November 27 – December 3: “Infectious disease as antagonist?”

thriller-roundtable-logo5What better to discuss post-Thanksgiving than infectious diseases? This week we’re joined by ITW Members Tony Healey, Ludwig Lettau, Terrence P. McCauley, Michael Sears, Patricia Gussin, Kathleen Valenti, Martin Roy Hill and D. P. Lyle to answer the question: Can an infectious disease take the role of an antagonist in a thriller? Learn more by scrolling down to the “comments” section!


New York Times and USA Today best-selling author Patricia Gussin is a physician who grew up in Grand Rapids, Michigan, practiced in Philadelphia, and now lives on Longboat Key, Florida, with her husband Robert Gussin. She is the author of seven novels including Shadow of Death, Thriller Award nominee for Best First Novel, and After the Fall, winner of the Florida Book Award.


Terrence P. McCauley is an award-winning writer of crime fiction and thrillers. The third novel in his University Series – A CONSPIRACY OF RAVENS – was published by Polis Books in September 2017. The other novels in the series, Sympathy for the Devil and A Murder of Crows were also published by Polis Books. Terrence has also written two award-winning novels set in 1930 New York City – Prohibition and Slow Burn.In 2016, Down and Out Books also published Terrence’s World War I novella – The Devil Dogs of Belleau Wood. Proceeds from sales go directly to benefit the Semper Fi Fund.


Michael Sears writes with Stanley Trollip under the name Michael Stanley. Their novels, featuring Detective Kubu, are set in Botswana, a fascinating country with magnificent conservation areas and varied peoples. The mysteries are set against current southern Africa issues such as the plight of the Bushman peoples of the Kalahari (DEATH OF THE MANTIS, shortlisted for Edgar and Anthony awards, won a Barry award in 2011), the pervasive power of witch doctors (DEADLY HARVEST, shortlisted for an ITW Thriller award in 2014), blood diamonds, the growing Chinese influence, and biopiracy. The latest book in the series is DYING TO LIVE.


Alex Lettau is the pen name of Ludwig Alexander Lettau MD, a former medical epidemiologist with the CDC’s Division of Viral Diseases and current infectious disease specialist in Charleston SC where he lives with his wife Lisa, two daughters, and a Bouvier. His special interest as an author is infection-related medical thrillers. In his Indie award-winning thriller Yellow Death, the protagonist Kris Jensen becomes accidentally infected with an unknown lethal hepatitis virus and has only five days left to find answers to its origin.


Kathleen Valenti is the author of PROTOCOL, a medical thriller that examines the dangers of technology, the price of progress and the depths of greed to uncover what happens when the invisible among us disappears. PROTOCOL is the first of the Maggie O’Malley mystery series. The series’ second book will be released in Spring 2018. When Kathleen isn’t writing page-turning mysteries that combine humor and suspense, she works as a nationally award-winning advertising copywriter. She lives in Oregon with her family where she pretends to enjoy running.


Martin Roy Hill is the author of the Linus Schag, NCIS, thrillers, the Peter Brandt thrillers, and the award-winning short story collection DUTY, and EDEN: A Sci-Fi Novella. Martin’s short stories have appeared in Alfred Hitchcock Mystery Magazine, ALT HIST: The Journal of Historical Fiction and Alternative History, Mystery Weekly Magazine, Crimson Streets, Nebula Rift, Devolution Z, and others.  A former national award-winning investigative journalist, Martin is now a military analyst.


D. P. Lyle is the Macavity and Benjamin Franklin Silver Award winning and Edgar(2), Agatha, Anthony, Shamus, Scribe, Silver Falchion, and USA Today Best Book(2) Award nominated author of 17 books, both fiction and non-fiction. He has worked with many novelists and with the writers of the TV shows Law & Order, CSI: Miami, Diagnosis Murder, Monk, Judging Amy, Cold Case, House, Medium, Women’s Murder Club, The Glades, and Pretty Little Liars.


Tony Healey is the bestselling author of Hope’s Peak, the first book in his Harper and Lane series. It was the 20th bestselling novel of 2016 on Amazon and had over a quarter of a million readers. The sequel, STORM’S EDGE, released on the 10th of October, 2017. Both are published by Thomas and Mercer. Tony’s fiction has appeared alongside such award-winning authors as Alan Dean Foster and Harlan Ellison. He lives with his wife and four daughters in Sussex, England, and is at work on his next novel. He is represented by his agent Sharon Pelletier, of Dystel, Goderich & Bourret Literary Management, New York.



