Alt-VITAS, Need Medical Feedback [Technothriller Shadowrun]

[Daddy Warpig]

The first part of my Altered States Technothriller Shadowrun material (see linked thread for more details) is an in-depth writeup of the VITAS plague. This is a very different pandemic from that in the official Shadowrun. Hopefully, it's both interesting and medically plausible (if only barely).

There's two reasons for a writeup this detailed. The first is that this is a Technothriller campaign, and elements are expected to be detailed, plausible, and accurate.

The second is that I'm building this as a fairly tight alt-history. Shadowrun game material ignores the effects of a plague that kills 25% of humanity in just a year. I need to include those effects (see Technothriller) and including them allows me to built an internally consistent alt-history.

VITAS would have an epochal effect on humanity. How that manifests depends on what it was. Hence this writeup.

If there's any members of TGD that have medical knowledge, and wish to chime in, I invite you to do so. Any help or commentary you could offer would be appreciated.

Design Note: In concept, this disease was built around the name VITAS: Virally Induced Toxic Allergy Syndrome. This is a disease that induces allergies in people, which (in some cases) kills them. Thus the medical details of the disease are based around the immune system, allergic responses, and other such minutia.

Due to the length of the writeup I've broken it up into several parts. Hopefully, this avoids the TL;DR problem, and makes it easier for people to comment.

[Daddy Warpig]

###Classified###
“VITAS Pandemic”
Task Group Archives
The Office for Strategic Analysis
01 Jan, 2032

File #001 - VITAS Pandemic (Annotated)

--begin part01--
Virally Induced Toxic Allergy Syndrome (VITAS)

Source: The American Encyclopedia, 2021 Online Edition. Dr. William Kohl, MD; Pathologist, USAMRIID.

Virally Induced Toxic Allergy Syndrome (VITAS) was a deadly viral epidemic that spread world-wide in 2010. The disease was the most severe pandemic in human history, killing approximately 20% of the world’s population through direct effects (1.38 billion), and another 30% (2.07 billion) through secondary effects (such as famine, civil unrest, and consequent diseases).

VITAS caused permanent allergies even in survivors, which prompted the development of advanced hypo-allergenic materials. Political after-effects of the disease included a global economic depression and the Balkanization of many countries (including The People’s Republic of China and The United States of America).

> Secondary effects list “civil unrest”, but most casualty estimates omit the several major wars that broke out in the wake of VITAS. Significant wars include the Plague War in Israel, Europe’s several internecine and international conflicts, the Chinese Civil War, the Mahdi War (a direct political-religious consequence of VITAS), and, of course, the NAN War.

Including those, secondary effect deaths climb another couple hundred million people (most of them Chinese). It’s “only” another 3% of the global population at the time, but that’s a whole lot of people to just overlook.
- PoliSci Perpetrator

Outbreak

The VITAS pandemic began in July of 2010 in a remote region of India, near China and Burma, and spread rapidly into all three countries. The first deaths from the disease occurred 1-2 weeks later, thereafter escalating rapidly in number.

The mounting death toll in the region prompted healthcare workers to notify the World Health Organization (WHO) of the possible existence of a new and more deadly strain of the seasonal flu. (At this time, neither Burma nor China had reported any deaths from VITAS, though later investigation revealed significant casualties in both countries, concurrent to the deaths in India.)

A month after the initial outbreak, Dr. Prasad Kapoor of India’s National Institute of Pathology in New Delhi first identified VITAS as a previously unknown pathogen, unrelated to the flu virus. A report detailing his findings, and blood samples from infected patients, were provided to WHO and the Centers for Disease Control and Prevention (CDC), and work on isolation and gene sequencing began immediately.

Dr. Kapoor’s report prompted the first widespread media coverage of the virus, under the names “The New Delhi Plague” or “The New Delhi Flu”. The Indian government began efforts to contain the virus, but by the time of Kapoor’s report it had already spread to Australia, Egypt, the United Kingdom, and Panama.

