Features / Technology

Orchestrating the theatre of contagion in Ascalon

by Dzachary Zainudden · August 24, 2020

Image credit: Sasin Tipchai from Pixabay

Fantasy enthusiasts immerse themselves in exotic worlds through video games as they do the written word. Massive multiplayer online role-playing games (MMORPGs) are exemplar in allowing players to transform into heroes and embark on adventures alongside each other. Roleplaying as characters has also served as an escape from the circumstances we are going through during the COVID-19 pandemic. Playing and completing quests promotes interactions with the online community and entertains many players as they remained at home. I am one such player and one game I am fond of is ArenaNet’s Guild Wars 2. I currently play as Askar Saberglass, a ferocious Charr whose homeland of Ascalon is threatened by the ghosts of war and treacherous zealots¹

As I traversed the Plains of Ashford, I recalled an online symposium hosted by Pembroke College where speakers discussed the importance of the fantasy genre in times of crises². When fantasy offers shelter to people struggling in difficult times, I was curious about how fantasy games could educate players about pandemics past and present — perhaps the realm of fantasy is a solution to comprehend what has transpired in the real world.

The Corrupted Blood Incident

Utilising video games to simulate pandemics is not uncharted territory for anyone familiar with the Corrupted Blood incident³. Corrupted Blood was a plague in Blizzard Entertainment’s World of Warcraft (WoW) where characters contracted a debuff that drained life points for 10 seconds while engaging Hakkar the Soulflayer in combat. A key characteristic of this debuff was that any character carrying the plague could transmit it to others by being in close proximity. However, it was discovered that animal companions of the Hunter class could transmit the disease from Hakkar’s dungeon to the rest of Azeroth, where the Warcraft franchise was established. Numerous WoW players were infected across the world’s four continents and employed strategies such as social distancing and minimisation of pet exposure to prevent Corrupted Blood from passing on to susceptible individuals⁴.

The behaviour these WoWplayers adopted is akin to the instructions of health officials to prevent the spread of COVID-19. This observation convinced epidemiologists to revisit studies based on the Corrupted Blood incident while others thought the virtual game world of WoW and MMORPGs could accomplish more before the outbreak began. Ran D. Balicer, Director of Health Policy Planning and Founding Director of Clalit Health Services Research Institute, published his comments on WoW’s epidemic and his belief MMORPGs can be “a testing ground for hypotheses” about how an infection spreads in a population⁵.

He also drew analogies between the Corrupted Blood incident and real-life outbreaks where animals, particularly ducks, became the zoonotic reservoir for influenza. In this example, players could transmit disease in communities by rapidly teleporting as fast as tourists did with severe acute respiratory syndrome (SARS) through air travel. Other researchers such as Dr Eric T. Lofgren and Dr Nina H. Fefferman supported Balicer’s opinion that the environment provided by video games has potential to benefit epidemiological studies⁶. But where these individuals considered utilising MMORPGs for running simulation models for disease outbreaks, I wish to explore its application in a workshop setting for students to understand issues associated with them.

Video game experiences for students

If MMORPGs are integrated into the learning experience of epidemiology, it is wise to consider how students engage with commercial games and demonstrate graduate attributes embraced by their universities. Research detected correlations between student performance and video games, but they were conducted with participants amongst young children and did not reflect students in tertiary studies. Fortunately, the Games and Gaming Lab’s co-director Matthew Barr from the University of Glasgow organised an investigation to determine whether undergraduate students gained positive benefits from playing video games⁷.

In his study, 100 first-year and second-year undergraduate students attended drop-in sessions to play various games and he measured influences on individual participants through online tests and interviews. Games incorporated into the experiment ranged from a variety of genres such as the sandbox game, Minecraft, the puzzle-platformer, Portal 2, and the real-time strategy game, Warcraft III⁸ ⁹ ¹⁰. For eight weeks, participants accomplished tasks like eliminating opponents on the battlefield as the Night Elves faction or solving puzzles collaboratively with portals and physics.

