in bright lights - can start minutes after infection, as nothing more than a small inconvenience, but steadily grows more severe until moment of turning
* Lack of appetite, nausea, & vomiting - can begin within several hours after infection, these are simply common responses of the body to being sick. Vomit becomes bloody (hematemesis) around the time the bloody cough symptom begins.
* Skin becoming paler - beginning several hours after infection and worsens over time
* Coughing up blood - some measure of internal hemorrhaging happens as a result of the infection, and coughing up blood (hemoptysis) is one of the most distinguishable signs of someone being infected. Usually begins a half-day after infection, except for the runner strain, it is **NOT** accompanied by fever onset
* Gingival bleeding - the gums may bleed easily and spontaneously, even if no wound is present. This symptom is another giveaway for infection, and is the source of paranoia for uninfected survivors, only because someone bleeding from the mouth bears a striking resemblance to an infected who has been consuming human flesh.
* People that are infected may experience anxiety, depression, bouts of anger and panic attacks, suicidal thoughts, hopelessness, paranoia - all not TRUE symptoms of the disease but rather a common psychological reaction to being aware of their infected condition
* Irritability - infected individuals may become increasingly irritable or "on edge". Their emotions are labile, but tend towards anger and despair.
* Coma - the coma is the final symptom before turning. The infected person falls unconscious, becomes unresponsive, and their heart rate and breathing slows significantly. It can last several hours or even days and during this time the subject begins releasing pheromones that signal that they are no longer uninfected. Due to this, other infected will leave the comatose body alone. Once they wake, they are turned. For the runner strain, this symptom may be either present or absent, but tending towards absent. A coma was only experienced by the strongest of immune systems as a final stand against the pathogen.
* Outbursts of rage and violence accompanied by transient global amnesia (TGA) & confusion - after being infected for some time, some survivors will suddenly become aggressive and attack as if they have already turned, then quickly regain their senses, confused about where they are and what has just happened. There is little to no chance of recovery at this stage, and in many cases they are killed by other survivors, who mistake these temporary outbursts as them already turning.
* Signs of adrenaline before turning - one of the final symptoms before turning for a runner is the loading of adrenaline into the bloodstream. Pupils dilate, vision tunnels, breathing and heart rate increases, digestion slows, muscles tense and shake. Some of these signs are outwardly noticeable and can be used as an indicator that the infected person is about to turn. This can happen in the span of a few seconds and often unexpectedly.

###### Turned symptoms:

*These symptoms are seen in those who have turned into a runner.*

* Adrenaline -
* Hyperaggression - detecting an uninfected human often sends the infected into an uncontrollable and violent rage
* Severe emotional dysregulation - similar to Pseudobulbar Affect (PBA), the brain loses the ability to effectively control one's emotions and so besides displays of hysterical rage, runners may be seen crying uncontrollably, and sometimes even giggling quietly to themselves. Also worthy to note is that the emotions experienced are incredibly intense and volatile - changing quickly and often disappearing as soon as they came.