The disease spread quickly, and in almost all cases went untreated. Potential treatments for the disease existed, such as corticosteroids, but there is no recorded instance of them being used.

> Due to its unique characteristics (many of which we still don’t understand today), VITAS moved faster than anyone could predict or cope with medically. We didn’t treat, because we couldn’t treat.

Identification of the symptoms and progression took a year. Conclusive identification of the pathogen (the first step towards developing a diagnostic test) took another year and gene sequencing another six months. Even the name “VITAS” wasn’t coined until two years after the the initial outbreak (by a pair of researchers from USAMRIID).

By the time all this was completed, the epidemic had long since burnt out. During the epidemic, those of us on the ground just didn’t know what the disease did, how it killed, or how to treat it.

VITAS is considered the modern Black Death for good reason: we were just as vulnerable to VITAS as Europe was to the Black Death. No prevention, no treatment, no cure.
- Broke-Down Back-Country Doc

Medical Effects

VITAS is a communicable pathogen, a retrovirus (a virus that incorporates itself into the infected cell’s DNA), that affects the immune system. It causes the infected to become susceptible to developing multiple new allergic reactions to previously innocuous substances.

It is fairly unique among infectious diseases, as it had no observable primary symptoms. Its only effect was to induce new allergies in infected patients. All other symptoms came from anaphylaxis, their own immune system’s reaction to the newly-developed allergy. Observed anaphylaxis symptoms matched those of naturally acquired allergies, and varied in severity from mild reactions (syncope or loss of consciousness, rashes, shortness of breath) up to lethal manifestations (myocardial infarction or asphyxiation).

> VITAS was wholly unique, in fact. No other known communicable pathogen causes the body to become prone to developing multiple new allergic (Type 1 Hypersensitivity) reactions. We know it caused allergies by modifying some element of the immune system, but which elements are affected is a mystery.

Hematopoietic stem cells in bone marrow that produce white blood cells? The white blood cells themselves, specifically mast cells and basophils? We can only speculate.
- Asclepian

> “Wholly unique.” No other natural disease operates like VITAS did. This strongly argues that VITAS wasn’t natural.
- XDA

> Whose? Everyone got hit, everyone died at pretty much the same rate. 2010’s genetic engineering was insufficient to the task. It had to be natural.
- Lost Cause

> Or paranatural. There are a lot of unknowns in biology and medicine, a lot of mysteries and idiosyncrasies. And that was before magic entered the picture.
- Atlantean in Exile

Most people never develop allergies severe enough to be life-threatening. Prior to VITAS, only .5% to 2% of the population experienced anaphylaxis during their lifetime.

In contrast, all those infected with the disease became sensitive to a few allergens, and many became allergic to a multitude of allergens. (Common allergens being, e.g., wheat or milk, metal or vinyl, and pet dander or dust mite excretions.) The danger to specific individuals varied according to which allergens they became sensitive to and how severe their anaphylaxis symptoms were.

> Something not mentioned, but important: these allergies were acquired for life. The virus changed the host’s body so you became allergic, and the allergies stuck around after the disease was cured.

(There’s a reason hypoallergenic materials became a boom industry. It wasn’t just for the sake of us metahumans.)

Talk to anyone who survived the plague (75% of those who caught it survived), and ask them what’s it’s like to be allergic to half a dozen random things, like metal or vinyl. Know how many things are made out of metal? Imagine that every time you touched a spoon or a car you got a rash, or fainted, or had an asthma attack.

Plus, each time you’re exposed, there’s a good chance your reaction became more severe. Touch metal too much, and you can find your windpipe closing or your heart stopping.

VITAS is still killing people, decades after the disease itself went away.
- Ork Rights Crusader

> A classified Federal Task Force with multi-national participation? Glad I don’t have to police it.
- Ell-Tee Charlie Six

> Above your pay grade. Aztlan has numerous enemies, and many have a seat at this table. Even those from former US states.
- The Director

Transmission and Progression

VITAS is an air-born contagion, transferred by bodily fluids (sneezing, speaking, coughing) and dust. Outside the body, it could survive for up to a day, in dust or on surfaces.

