Red Rot


This is not a holy site
Evil lurks below the ice
Do not disturb its rest.


Thus reads the warning carved into a boulder on Kenato Island, a small island in Contraturris that is covered in ice even in summer. The cautionary message is written in a dozen languages from across the world, and dates to the time of The Second Reckoning.

  But the warning was not there in the year 2391 of the Second Age, when an earthquake rocked the southern coast of Armorca. Every spring, hunters from western Armorca landed on the island to collect seal pelts. This time, when they looked up at the glacier running out of the mountains at the heart of the island, they spotted a mile-long crevasse just up from the toe.

  A handful of hunters couldn't resist their curiosity. They climbed up the toe of the glacier towards what looked like a slashing claw-mark on the sheet of ice. When they reached its edge, they found vibrant blue ice exposed and a long drop. They would have been content to just look... until one of them took a step too far on unstable snow and plunged into darkness.

  His companions immediately readied the rope. The unfortunate man was injured, but had wedged himself in a narrowing of the ice about forty feet down. A brave companion tied a rope around himself and rappelled into the crevasse to carry his friend out. Both men survived to return to camp, and, after a chewing-out from their captain, eventually return home to mainland Armorca.

  But the hunting expedition brought something else back to Armorica with them - something that had lurked beneath the ice for tens of thousands of years until the pair of hunters unwittingly wiped it off the crevasse walls and onto their hands. Their trip up to see the crevasse had pulled the trigger that would end the Second Age.

 

The Plague of the Ancients

Plague Map.jpg

Around 5,000 years ago, civilization across the known world screeched to a halt after the Second Reckoning. The situation in the world was already dire, however. In the preceding decade, a pandemic ravaged the world. From its start in western Armorca, the plague spread throughout the world, leaving no inhabited area untouched.

  They had no cure for the disease. They didn't know what caused it to spread. Its effects were gruesome, painful, and often fatal. By the time the Reckoning hit southern Cuyania, where the plague had come and fizzled out years previously, there were hardly any population centres left to topple.

Transmission & Vectors

The disease is airborne and transmitted via aerosolized droplets expelled by coughing or sneezing. It spreads from person to person, either directly by breathing it in from a cough, or indirectly, by archea left on surfaces by coughs or sneezes. The archea can survive in the light for a few hours before dying. Once someone touches an infected surface, the archea needs to enter the body via mouth, nose, eyes, etc.  

The infectious stage begins when the infected person begins to cough. They have an incubation period of 3-4 days, and then coughing begins. Dangerously, the infected person might go another several days thinking they just have a cold before symptoms begin to get severe, giving them ample time to cough and sneeze while out and about in their community.

 

I thought I just had a cold. I've felt fine other than the sore throat and sniffles. This morning, I found blisters on my tongue.... I kissed my husband last night. Oh Spirits, what have I done?
— From a woman's diary, eastern Armorca, 2393

Causes

Kenatarcheaota

Red Rot is caused by a type of archea, which are single-celled organisms similar to bacteria, known Kenatarchaeota. They have only one known reservoir: a sub-glacial lake on Kenato Island and the ice immediately above it. The hardy archea survive off energy and methane given off by an underground volcano.

  Kenatarcheaota thrive in dark, wet environments, and seem to have no reaction to temperature. Their main weakness is bright light; they will die if exposed to bright sunlight for more than a few hours, or if they are in an arid environment. Kenatarcheaota are usually content to lurk under the ice, munching on methane. If they happen to get into a human body, though, there's some trouble.

  The trouble is this: Kenatarcheaota really want to live in your central nervous system. Your body really doesn't want them to be there. The dispute between these two parties wreaks havoc on the patient. Once introduced, the archea burrow deeper and deeper into the body, targeting the meninges that envelope the brain and spinal cord.

  Once there, the body's immune system freaks out. The presence of kenatarcheaota triggers the pathway causing a form of toxic epidermal necrolysis, a severe skin reaction. Meanwhile, the archea causes inflammation of the meninges. Once it has taken root in the meninges, it frequently travels to other parts of the body, especially the lungs.

  It's thought that long ago, kenatarcheaota were more widespread and adapted to cause illness in an early hominid. The archea caught under the glacier by a shifting climate are the last remnants of an otherwise-extinct pathogen. In this earlier hominid, the disease would not have been as severe, so that the archea could live in the hosts for a prolonged time. When it re-emerged in the Second Age, modern humans were not equipped to deal with the ancient plague, allowing it to decimate the global population.