  1. Infectious diseases have terrorized the world for centuries. The Black Death was just one, maybe the worst, of the plagues that swept through Medieval Europe. The 1918 flu claimed millions of lives around the world. Now we have such pleasant afflictions as HIV, Ebola, and the Marburg virus. Besides, isn’t the coming Zombie Apocalypse due to an errant virus?

    Scary stuff.

    I’ve practiced medicine for over forty years and I can say without doubt that the greatest stress placed on any human is when they face death, disease, or injury. There are so many unknowns and the feeling of helplessness is universal. The same is true if the suffer is a parent, child, or loved one. It is fear on a very basic and visceral level.

    This innate fear of death and disease is part of the human experience. And excellent fodder for thriller writing. Sure Frankenstein is scary, and Godzilla stomping your city to rubble is an epic disaster, but what about an unseen, unavoidable, untreatable enemy? One that has no boundaries, invading in the air you breath, the water you drink, the loved one you hug. There is nowhere to hide since the miasma can creep beneath your door.

    And, it attacks from within. By the time the victim realizes something is wrong, it’s often too late to fix. Or worse, there is no fix.

    Infectious processes have been the subject of many thrillers, both written and cinematic. Michael Crichton’s Andromeda Strain (1971) was an early example. An organism comes from outer space and kills quickly. Earthlings have no defense. Just as Europeans had no defense when the Black Death appeared. Others include The Cassandra Crossing (1976), 28 Days Later (2002), and Outbreak (1995).

    Thrillers need a resilient, believable, relentless, deadly, seemingly-unstoppable antagonist. An unseen infectious creature that attacks from within fits the bill.

    The Black Death:

    1918 Flu:

  2. I have read discussions on this topic before, and know many writers and critic do not believe a disease can be the antagonist in a novel. I disagree.

    What is a literary antagonist? Merriam-Webster defines it as “one that contends with or opposes another: Adversary.”

    In my day job, I work for a Navy health research center. Perhaps that’s why I can see disease as an adversary. And a very scary one, too. One of the most terrifying books I ever read was Richard Preston’s nonfiction work, The Hot Zone, in which he details the worldwide threat of pandemic diseases.

    Because of my Navy work, it should be no surprise one of my favorite movies is Outbreak, a medical thriller inspired by Preston’s book that features Dustin Hoffman as an Army virologist. True, the plot includes a conspiracy by a corrupt general (played by Donald Sutherland), but the main adversary—in my view—is the Ebola-like virus. Without the virus, there would be nothing to fight, no corrupt general, and no conflict or tension.

    Michael Crichton’s The Andromeda Strain also features a virus as the primary antagonist (again, in my view). Categorized as a sci-fi or techno thriller, Andromeda features a team of medical researchers struggling against time to identify and destroy an extraterrestrial virus. There’s no human antagonist, just a virulent, deadly disease. The conflict is between the researchers and the virus which, as it mutates, virtually goes on the offensive and threatens the medical staff and the entire world.

    David Morrell used a mysterious disease as the antagonist in his horror novel, The Totem, in which a rural sheriff contends with a rabies-like virus that turns his town’s citizens into violent, raving killers. There is no human opponent other than scared or infected townspeople. The main adversary is the mysterious disease. Finding its source is what drives the plot.

    So, yes, I think a disease can be an antagonist. I don’t think I could pull it off, but as I illustrate here, I think others have.

    1. Couple of comments. The Andromeda strain was actually a new life form and not a virus. It would kill someone shortly after inhalation. No virus would act that quickly. That’s the beauty of conjuring up a new life form. You can do almost anything you want with it.

      Funny you should mention the movie Outbreak with Dustin Hoffman. The movie was pretty good I thought until the ending. After catching the infected monkey they somehow suddenly came up with serum to save hundreds of infected townspeople. That made no plausible, biological sense to me and I told myself I can do better than that ending. That got me started writing an infectious disease thriller novel (Yellow Death) which has a very plausible resolution involving serum. But Hollywood has yet to come calling! Haha – I’m not holding my breath.

      I wasn’t aware David Morrell wrote an infectious disease filler. I try to read as many as I can get my hands on. I’ll check it out.