The disease is highly contagious. In the United States, it is estimated that 85-90% of the population were exposed, and 80% of the total population contracted the disease. (4% of the population were immune or resistant, so failed to develop the disease even after being exposed.)

Once contracted, the disease has a latent period of 12-24 hours, then an asymptomatic period of 3-6 days, during which the patient is infected but not symptomatic.

The first symptoms are extremely mild, consisting of a light rash, shortness of breath, or lightheadedness. Severe symptoms, present in approximately 25% of all patients, usually begin 12-24 hours later. In most cases, VITAS infections last 5-6 weeks from the onset of first frank symptoms. During this time, those with mild or moderate symptoms are only sporadically symptomatic.

> The contagiousness of the virus and this progression gave VITAS its characteristic “death spike”. The disease spread quickly and quietly, as those carrying it didn’t appear to be ill. (In both the asymptomatic and symptomatic period.) Once a person became severely symptomatic, they usually died within a day.

So the progress of the disease was a fast, undetectable spread through the population, followed by a quick burst of deaths, then a slower spread from survivors with intermittent symptoms. The disease hit hard, killing 20% of the total population, but after the sudden wave of deaths, the disease seemed to go away. Many otherwise uninfected people contracted the disease from apparently healthy people.
- Asclepian

> So where did it go? Like a lot of lethal pandemics, it just burned itself out. It spread too fast, killed too often. Evolutionarily speaking, it was just too vicious to survive. Thank God.
- Global Nomad

> Studies on VITAS continue today. USAMRIID (which eventually absorbed the functions and facilities of the CDC) maintains several samples, all in Biosafety-4 labs. Other countries almost certainly maintain their own samples.

USAMRIID is preparing for a possible recurrence of the disease, but there is no solid information on what other governments or private groups are doing with their samples. Rumors of weaponized VITAS strains circulate in the medical community, but for now they are just rumors. Thank God.
- Broke-Down Back-Country Doc

Statistically speaking, approximately 25% of those infected develop severe symptoms, all of whom eventually die. 30% develop moderate reactions, about half of whom are effectively crippled for life. 45% develop minor allergic reactions, which are often painful but not crippling or lethal.

> There are several statistical quirks of VITAS. Due to the nature of the pathogen, some portions of the population survived at higher rates, while others died at higher rates.

Those who survived more frequently than usual included severe asthmatics, who had steroid inhalers (an anti-inflammatory). Autoimmune patients, with weakened immune systems, tended not to progress to Severe symptoms. Patients on immuno-suppressants, such as transplant patients or those who already had severe allergies, often survived. Conversely, people who began taking Vitamin C megadoses (back when the disease was identified as a unusually virulent strain of the flu) died at higher rates, because their immune systems were strengthened by the vitamin regimen.

These statistical anomalies were a large part of what lead USAMRIID researchers to discovering the etiology of the disease.
- Asclepian

Global Effects

VITAS transformed global society. It caused economic and civil disruption on a scale never before seen. It ignited civil and regional wars and lead to the creation of several new countries as larger nations Balkanized. Trans-national bodies, such as the United Nations, ceased to exist as did nearly all multi-national alliances, like the Northern Atlantic Treaty Organization.

Economic devastation lead to the Second Long Depression, and a huge increase in global poverty levels. Life expectancy, standard of living, and literacy all tumbled, in many cases to pre-Twentieth Century levels.

Cultural changes were widespread, in some instances causing a resurgence of traditional culture, in others radical changes away from pre-VITAS cultural norms. Religious observation generally increased, which had a significant impact on the later Awakening of magic.

Debate on the full impact of VITAS continues in academic circles. Most agree that a full accounting of its effects won’t be possible for decades, perhaps centuries.