Symptoms

Last week, Mother started coughing. We all thought it was a simply cold. Five days ago, blisters appeared on her hands, which she said were terribly painful. Yesterday, her tongue was so blistered she could not speak without agony, and the red rash on her arms caused her skin to peel like rice paper. Today, I began to cough. I'm so afraid.
— A nobleman's daughter, from the Shilo Peninsula, 2397

The symptoms of Red Rot are notoriously gruesome. The classic symptoms of the disease are divided into two groups: the disease, and the reaction.

The Disease

The disease itself attacks the meninges throughout the central nervous system. This is the cause of:

  • Fever
  • Seizures
  • Increased pressure in the brain
  • Organ failure
  • Stroke

The precise symptoms are highly variable due to the way the archea target the central nervous system and affect different areas of it in every patient. The archea sometimes travel to other parts of the body to cause more damage. Most frequently, they infect the lungs and cause laboured breathing and hemoptysis (coughing up blood).

 

The Reaction

While the archea lay waste to the body's internal systems, the body's immune system attempts to combat it. Unfortunately, the human immune system is not equipped to deal with kenatarcheaota, and reacts by, metaphorically, lighting everything on fire and hoping the host survives longer than the invader.

  The immune system triggers the skin to erupt in painful blisters. They usually start in the mucous membranes, especially the tongue and mouth, or the genital region. Four days later, the patient will be covered in painful blisters from face to toe, though usually not the scalp.

 

symptoms illustration.jpg
Illustration of stages: cough, blisters, peeling skin, & death.

Within a few days, the person's entire body is covered in large, red blisters that are painful to the touch. In about 50% of cases, the eyes are afflicted.

  When the blisters begin to burst, the flesh peels away to leave open wounds beneath. This is where the disease gets its name; the skin isn't literally rotting, but to the uninformed spectator, the skin appears be be sloughing off like a rotting corpse. Burst blisters are also liable to get infected on their own, adding additional complications to the symptoms.

 

Stages

The disease progresses in three main stages after symptoms begin to manifest.

Stage 1: Malaise

  • Sore throat
  • Coughing
  • Low fever
  • Sensitivity to light
  • Gradually increasing headache
  • (Near end of stage 1) Sensation of skin burning all over the body.

Lasts 2 - 4 days.

 

Stage 2: Blisters

  • Blisters cover patient's body
  • Worsening fever
  • Bright lights are unbearable
  • May experience symptoms from the inflammation of the meninges.
 

Lasts 4 - 7 days.

 

Stage 3: Sloughing

  • Blisters burst
  • Skin sloughs off, leaving open wounds
  • Fever reaches peak
  • Patients typically slip into coma on 3rd or 4th day, from which they either wake up recovered or die.

     

    Lasts 3 - 6 days.

Treatment

It's no wonder that so many of my colleagues have given up. It is so hard to look a grieving parent in the eye and tell them the only thing you can do for their suffering child is make them somewhat comfortable and hope for the best.
— Doctor Tehea, from the Khanty Sea, 2398
  There is little that can be done once a person is infected by the Red Rot. Even in the Fifth Age, medicine is not advanced enough to do more than treat the symptoms. The only thing to be done is to let the disease run its course and attempt to ameliorate the symptoms. These were the two main tactics used throughout the course of the pandemic.  

Bedrest

Once the blisters really set in, the patient would not have the energy to walk around anyway. Often, patients remained at home, treated by family.

  In other areas, especially during times with significant numbers of cases, patients were gathered in large areas such as town halls, audience chambers, or dance halls. These rooms were kept dark due to patients' sensitivity to bright light. The rooms reeked from sweat and open sores, and were filled with the moaning of patients in agony. To fall into a coma in one of these places was sometimes seen as a mercy.

 

Bandaging

Nurses worked hard to cover the wounds left by burst blisters. Many patients died not from the disease itself, but from infections brought on by the open wounds the blisters left.

My patients look like mummies, as if I were preparing them to ascend to Rekah. They cry out when I wash their wounds and it pains me to cause them more suffering. If only I had any indication this is even helping!
— Journal entry from a Tanishite nurse, 2398


Across the world, every culture reacted to the plague in their own way. These are a sample of some methods various cultures used to try to treat Red Rot.  