  3. Using an infectious disease as an antagonist in a thriller. Yes—exactly the premise in my thriller Weapon of Choice. The weapon is a flesh-eating antibiotic resistant staphylococcus. But, of course, behind a bio-weapon like that is a very diabolical human element. In Weapon of Choice, there are two. An “Angel of Death” scenario in a surgical ICU and a white supremist attack on a large scale. So, it’s not so much the infectious disease pathogen, but the evil dispersing it.
    The plague is a frequently used antagonist in thrillers. I last saw it in John LeBeau’s Collision of the Centuries. Seems far-fetched, but it could happen! Personally, I’m grateful to the pharmaceutical companies for research into new antibiotics that stay ahead of resistant infectious organisms.

    1. The unfortunate reality is that many pharmaceutical companies have abandoned antibiotic discovery efforts in favor of research into new drugs to treat chronic conditions such as depression and high cholesterol. There’s a lot more money to be made by capturing even a small percentage share of those life-long treatment markets. As a result there fewer new antibiotics in the pipeline than ever before.

      1. About new antibiotics. I just read a quote by an ID MD that it’s been decades since there were so many antibiotics recently approved or in the near-term pipeline. So that sounds a bit promising. But in reality, the new “plague” will strike out of left field and chances of having the right antibiotic are remote.

  4. Given the rise of zombie fiction and post-apocalyptic/dystopian future novels in the past decade or so, I think an infectious disease can play the role of antagonist if it’s done right. The idea of a protagonist racing against time to stop a mutation before it spreads could be a compelling piece of fiction. In my novel SYMPATHY FOR THE DEVIL, I use the prevention of an outbreak of an amalgamated disease as the main motivator for my protagonists. The disease was scheduled to be released by a group of terrorists, and its contagious nature made it something of a villain of its own.

  5. One’s normal concept of an antagonist is the bad guy — the murderer, criminal, monster — that there is an aspect of evil to it. One can’t really assign dastardly motives to bacteria or viruses. But at another level, the antagonist’s job is to threaten life and safety at a personal level and — in some thrillers — even to destroy the world as we know it. A disease can play that role more than well enough, even if there is no evil intent behind it.

    There are plenty of examples out there. Here are two books by South African authors, one set in SA and one set in the US. SOUTH supposes a US where the civil war didn’t happen until much later, when unification of the North and the South became more a matter of political ambition than of policy. By the time the war does happen, it has many modern warfare horrors available and spirals into germ warfare. The North uses the wind and multiple mutated viruses to destroy the South, and also builds a wall across the continent to enforce the separation. The world that Diane Awerbuck and Alex Latimer (writing as Frank Owen) build on this foundation is as real and bitter as McCarthy’s THE ROAD.

    The other is FEVER by Deon Meyer, South Africa’s best known mystery and thriller writer. The novel takes place in rural South Africa in the near future after a virus has killed most of the population of the world. The narrator is the son of a principled man who tries to establish an embryonic just society from the ashes. We learn early that the man is murdered, but the story is also coming of age parable and explores the difficulties of achieving a new society as much as explaining that death.

    (If either of these sound intriguing, SOUTH was featured in The Big Thrill Africa Scene at and FEVER will be up next month.)

  6. This roundtable is familiar territory for me because I’ve been practicing in the specialty of infectious diseases for over 35 years. My short answer to the question is yes, although a killer virus or bacteria clearly doesn’t fulfill one of the usual criteria for a villain which is to specifically target and thwart the protagonist.

    Having said that, plenty of scary, lethal infectious diseases arise out of nature and DP listed some of them. Nowadays it becomes even more frightening when bioengineering can create even more terrible diseases intended for use in biowarfare. When one of these escapes as in Stephen King’s The Stand, the potential is there to wipe out civilization. Another type of biothriller involves the intentional use of a natural or a bio- engineered killer germ by a bad guy or their villainous organization as a tool to achieve their evil objective.

    In my novel, Yellow Death, DEA conspirators mix a highly lethal South American hepatitis virus into heroin hoping that the death of some drug users will create a new deterrent to drug use. Kris Jensen is a CDC disease detective who is the protagonist. She becomes accidentally infected with the virus and then must battle both the disease and DEA assassins who are determined to keep her from finding out the truth.

    In a way, a lethal infection is a force of nature, although animate, and perhaps more like a beast that kills indiscriminately. But infection is much more abstract and more devious than any beast. It comes unseen and initially unfelt and kills over hours to days from within rather than from sudden external trauma. This stealth magnifies the terror and fear of lethal contagion as a mass murderer and serial killer.