> Doc is right: VITAS was a modern Black Death, only more lethal and global in reach. BD caused massive political and cultural upheavals, so did VITAS. (See vague generalities above.)

For the United States, it lead directly to defederalization, effectively the same as Balkanization without the honesty of admitting it. Thus our current “internal and external political and military crises.”

The current global climate was shaped by two events: VITAS and the Awakening. And we haven’t seen the end of either’s effects.
- PoliSci Perpetrator

--end file--

###Classified###

[Username17]

The original Shadowrun VITAS writeup called for a couple of waves of VITAS spread years apart. VITAS-1 in 2010 and VITAS-2 in 2022. The concept of "Toxic Allergy Syndrome" doesn't make a whole lot of sense. If something is a toxin, the immune system is supposed to react to it. An allergic reaction is an IgE mediated overreaction of the body's own defense mechanism, a toxic reaction is a substance that intrinsically causes damage to the body. These are not the same thing. There are however allergies to toxins (example: bee sting allergy), as well as contact and atopic dermatitis (which are toxin and immune related inflammations of the skin).

The Toxic Allergy then is either something that is a poison similar to bee venom or poison oak that is produced by cells taken over by the virus; or it's a fundamental breakdown of the body's immune system provoked by the virus; or perhaps most likely it's an autoimmune condition that happens to look like toxic dermatitis. So... big red splotches and a concomitant loss of barrier function in the skin of the hands, feet, and joints. I like that last one, because it happens to look a lot like bubonic plague.



Viruses are a good source of high fatality numbers, because we do not actually have any broad spectrum anti-virals.

-Username17

[Daddy Warpig]

The concept of "Toxic Allergy Syndrome" doesn't make a whole lot of sense.

Thanks for the reply, Frank.

Right now, I'm working off the assumption that VITAS was caused by a retrovirus that affected the body's white blood cells. From part 3 (yet to be posted):

> VITAS was wholly unique, in fact. No other disease prompted allergic — Type 1 Hypersensitivity — responses by the immune system, even indirectly. We know it caused allergies by modifying some part of the immune system, but which parts and how it did so are unknown.

Hematopoietic stem cells in bone marrow that produce white blood cells? The white blood cells themselves, specifically mast cells and basophils? We can only speculate.
- Asclepian

Once the body is infected, the retrovirus alters the affected cells (white blood cells) directly or by modifying the bone marrow cells that produce them. Once modified, the person becomes highly susceptible to developing actual allergies. (Developing those allergies requires at least two exposures to a potential allergen, just as with real allergies.)

As you point out, "Toxic" is a misnomer, because no actual toxins are involved. I could rename the disease, and came up with a couple possibilities, but I left it alone for the sake of familiarity.

"Toxic", in this case, would refer to "deadly". (The "deadly" part due to severe anaphylaxis, such as myocardial infarction or asphyxiation.) Not medically accurate, but understandable to laypeople.

Possible alternate names:

Acquired Allergic Immunoreactive Syndrome (AAIS)

Virally-Induced Allergic Sensitivity Syndrome (VIASS)

If you have a better suggestion for medical terminology that could be used instead of VITAS, I'm open to suggestions.

EDIT: Another possible name: Virally-Induced Acute Allergic Hypersensitivity Syndrome. (VIAAHS)

[Zaranthan]

The Toxic Allergy then is either something that is a poison similar to bee venom or poison oak that is produced by cells taken over by the virus; or it's a fundamental breakdown of the body's immune system provoked by the virus

These two point to yet another possible design: A virus that produces false antibodies in its reproductive cycle.

1. Virus infects cell
2. Cell starts to produce new virii, along with some sort of directly toxic substance as a byproduct of the virus production.
3. Cell bursts, releasing virii (as normal) and the toxin.
4. Virii infect more cells, toxin binds to some sort of common receptor in human cells, perhaps strangling an important process like hydrogen ion pumps (the toxic effect).
5. Immune system detects the bound toxin, and attacks uninfected cells rather than infected ones (the allergic effect).