Divine Intervention

Every culture had their own god from whom to beg help. Some examples:

  • Sending a shaman into the spirit world to defeat the demon causing the illness (common in, for example, the Vishim Desert and Dàn Coast)
  • Conducting rituals with blessed water or strengthening incense (common in northern Cuyania)
  • Sacrificing an animal to beg the gods for healing (common among the Tanishites, who preferred to sacrifice moas).
  • Individual prayer (near universal)

 

Lancing the Blisters

This was especially common in southwest Kaabara, although other regions practiced it as well. The doctor would use a sharp needle and painstakingly pop the blisters all over the body, a process that could take hours. In the region that is now Hosquerre, the thought was that if they lanced the blisters before they burst, the resulting wounds would be less severe. In the savannah region, the thought was that the disease dwelt into the pus of the blisters, and they needed to release it from the body. This rarely worked, and more often led to significant infections.

 

Medicine

Many medicines were attempted, but with no understanding of what was causing the disease, they were placebos at best, and caused poisoning at worst. These included mixtures of various herbs, pastes made from clay and dung, tinctures of alcohol and tree sap, and so many other attempts.

 

Quarantine

Though they did not understand the mechanism of transmission, most cultures recognized that it tended to pass to nearby people. Most urban areas attempted quarantine of some sort. The two most popular strategies were:

  • Building walls: Many cities prepared as if they were under siege, but all eventually had to open their gates when their food supply ran low. Still, some of these cities remained bastions of health even at the very end of the Second Age

  • Rounding up the sick: Even the smallest cough might be reason to be sent to a quarantine camp, where if you didn't have Red Rot yet upon being sent, you certainly would after arriving.

 

Amputation

In the western foothills of the Iceforge Mountains, they went to extreme measures to try to stop the spread of the disease. As soon as the blisters appeared, they amputated the afflicted body part, hoping they wouldn't spread. Unfortunately, the blisters were only an external materialization of a disease within the meninges, and the treatment only lead to more deaths from amputated wounds getting infected or sufferers being weakened by the amputation and unable to fight the disease.

A few days ago, they cut out Vari's tongue because the blisters came in. He bled for so long, and cried horribly, but we all thought it would be worth it to keep the blisters from spreading. He can't talk, so I've just been sitting with him and stroking his hand. Today, though, I spotted a new blister on the side of his neck. So what was the point of that?! What are they going to do now, amputate his head?
— From a letter written between sisters in the Iceforge region, 2397
 

Prognosis

Red Rot has an average fatality rate of around 40%. The prior health of the patient has a large impact on their chances of survival. The very old, the very young, and the very weak are unlikely to survive. An adult in good health, who receives appropriate care in dressing the wounds and plenty of rest, drops the fatality chance to around 20%.

  Living conditions also factor into prognosis. Patients living in poverty have significantly fewer chances of survival, both because of a decreased access to doctors or quality medical care, and an increased risk of infection of the open wounds due to squalid living conditions.

  The cause of death varies, but the most common is organ failure due to infection of the meninges. The second most common is death from a secondary infection brought on by the blisters.

  Of those who survive, many have long-lasting effects from the disease. Some of the more common are:

  Scarring - Affects 99% of survivors Ubiquitous among survivors. The blisters and open wounds leave rough patches of scars on many areas of the body and are the tell-tale sign that someone has survived the Red Rot.
Hearing Loss - Affects 55% of survivors Caused by pressure in the brain due to the inflammation of the meninges. Can range from mild to complete.
Brain damage - All brain damage affects 40% of survivors; severe brain damage affects 10% of survivors Caused by inflammation of the meninges. Most common if the patient became comatose for an extended period. Could be mild or severe.

Blindness - Affects 35% of survivors Caused by blisters scarring the corner, or blisters on the inner eyelid damaging the cornea while blinking.
Paralysis - Affects 20% of survivors

Caused by damage to the spinal cord by the archea. Could affect any parts of the body, in any level of completeness, depending on where precisely the archea targeted.