    I have more comments on this subject but would like to see what the others have to say first. Also I would be glad to field questions on any aspect of infection.

  7. Harry Potter has Draco Malfoy. The man in “To Build a Fire” has the arctic cold. And Blumenthal has the Ebola virus in Outbreak.

    At least that’s how I see it.

    There’s a great deal of conversation about who—or what—can be an antagonist. Some say that forces such as the environment or an infectious disease simply shape the story rather than provide an antagonist against which the hero must struggle. And I see where they’re going with that. But I believe that an antagonist can be any force that provides an obstruction to the protagonist’s goals.

    In PROTOCOL, my debut medical thriller, my protagonist, Maggie, is faced with multiple antagonists, including diseases her pharmaceutical employer is tasked with eradicating. She struggles against the specter of disease and the destruction it can bring, just as she battles flesh and blood enemies. These diseases serve as near-characters that impede Maggie’s progress and success, thereby serving as antagonists.

    I absolutely respect those who relegate disease as a storytelling factor that causes conflict rather than an antagonist that can be personified. For me, a disease can antagonize the hero and his or her goals.

  8. (Disclaimer: this is written on my ipad, so be warned: typo’s incoming!)

    An infectious disease often assumes the role of Negative Force, Ticking Clock, and sometimes, both. In Zombie survivalist fiction, an infectious disease becomes the Negative Force. It doesn’t become a single villain, as the nature of the threat is large and amorphous. But it does become a Negative Force that drives the heroes actions, and has a direct impact on their decision making. Although the Zombie virus takes physical form when it inhabits a human body, we the audience are aware that it is not the ‘walking dead’ who are attacking the heroes; but the virus itself, puppeteering the host bodies.
    Perhaps what defines the Zombie genre is that the Negative Force the Zombie contagion represents lacks conscious thought. We can be scared of the ‘walking dead’ but they are never more than thoughtless puppets. The same can be said of the Borg in Star Trek. Think about their sole aim: to assimilate every life-form and culture. In this case, the Negative Force is the threat of absorption by a vast hive mind, consuming everything in its path.
    With ‘Invasion Of The Body Snatchers,’ on the other hand, our heroes face the opposite of a thoughtless, impulsive virus. The Negative Force of ‘Invasion’ takes the form of human beings who have had their minds and bodies stolen by a contagion from outer space. While it is not an infectious disease per se, it does exhibit the same viral behaviour. In ‘Invaders’ the town where are heroes reside falls victim to the space spores from which the Negative Force originates. The townsfolk are slowly replaces by doppelgängers, with their sole aim being to increase their number by making ‘pod people’ of everyone in town. But they do not lack conscious thought. Unlike Zombies, the doppelgängers of ‘Invasion’ can act (for all intents and purposes) like their original hosts. They can deceive and manipulate. So much more of an actual villain, when compared to the Zombie virus.
    Another trope of thrillers and horror fiction is Vampirism: Dracula bites a young lady and infects her with the same strengths and weaknesses as himself. She is altered biologically. Weak in the daylight. Finding strength in new nocturnal habits. Thirsting for the taste of warm, human blood. Like the dreaded AIDS virus, the Vampirism disease is spread through direct contact with the blood. Again, as in ‘Invaders’ victims of this infectious disease continue to exhibit human emotion and conscious thought. While the Vampirism itself remains a Negative Force, the Vampires themselves are very much villains with evil intentions. Zombies, on the other hand, are a physical embodiment of something that just wants to INFECT every available host. For after all, isn’t the role of an infectious disease to multiple and thrive?
    As I mentioned above, the other role of an infectious disease in fiction, is to provide the Ticking Clock element that drives the plot forward. In the ‘Fringe’ episode ‘What Lies Below,’ the Fringe Division team are separated when two of its members are locked inside a building, in order to contain an ancient virus. Many of the people inside are infected, and what is already a Ticking Clock—“How can we cure these people before they die?”—becomes all the more urgent when one of the team finds that they, too, are infected. In this situation, the Ticking Clock speeds up. The heroes have even less time to find a solution, because they are now working to save on of their own. This increases the stakes, which in turn tightens the screw that is tension. The tighter it gets, the less the audience can take it. The tension becomes unbearable. It is the key to great TV and, to great fiction. In a thriller, you can’t have high stakes if you don’t have characters you care about. On the flip side of that, you can’t have characters anyone gives a crap about, if you aren’t pushing them into jeopardy. I always think of this episode of ‘Fringe’ because even though it’s not the best episode of the series, it is a great example of the Ticking Clock. And it is a great example of using characters in trouble as a source of tension. We care about the Fringe Division team, so what do the writers do? They split them up. Half inside the building, facing the Negative Force of the infection itself and the Ticking Clock of when they will catch it. The other half of the team are stuck outside, tasked with finding a cure. The Ticking Clock pushing them to save their friends. Each passing minute turning the screw, driving the tension, raising the stakes.
    Writers can use an infectious disease in a multitude of ways (Hey, how about locking some robust characters in a room and introducing a virus, as in John Carpenter’s The Thing?) but always in service of driving the plot. Putting characters in jeopardy. Forcing them to act—to make questionable decisions.