I've only had a few semesters of general biology, but this seems plausible. Evolutionarily bizarre, of course, but VITAS is supposed to be some sort of engineered/magical/both plague. It can be a little strange.

[Username17]

VITAS was wholly unique, in fact. No other disease prompted allergic — Type 1 Hypersensitivity — responses by the immune system, even indirectly.

That certainly isn't true. You can have a Type 1 Hypersensitivity reaction to pretty much anything, and viruses (note: correct plural of virus is "viruses") can create whatever proteins they feel like making. Beyond that, "disease" doesn't just mean "you're infected with a virus", it means that "there's something wrong with you". There are in fact lots of diseases that promote or create allergic attacks - Asthma for example.

-Username17

[Daddy Warpig]

VITAS was wholly unique, in fact. No other disease prompted allergic — Type 1 Hypersensitivity — responses by the immune system, even indirectly.

That certainly isn't true.

I must have misread the research material. What I understood was that no known infectious disease — virus or bacteria — causes the body to acquire an allergic sensitivity to an allergen (such as dust, metal, etc.)

Is this a case of me misusing medical terminology (Asclepian is supposed to be an actual medical doctor, which I am not, and I want to get his phrasing right) or is there actually a disease which promotes/provokes the body to develop a new allergy?

The second would be great, because I can use it as a template for the alt-VITAS. VITAS could be a super-charged version of that disease.

EDIT: Other than that error, is the rest of it plausible? That is, could a retrovirus alter bone marrow/white blood cells in the manner suggested?

[Username17]

Converting someone from not having an allergy to having an allergy is really not very difficult. Get yourself a good old fashioned respiratory infection and you can go from having a sub-clinical sensitivity to having a full-blown life-or-death hypersensitivity. There's no specific communicable pathogen that makes healthy people have an allergic hypersensitivity to a specific thing that I know of, but the general case of getting an infection and then having an allergy to things is something that can totally happen.

-Username17

[Daddy Warpig]

There's no specific communicable pathogen that makes healthy people have an allergic hypersensitivity to a specific thing that I know of, but the general case of getting an infection and then having an allergy to things is something that can totally happen.

Perhaps an alternate phrasing would work:

"No other known communicable pathogen causes the body to become prone to developing multiple new allergic (Type 1 Hypersensitivity) reactions."

Does that say what I intend? (That alt-VITAS, in causing people to develop new allergies, works unlike any other known disease.)

(Yes, I did borrow terminology from your post. You're a doctor, so you're a good source to steal jargon from. Hopefully I can do it again when I post my Africa writeup.)

[Daddy Warpig]

<combined into original post>

[Daddy Warpig]

<combined into original post, top of the thread>

[sabs]

You do understand that the Plague, which still exists today, had a death rate of 20% - 75% depending on location. In England, it had a 20% death rate, but in southern france and italy.. closer to 75%. It killed 40-45% of the Egyptian population. The Eboli virus has roughly a 50% death rate.

VITAS having a 20% death rate is silly and stupid. That's a fuckload of people yes. But a serious Eboli outbreak that was resistant to modern medicine would make VITAS look like a joke.

You need to rethink your VITAS death rates. 1 in 5 people dying from a disease is bad, and it's going to cause panic. But it's not going to cause the entire world to spiral into an additional 2 in 5 dying from famine and wars, globally.

[Daddy Warpig]

VITAS having a 20% death rate is silly and stupid... t's not going to cause the entire world to spiral into an additional 2 in 5 dying from famine and wars, globally.

I've been doing a lot of research on this topic, and I can find no definitive academic sources that give exact figures for societal collapse one way or the other. I've looked at articles describing flu pandemics, bioterrorism, and nuclear war. None that I've found give a definitive figure of what percentage of mass deaths would cause a breakdown in society.

So, while you clearly have a very set and definite opinion on the subject, nothing I've found corroborates your statements.