There are so few left to bury the dead.... Even those who survived the pestilence are too crippled to dig graves. My neighbour was the last to die in his house, and after several days he was eaten by his orphaned dog because there was no one to tend to his corpse.
— From a merchant in central Cuyania, 2400

Sequela

The primary complication arising from Red Rot is infection of the burst blisters. A patient might survive the initial Red Rot only to succumb to an infected wound a week later. Infections normally begin in stage 3, after the skin begins to peel off.

  The disease also causes permanent, disabling conditions that can cause future troubles. The brain damage patients sometimes experience can leave a patient in a vegetative state even if they recover from the Red Rot. Milder brain injuries can sometimes take months or even years to manifest, with patients going on to suffer a lifetime of headaches, memory loss, or communicative disorders.

  Cases in which the archea significantly damage the spinal cord have the most severe subsequent conditions. Patients who suffered significant paralysis usually died several months later from organ failure, intestinal blockage, deep vein thrombosis, pressure ulcers, or pneumonia. This was especially true at the height of the plague, when there were not enough doctors to go around to treat chronic issues.

Prevention

Red Rot is contracted by breathing in the archea, or by getting them into your body from your hands. There are no vaccines, so the only prevention is to avoid letting the infectious archea get into your body.

The town council cancelled the spring dance tomorrow. I'm so mad! It's not like we even have Rot in Harabay yet. I was going to ask Jalpan to dance with me and that plan is ruined! They closed all the coffeehouses, too, and banned physical contact outside the home. Now, even if I managed to be alone with Jalpan, he wouldn't even be allowed to kiss me. This is the worst!
— From the diary of a teenage girl, eastern Iceforge region, 2391

  • Hand washing - regularly washing your hands and not touching your face is one of the easiest ways to avoid getting sick. It isn't foolproof, but definitely helps.
  • Face masks - tying cloth over your face can help keep you from breathing in infectious particles.
  • Avoiding public gatherings - every time you go out in public, you risk exposing yourself to the disease. Stay at home unless necessary.

Epidemiology

Red Rot is infectious via droplets propelled by coughing or sneezing. This was not known by the majority of the population during the plague, who understood only that the disease tended to spread by proximity. The average patient will infect 3 other people before they recover.

  A typical case would involve someone arriving in town from travels, such as a merchant or a local gone on a trip. They were incubating the disease for several days before mild symptoms even began to show up. Upon coughing in the community, the disease spreads. People they came into contact with began to get sick a week or so later. Red Rot typically spread through households, as it was difficult to avoid catching it once it was in the air in the house. This was especially true in impoverished areas, where many people lived together in crowded circumstances.

  Those who can try to flee the town and find refuge in a nearby village that is not yet infected. Unfortunately, they are often already carrying the archea, and a few weeks later the pattern repeats in a new village.

  Red Rot spreads faster in winter months, when more people are huddled inside and spending time in close proximity. Its spread is slowed down by stringent quarantine procedures that isolate suspected cases as soon as possible. The disease makes its rounds in a community until eventually everyone has either had it already (and is immune from a second bout), or the disease peters out by not being able to infect anyone new before the archea die outside the body. During the Plague of the Ancients, the disease typically lost momentum once populations were scattered away from urban centres.

  There has been only one known outbreak of Red Rot, which began by picking up the archea at the glacier on Kenato Island. Tampering with the ice above the lake and exposing yourself to the archea is the only way to trigger a subsequent outbreak.

Cultural Reception

Dear Sir,
This is my letter of resignation. I have served the military with honour and loyalty for fifteen years, but I can no longer condone nor participate in the plague directives we have been ordered to carry out.

  I am aware that survivors of the plague are often a burden on society. It is hard to tend to the deaf, the blind, the mind-addled, and the paralyzed when we are already struggling to care for the sick and hungry.

  But spreading the misinformation that the recovered are still contagious is unethical. Demanding all survivors report to indefinite quarantine to get them out of the general population is cruel. Crowding them in the arena and then shooting them with arrows to remove the burden is abhorrent.

  I will not participate in the murder of my countrymen. My wife and I will be leaving the city tomorrow.

Sincerely,

Captain Ganasof, 3rd division
— Letter from an officer in the Maran Republic, 2400

In all places, victims of the plague were met with a mixture of pity and fear. Those suffering from the condition were given the best medical care they could get (even if it wasn't a lot), but the fear surrounding the disease was overwhelming.

  A single cough could send a crowd into a panic, and fully-healthy people were sent to quarantine zones over pimples that might be mistaken for an early blister.