  9. I think the question here is being parsed differently by panel members. In my original post, I differentiate between a disease being used as a weapon by a person (who would then be the actual antagonist) and a disease that, in itself, is the antagonist. Exchange the disease with a nuclear device, and the antagonist remains the same. However, if the human adversary is removed from the equation (perhaps he dies early on), then the disease becomes the remaining antagonist.

    I look at it this way because in another discussion on another website on this same question, a writer proclaimed that a disease itself could not be the antagonist because the protagonist couldn’t affect it. If, the writer maintained, the protagonist entered the room with the bacteria or virus, then left, the “bug” wouldn’t be changed or affected.

    I disagree with this. Humankind has had great impact on bacteria and viruses. The over use of antibiotics by patients and meat producers, for instance, have contributed to the development of antibiotic resistance bacteria. In Andromeda, the alien virus mutates into an even more virulent form, breaking out of its containment room and threatening the lives of the researchers. The researchers realize the virus feeds on energy, and plans to neutralize it with a nuclear explosion would only serve to increase its growth rate. There is no human connection to the virus-adversary, but the human can potential increase the virulence of the virus.

    Then again, maybe I’m overthinking this.

    1. I’d put that issue a bit differently. If a human (or sentient evil) is involved, then there is conscious motivation behind the virus. It is, in effect, a weapon – an example would be Terry Hayes’ I am Pilgrim. What makes it a different sort of weapon, is that stopping the antagonist doesn’t necessary stop the weapon.

    2. Interesting, that you’re on a different blog about the same topic. I’m with you in your original post, and of course, I’m in agreement with Doug Lyle, to whom I defer in all things medical, forensic, and literary.

  10. It’s not really a thriller as such but in Ken Follett’s World Without End The Black Death could be regarded as an antagonist. It’s like an unstoppable evil villain working away at destroying everyone, and affects and shapes every part of their lives.

    Then in the HG Wells The War of the Worlds along come the germs and attack the enemy for a change!

    1. Ken Follett used The Black Death so effectively. Maybe a case where the true villain is the organsim vs an evil human manipulating it.
      I loved how he used “he/she sneezed” as an indicator of the next victim.

  11. The Ebola virus plays a role in my espionage thriller, The Riviera Contract. Terrorists plan to spread the virus in the United States. I had to confer with a biochemist in Cambridge, Mass to determine if Ebola could be manufactured in powder form and spread in cities. Hypothetically it can, but practically, they don’t know. That eased my mind using the virus in the novel, because one doesn’t want to give terrorists any ideas.

    1. About giving terrorists ideas: I have read so many thriller novels that make me think “This could really be done.Just follow the plot line.” And whenever I do research for a new novel, I can’t help but wonder if the NSA has me flagged!

  12. Excellent discussion about the nature of an antagonist. My vote is yes, a disease qualifies for the role. An unthinking killing machine is much more terrifying than one with goals and emotions to be manipulated and understood by human protagonists.

  13. Somewhat appropriate for this discussion is an article I read this morning about Russia claiming to have discovered extraterrestrial bacteria on a swab taken of the ISS external skin. Apparently, the swab was brought back to earth some time ago but only recently was found to contain bacteria Russian scientists believe *may* be extraterrestrial.(It could be earthly bacteria.) They *believe* the bacteria they found is harmless.(Link below.)

    Also interesting in this article is that NASA is very concerned with introducing earthly bacteria into moons in this solar system which they think might harbor life.