You cite the experiences of the Black Death, in the 1300's. The problem is, that wasn't a modern society. In that time, a plurality of people were involved solely in farming (between 30% and 50%, depending on location IIRC). An agriculturally centered, fuedal society isn't the same as a modern industrial nation-state. The applicability of that experience to a modern society is therefore limited.

There are a lot of complex, inter-related, and fragile pieces in modern society. Just-in-time inventory management, for example, means that modern industries are highly vulnerable to disruptions (they having a limited amount of inventory on hand). The power grid is also very vulnerable. From my writeup of the Collapse:

"In August 2003, a powerline in northern Ohio brushed against some trees. This single incident set in motion a series of events culminating in a blackout that affected 6 states and the Canadian Province of Ontario. 10 million Canadians and 45 million Americans were without power for up to 16 hours. That one single accident knocked out power to 15% of the US."

A single tree and some powerlines caused all that trouble.

We're talking about a disease that caused 20% absenteeism just from worker deaths. Then add in the absenteeism from workers sequestering themselves, in an attempt to avoid being infected. And the absenteeism caused by the 20% of the population that have to deal with a death in the family. And the 12% that are permanently crippled by the disease. And their families. And another 12% that are intermittently crippled. And their families.

32% of the population dead or permanently crippled. 12% intermittently crippled (or far less able to carry out their duties). 44% of the population out of commission some or all of the time. (And the effects on their families, loved ones, friends, etc.)

That will, must, have an effect on all businesses, government, police forces, and the military.

Then couple that with a global interdiction of trade (as a side effect of national quarantines), which would, in a couple of days, bankrupt many major corporations.

And those bankruptcies will have an effect on the banking system. And disruptions in the banking system cause problems for other businesses, private citizens, and the government. (See: the bankruptcies that touched off our current economic problems.)

Then add to that the vulnerability of water supplies (New York City requires 1 billion gallons of water each day), limited supplies of food in cities, mass panic (AIDS times a thousand, packed into a couple of months), and on and on.

I've done a lot of thinking about this, and I simply disagree that the issue is as clear as you claim. I know it's not, because there is nothing I've found that makes a definitive declaration one way or the other.

The 20% figure came from a source that isn't academically reliable, but was plausible enough to use. Having done the research, and having found no other source with the required information, I went with that.

So, while I respect your right to your opinion, I must disagree.

[Daddy Warpig]

VITAS, in First Person
Broke-Down Back-Country Doc

What was VITAS like for those who lived it?

VITAS, when it kills, is a sudden killer. A person is doing what they always do, working at a bank, driving a bus, walking their dog. Then, for no apparent reason at all, they begin to cough or choke, or have sudden heart pains. After a few minutes, they just die.

Out of the blue. For no reason at all.

You’re at a bank, flirting with the pretty teller. She starts to scream, and her lips turn blue. She falls to the ground, and by the time the manager has reached her, she’s dead. Any nobody can say why.

You’re on a bus, going to work. The driver begins to choke, then falls unconscious. The bus crashes into oncoming traffic. If you survive the sudden impact—being thrown against seats, the ceiling, or other passengers—you find out the driver had a heart attack, for no apparent reason.

You’re out for a smoke. The nice elderly lady who lives above you is coming in, leading her Lhasa Apso. Yappy dog, but harmless. You pass a few words. She smiles, but as soon as she breathes the smoke, she begins to suffocate. Her throat swells. You took CPR, you begin chess compressions and mouth to mouth. Her throat is sealed, and she suffocates despite all you can do. For no apparent reason.

That’s how VITAS kills. Like a bolt of lightning out of a clear blue sky. No cause that can be predicted, no reason that an autopsy can confirm.

And this begins to happen in LA, New York, Seattle. 1 out of 5 people begin to just drop dead.

Rich and poor, white, black, asian, and hispanic, rural and city dwellers. Everyone died.

And it goes on for two weeks. “The Red Days.”

