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VITAS – History, Epidemiology, and Treatment

by Dr. David Path-on-the-Peaks

I. History

Virally Induced Toxic Allergy Syndrome was first identified by Doctor Meehrut Saharanpur of the Sri Ramchara Medical College in Delhi, approximately three weeks in to what would eventually become the worst pandemic in human history. From late 2010 to early 2011 VITAS killed approximately 1,880,500,000 people worldwide, or roughly 27% of the earth's population at the time. A second VITAS pandemic in 2022 resulted in another 650,675,000, or around 11% of the remaining world population. Rumors of a third outbreak of VITAS have circulated for years, but the only confirmed outbreak in recent years up to this point has been in Seattle, in which a new strain of VITAS took several hundred lives. It now appears that there has been an additional outbreak in Germany - its current extent is unknown.

II. Etiology and Pathogenesis

The reservoir for VITAS, if any, remains unknown at this time. There are six known strains of VITAS, each causing near identical symptoms but antigenically distinct from the others. Infection with one of these serotypes does not provide cross-protective immunity, so it is possible to contract VITAS up to six times.

VITAS is transmitted person to person by direct contact or inhalation or ingestion of droplet nuclei. Contact with contaminated clothing, bed linens, or contaminated personal possessions will also transmit the disease. Active VITAS cases the virus through all bodily fluids, including saliva, urine, phlegm, feces, tears, and perspiration. VITAS I appears to have been more virulent than VITAS II, and it was not unusual for 20-30 secondary cases to develop from a single primary case. For VITAS II 10-20 secondary cases was far more common. The virus is somewhat sensitive to cold - infection rates rise in spring and drop in autumn.

III . Symptoms and Signs

Incubation for VITAS varies depending on the strain - VIT-1A, VIT-1B, and VIT-2A are fast acting, often manifesting within 6 hours of exposure. VIT-1C and VIT-2B are slow acting, often incubating for as much as 14 days (though serological tests for antibodies show positive after only 6 hours). Based on limited information I currently posit two additional strains of VITAS III - VIT-3A which has an incubation period of up to two days, and VIT-3B which appears to become active almost immediately. Once the virus becomes active symptoms follow in three stages. Stage I, in which the virus multiplies throughout the body systems, is characterised by a mild fever, headache, back ache, and general malaise. This stage lasts between one and four hours. Stage II, in which the disease concentrates in the lymphatic system of the patient, is characterised by a rapid rise in temperature to an average of 38.8 C, a drop in blood pressure, watery diarrhea, headache, sore throat, vomiting, and muscle aches. The skin also takes on a sunburned appearance. Stage II usually lasts between 2 and 5 hours. In a small number of cases (around 1%) the disease does not progress past Stage II. In other cases the onset of Stage III is characterised by a drastic decrease in blood pressure, upper respiratory tract obstruction due to swelling, cardiovascular arrythmia, severe gastrointestinal distress, delirium, and a sense of impending death. Blood vessels in the skin rupture, and the patient typically exhibits bloodshot eyes, and unusual redness around the eyelids, the inside of the mouth, and, if female, the vagina. Death occurs after 4 to 6 hours, almost exclusively due to complete cardiovascular shutdown. Fatality rate for Stage III patients is 98%.

IV. Mortality

Mortality for all strains of VITAS thus encountered is approximately 96%. With proper treatment mortality rate for the VITAS II outbreak was dropped in some cases to as low as 80%. There have been some indications that dwarves, orks, and trolls have an increased rate of survival. VITAS affects both genders equally.

V. Treatment

All known treatment for VITAS is supportive care. Hemodynamic monitoring and ventillary support should be supplied as necessary. Intravenous fluids, epinor, and dopamine analogues should be administered to combat dehydration and hypotension. Broad spectrum antibiotics should be administered to prevent secondary infection.

During the outbreak of VITAS II there were scattered reports that the virus could be treated, and even cured, by the application of powerful magic. Unfortunately systematic study of magic was still in its infancy during VITAS II so the magnitude of magical energy needed to cure VITAS II is not known, though it is generally agreed to be between magnitude 6 and 9.

VI. Precautions

Patients should be placed in strict respiratory isolation, preferably in negative pressure isolation wards. All fluid specimens must be handled with gloves and mask. Because of the virulent nature of the disease, it is recommended that all members of the Trauma Team wear level A HAZMAT protective gear at all times when in or around an outbreak area.

VII. VITAS III

Experience with the VITAS III plague is extremely limited. The initial outbreak was cultured in a laboratory setting, and was apparently harvested from a "carrier", and was administered via injection to unknowing subjects. We therefor have no data on the disease's natural transmission rate. While it can be confirmed that the disease was quite virulent it cannot yet be ascertained whether it was more or less so than previous strains. Incubation period for the Seattle VITAS III outbreak appeared to be around 24-36 hours.

I have had the opportunity to examine only a single case of VITAS here in Germany, but from what I have seen there has been a major shift in the disease's pathology over both the previous outbreaks of VITAS and he strain released in Seattle. Onset of symptoms is now almost immediate, and the development of the disease is rapid. In addition, astral examination of the disease confirms that it is active on the astral as well as the material plane, leading me to hypothesize that we may be seeing the emergence - or development - of the worlds first awakened virus. The implications of this possibility are, to say the least, terrifying.

In the single case so far examined, powerful magic was in fact successful in curing the patient. However, the magic required was of magnitude 8, putting it beyond the capabilities of the vast majority of shamans and magi currently practicing. This means that if the disease is as virulent as previous strains of VITAS there will be insufficient magical resources to deal with any sort of serious outbreak.

VIII. Trauma Team Response

Our first and most important goal must be to acquire multiple samples of the VITAS III virus for future study. This will require not only access to samples, but appropriate containment facilities and a medical lab with which to prepare them for treatment. This in itself will likely require some sort of covert operation, as the purchase of a private medical lab for our use is not feasible at this time.

Given that the outbreak here may have been ongoing for several weeks or months, containment must be our second goal. Investigation of the outbreak sites will be required to determine whether or not such an activity is feasible.

Treatment of the individual cases and suppression of the outbreak may well be beyond the capabilities of the Trauma Team. In this case we will have to locate additional support to deal with the larger problem of cleaning up the mess.

Questions?

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