    Kind of gets your creative juices going, doesn’t it?

  14. I’d like to expound a bit about infectious diseases and their evolution in relationship to humans. First of all let me emphasize that it is not in the evolutionary best interest of infectious agents to kill the host. This makes sense because a dead host is literally a dead-end for the infection – excluding zombies and cannibals of course! An infection is most lethal when the invading microorganism and the human host are poorly adapted to each other. For example when syphilis was introduced to Europe from the New world around the time that Columbus returned from America, the Great Pox as it was called, was highly lethal. It was many decades before the syphilis spirochete attenuated and Europeans perhaps through natural selection, acquired more natural immunity. Similarly when European infections such as smallpox and measles were introduced from Europe to the New World those viruses ravaged the Amer-Indian populations. Obviously the Martians in The War of the Worlds were totally unadapted to our “ordinary” viruses and bacteria and that is what saved our butts.

    So when microorganisms, whether viruses, bacteria, rickettsia, fungi, parasites etc. are able to mutate to improve their own transmission success, those mutated strains are going to be favored by natural selection. The mutations can be in the direction of lesser virulence and improved host survival but especially fascinating are mutations that negate the human host immune system in some way and also mutations that alter the behavior of the human or non-human host.

    I will post in the next day or two about how two mutations enabled Yersinia pestis the bacterium that causes plaque, to became so “successful” in terms of its transmission.

    The best example of a micro-organism changing behavior is the protozoan parasite toxoplasmosis. The life cycle involves a cat as a definitive host and rodents as the intermediate host. The sexual stages of the parasite live in the intestinal wall of the cat and they produce oocysts excreted in feces. Along comes the rat who ingests the oocysts which transform to tissue cysts that get deposited into muscle and the brain. The location of the brain cysts especially in the amygdala, causes the rat to lose its fear of cat urine and it becomes more likely to be eaten by the next cat that comes along. The tissue cysts are taken up in the cat’s intestine and transform to the sexual stages to complete the lifecycle.

    The biting behavior of a animal with rabies encephalitis is thought to be another evolutionary change in host behavior that favors rabies virus transmission to another animal.

    The problem with using human behavioral change induced by a germ in a thriller is that the mutations take so long to evolve. But it should be doable faster maybe with modern day gene splicing in the hands of a villainous molecular biologist. Or maybe global warming will unfreeze a dormant but viable mind altering micro-organism?

    1. Someone’s already thought of that, Alex? Did anyone see Fortitude? Set in the Arctic Circle where a mammoth carcass is uncovered. People start to turn into crazed killers and eventually the carcass is the suspect.

  15. I had not been aware of Fortitude but that’s OK. I didn’t think the idea was that original and every author will put their different spin on it anyway. It’s actually true that no one knows why the mammoths went extinct about 10,000 years ago. It could well have been an infectious disease. The trick will be to figure out how to revive
    the virus or a bacteria from tissue long frozen. My thought would be to have an epidemic start among tuskers who are typically poor dirt miners who go out into the Siberian wilderness and use high-pressure water hoses to wash away hillsides of thawing permafrost in search of the remains of mammoths and specifically their tusks. One big tusk of such “legal” ivory is worth $10,000 or more in cash from Chinese agents in the area. Anyone interested can run an Internet search on “tuskers” to find out more about this trade.

    Re Michael’s question on how long acclimatization takes. I’m not sure. I suspect decades or even much longer. I think syphilis took 100 years or more with a huge death toll in the process since there were no antibiotics at that time. As a footnote, there was an international blame game that went on as the Great Pox spread through Europe. It was called the “French disease” by the English and Germans, the “Spanish pox” by the French, the “Polish disease” by the Russians, the “Turkish disease” by the Persians and so on.

    More on toxoplasmosis. When we humans ingest oocysts or meat with toxoplasma tissue cysts, we get infected and tiny cysts end up in our muscles and brain. Almost always the acute disease is mild and unnoticed and the tissue cysts are controlled by our immune system. But they are in our brain and large studies have shown that people who test positive for toxoplasmosis seem to have a higher risk of psychiatric disease and suicide. A large study in the Czech military showed persons who tested positive had a higher risk of road accidents than those who are
    negative. Maybe those who test positive should avoid zoos and African safaris!