You can’t predict it, prevent it, or or protect against it. So, in many cases, you either flee or lock yourself up. You grab supplies, get a gun or other weapon, and quarantine yourself behind closed doors.

You got a job? F*** the job. You’ve got a family.

Some people buy those masks, hoping they’ll protect against whatever’s out there. Some people buy megavitamins or get a prescription for antibiotics. They take both, in massive doses. It doesn’t help.

Nothing helps.

That was VITAS. And it did a number on just about everything.

[Daddy Warpig]

To make it easer to read, and to follow the posting conventions here, I've combined the three parts of the VITAS writeup into one. It's now the second post in the thread.

[Daddy Warpig]

Demographic Effects of VITAS in the United States

Using the 2010 US Census data, I estimated rates of infections for areas of varying populations, then calculated the death toll based on the following assumptions:

• 4% of the population was resistant or immune.
• 25% of those who contracted the disease died.
• 30% of those who contracted the disease developed moderate reactions to multiple allergens (from 5-15), and half this group is effectively crippled for life.
• 45% of those who contracted the disease developed minor reactions to a few allergens, between 1 and 5.
• The more densely populated an area is, the larger a percentage of people were exposed.

In table form, this looks like:



This is the primary kill rates for VITAS. Secondary kill rates (due to famine, consequent infection, and the like) also vary by the size of the affected region.

In table form, this looks like:



All survivors of VITAS developed new allergies (as detailed above.)

• 37,000,000 developed crippling allergies.
• Another 37,000,000 developed multiple moderate allergies.
• 111,256,000 developed minor allergies.

These allergies last for life, and have a chance (if the afflicted is exposed to an allergen) of escalating to severe anaphylactic response. (Which can be lethal.)

Similar percentages hold for every population on the planet, indicating why hypoallergenic substances and research into allergy suppression are key industries.

Demographic Consequences

This distribution of casualties will have strong effects on the United States.

• A large percentage of Progressive Democrats live in urban areas, indeed almost all urban areas vote Democrat in presidential elections (even in "Red States"), so the high casualty rates among urban dwellers will affect the relative strength of the political parties.

One possible consequence of this: Assuming the Republican party emerges dominant, there will likely be a split between Conservatives and Libertarians. The Republicans could emerge as the "party of Big Government" as they try and reverse defederalization.

Progressives would be a smaller third party, much like modern Libertarians, with a great deal of influence as swing voters. On government issues, such as taxation, they may side with Conservatives, on Social issues, such as gay marriage, they could side with the Libertarians. Other outcomes are possible, of course.

With the increased religiosity common after VITAS, a religious populist party could arise. This kind of party would be a return to the politics of the late 1800's (Social Religion), and doesn't fit into the Right-Left paradigm of current US politics.

With defederalization, different mixes of parties could predominate in different regions. In California, Libertarians and Progressives could dominate, and would be bitter enemies. In New England and the Golden Triangle (NY, PA, NJ), Populists and Progressives are the dominant parties. In the Midwest and South, Republicans and Populists. In Texas, Libertarians and Republicans.

The national Congress would be split between the four parties, with none having a majority. This deadlock could be another reason for the weakness of the Federal government.

• Races and ethnicities are not evenly distributed across regions of varying size. I have yet to do the research on this, so I can't draw any conclusions as yet.

• Differing Socio-Economic Status groups are not evenly distributed. The poorest and wealthiest Americans tend to concentrate in cities (ignoring outliers, like Appalachia). Both groups will be reduced in size, relative to the Middle Class.

(Though this is not a permanent effect. The Collapse impoverishes most of the wealthy, and the Long Depression much of the Middle Class. In 2032, about half the population lives below the poverty line.)

In other words, because of its unique characteristics, VITAS will have an effect on ethnic composition, poverty rates, political identification, and other areas of public life. Figuring these out makes the setting more unique (highlighting the sci-fi aspects) and more plausible (as technothrillers must be).