  What varied the most was the reception of survivors of the disease. Across the Taalorang steppe, to survive the disease was seen to be proof you had favour from powerful spirits. Survivors, always identifiable by the scars on their limbs or face even if they had no further complications, were revered.

  In parts of northern Cuyania, where beauty was equated to goodness and the plague was seen as divine punishment for sinners, survivors were shamed by their visible mark of having been punished by the gods.

The End of the Pandemic

Dear Mama,

I hope you can read this ok even though I can't see the letters as I write anymore. I just want you to know that I have gone with Dad and I am ok. Please don't be mad at me and I promise I will be home soon.

  I know you forbade me from joining the expedition, but you have to understand that I needed to go. I know first hand how horrible it is to endure Red Rot, and I couldn't just sit here and feel sorry for myself while others set out to end the plague. When we first heard about the plague spreading through central Cuyania, we all said it would never come this far north. But then it did, and I almost died. Now we're all saying it will never come back now that it's killed everyone who got sick originally, but what if that's wrong, too? What if it comes back and you or Dad get it?

  The Tower of Origins is our only hope. We need the world regenerated now more than ever; someone has to play the World's Heart at its top. You understood why Dad had to leave to join the group trying to make it there, so you must understand why I need to, too.

  Don't worry about me. Qimmiq is coming with me and he's really good at helping me find my way even though I can't see anymore. We'll be ok. Next time you see us, the world will be saved and Red Rot will be no more!

  See you in a couple months. I love you.
 

The Plague of the Ancients didn't end until the Second Reckoning. It's thought that the destruction and death caused by the Reckoning caused the population to be spread so thin that the disease was unable to continue propagating. In any case, no reports of Red Rot ever came from the Third Age or on.

 

warning stone.png

Sometime in the early Third Age, the warning stone appeared on Kenato Island. Residents along the coast have passed down the story of seeing a large boulder dragged over the tundra toward the island by an old woman, a young girl, and a dog in the early years of the Third Age, well after all other domesticated dogs were lost. Even more strange, some stories claim that the old woman had wings.

  Whoever put the warning stone there, it has stood on that ice-covered island for 5,000 years. Sometimes the text gets refreshed, but no one knows who does the upkeep because the people who placed it there are surely long dead. It's good that the warning is kept from eroding, though. The ancient archea had survived under the ice for tens of thousands of years before the first pandemic, and they endure to the present day. In the dark they lurk, waiting for someone to release them once more.

Type
Bacterial
Origin
Natural
Cycle
Short-term
Rarity
Rare
Cause Kenatarcheaota
Transmission Airborne
Average Basic Reproductive Rate R3
Overall Fatality Rate 40%
Clinical Presentaion
  • Toxic Epidermal Necrlysis
  • Gradually worsening headache
  • Sensitivity to bright light
  • Flu-like symptoms
Alternate Names
  • Sloughing Sickness - especially throughout central Kaabara, where the local population has dark skin that doesn't clearly show redness
  • Gods' Wrath - or variations thereof, common in the more religious areas. e.g., "Entu's Punishment" among the Tanishites.
  • Shade Fever - in north Cuyania, some doctors declared it was caused by spending too much time inside and out of the sunlight, considering it spread faster in dark winter months when people were clustered indoors.
  • Blasphemer's Tongue- the way the blisters usually started in the mouth or genitals led to the belief in Cuyania's desert region that it was caused by saying unholy things or partaking in scandalous acts.
  • Witch Warts - in the central jungle of Cuyania, it was thought to be caused by witches' curses

Comments

Author's Notes

Archea are microorganisms that were classified as a type of bacteria until recently. The main difference between archea and bacteria is that they have different membrane lipids in their cell walls. There is currently no proof that archea cause any disease, but they do have all the traits necessary to do so. Not much is known about them, because they're usually found in extreme environments such as within volcanic craters or beneath glaciers. There are even those who think they are involved in many diseases, we just don't realize it yet.   Toxic epidermal necrolysis is a real symptom, and is usually a reaction to a medication. No one really knows exactly what causes it to be triggered... but it's recommended not to Google image search for it if you have a weak stomach.


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16 May, 2018 04:38

Slight spelling error in Stage 3: Sloughing - Leaveing instead of leaving

17 May, 2018 21:31

Oops, thanks for the tip!