    1. That’s all incredibly interesting, Alex. It’s so good to have an expert here!

      The tusks were originally the main lure in the Fortitude story, if I remember correctly. It was a very strange program, made even weirder by the harsh environment and I haven’t seen a second series to see a resolution.

  16. One more thought. Nowadays in America some crazy and reckless person who does something bad might have a smart lawyer test for toxoplasmosis. If positive, the legal plea would be to the court: “It was the disease that made him do it!”

  17. Doug, I agree with everything you said. Of course, I do.
    Since we’re getting into examples. Do you remember if Dan Brown’s “Inferno” was based on a virus or bio-engineering or bioenginering a virus as a vector? At any rate it was an evil attempt to solve the world’s population problem.

    1. I don’t remember—which goes for the entire book. I thought it was forgettable. As for solving overpopulation, Mother Nature usually takes care of that with famine, war, and pestilence. In enclosed and crowded populations, disease can literally spread like wildfire, particularly if a foreign invader the population has never encountered is introduced. An earlier questions was how long does it take a population to get immune to or at least tolerant of the new illness. That is, what is the timeline for moving from epidemic to endemic. It varies greatly but common sense would suggest it takes many generations for the immunity to develop and be passed on to future generations.

        1. True. Whenever any epidemic hits, there are those who are very vulnerable and die in short order, those who die more slowly, those who become ill but survive, and those who seem to have complete immunity. It speaks to the great variations among humans.

  18. Some final thoughts on this roundtable.

    There is an interesting feature of bacterial colonies called quorum sensing which is widespread among bacterial species. Basically this is a way that bacteria communicate with each other via chemical signal molecules called autoinducers. These chemical signals activate group benefitting processes such as expression of virulence factors or production of biofilm which is kind of a protective coating for
    bacteria. This communication system enables bacteria to act as a multicellular organism for co-operative behaviors that maximize an effect on their environment or host – meaning you and me! I haven’t thought much about using this in a thriller but there’s potential for it. Kind of scary.

    On the subject of mutations. Yersinia is a genus of bacteria that once upon a time didn’t do us much harm. Yersinia pestis (the Black Plague bacillus) was mainly a pathogen of animals that occasionally infected people who directly contacted them or their fleas. Human inoculation with the bacterium caused enlarged local lymph nodes called buboes (hence the term bubonic plague). But there was no further human to human transmission. Two mutations turned the plague bacteria into a killer. The first was a mutation that made the disease much milder in fleas that picked up the bacteria from animals. The fleas lived much longer and had more opportunities to bite humans. The second genetic mutation was one that negated the initial human immune reaction to the
    bacteria. This allowed the bacteria to grow in disturbed and build up high levels in the lymph nodes, pass into the blood and spread to the lungs. In the lungs, massive levels of bacteria built up before the immune system woke up so to speak. Persons who had this pneumonic form of plague spewed out huge numbers of bacteria into the air with their coughing. This enabled direct person to person transmission and the disease took off as a killer of humankind. The island of Madagascar is currently experiencing an outbreak of pneumonic plague, so this disease is still around!

    A killer disease in waiting for the right mutation is H7N9 avian influenza A. It has affected about a couple thousand people in China but really only those who had direct contact with poultry or poultry-contaminated objects or environments. There has been a 40% death rate even with antiviral drugs such as Tamiflu which are active. A mutation that enables sustained human to human transmission is a
    potential disaster. Could an evil microbiologist achieve this in the lab, or could a government develop it as a bio-
    weapon? The answer is yes – great fodder for a thriller – and if they are really evil, will make it drug-resistant.

    A couple of book recommendations. I am a stickler for accuracy when writing about our known communicable diseases. A great resource for information on the epidemiology including reservoir, incubation period, transmission, risk groups, etc. is the book “Control of Communicable Diseases” put out and updated every year or two by the American Public Health Association.

    Richard Preston’s book “The Hot Zone” is a good one but Preston gets a little carried away with the liquefaction of internal organs as part of the disease process. A more recent book that reviews recent killer diseases, mostly viruses in fascinating and readable detail is “Spillover” by David Quammen, an award-winning science writer. I highly recommend it.

  19. I believe they are still valuable. If I respect an author, I respect their opinions, and a positive blurb will help convince me to read a book. In my experience, authors won’t positively blurb a book they don’t like — they will just say “no.” So if I see an author I respect speaking highly of a particular book I’m more likely to give it a chance.

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