Collated data from online tests supported Barr’s hypothesis that video games promote communication, adaptability and resourcefulness in student performance. Despite positive results, interviews revealed students’ perspectives and scepticism regarding the benefits of video games. The key question Barr asked in each interview was: “Do you think the games we played might have helped develop any skills or competencies?” before enquiring about graduate attributes. Participants’ attitudes expressed optimism towards video games encouraging graduate attribute development, but some voiced doubts on the credibility of skills gained and their transferability into academic performance.

Case scenario in the Black Citadel

Some MMORPGs could be inaccessible due to subscription fees or technical restrictions, while participants may possess little understanding of playing video games in general. Any assignment involving video games requires clear objectives that participants can accomplish within a virtual environment. Those objectives need to efficiently deliver an experience stimulating them to comprehend concepts and issues in current events. Thus, what I shall describe is a case study designed within Guild Wars 2 which is accessible due to its free-to-play model and easy for new players to learn. The scenario is also based in the Black Citadel which is the main hub for Charr player characters like myself.

Imagine a situation where Tribune Rytlock Brimstone sought out a team of epidemiologists to investigate an outbreak that the feline residents of the Black Citadel are succumbing to. One patient, in particular, is Leatho Fowlblood, a Charr cub first among his friends to contract a fever, sore throat and headache. The team confirms through diagnostic testing the presence of a coronavirus similar to the COVID-19 viral agent, SARS-CoV-2, within the cub’s tissue samples. After reporting their findings to Brimstone, he realises potential complications that could arise if the virus, dubbed the Ascalonian coronavirus (ASC-CoV), infects the populace and spreads across the region. Now, their mission is to identify how the infection began, find its possible sources, and propose solutions to control the outbreak before it is too late.

Overview of Ascalon and the Black Citadel, home of the Charr in Guild Wars 2

Activity: Detecting Reservoirs of Infection

One activity to engage participants is figuring out potential reservoirs of ASC-CoV infection in Ascalon. Supervisors would share statistics and diagnostic data briefing participants on the scale of infection based on time, place, and person. Information can include schedules that recorded Fowlblood’s whereabouts within a 2 to 14 day period before becoming ill, which is the average incubation period of the related SARS-CoV-2. Other materials at participants’ disposal include the number of Charr that came into contact with Fowlblood, the rate of infection in his fahrar (their equivalent of a school) and symptoms from reported cases. This is the result of passive and active surveillance which allows participants to propose how widespread infections have occurred before laying a foundation for hypotheses.

As Ascalon is a large region, multiple hypotheses can serve as the basis of various theories on how ASC-CoV infections originated. For example, if a participant believes the evidence points to cross-species transmission, they can explore the neighbouring Diessa Plateau or the Plains of Ashford for local wildlife or communities for potential reservoirs. As viral agents associated with the 2002 SARS outbreak in Asia and the 2012 MERS Outbreak in the Middle East originated from bats, one identifiable reservoir could be cliff bats that roam both regions and frequently come into contact with the catlike soldiers¹¹. Therefore, that participant can claim ASC-CoV originated from cliff bats as the result of zoonotic transmission.

However, different participants may argue a Charr engaged in combat with a human carrier of ASC-CoV if surveillance data contains reported cases with infected humans. As SARS-CoV-2 was detected in big cats at the Bronx Zoo, New York in April 2020, they can propose human separatists are another source of transmission as intermediate hosts, contracting ASC-CoV from cliff bats through spillover prior to altercations with Charr soldiers¹². Either way, the vastness of Ascalon and the communities dwelling in the region allow participants to concoct theories of transmission. While it is difficult to emulate diagnostic procedures to detect viruses in hosts or thoroughly illustrate host-pathogen interactions in the virtual environment, this activity promotes critical thinking and confidence in participants to debate plausible origins of infection.

Activity: Outbreak in the Population

Another instance would be introducing the concept of super-spreaders. According to Dr Richard A. Stein from Princeton University’s Department of Molecular Biology, super-spreaders are individuals who infect more susceptible contacts in a population than the average person during epidemics¹³. Super-spreaders have been documented in events such as the 1995 Ebola hemorrhagic fever outbreak in Congo and the 2002 SARS outbreak. If supervisors intend to demonstrate this in a community, they can achieve it with assistance from volunteers.

Suppose there are one hundred participants in a workshop and supervisors confidentially notify a few to roleplay as civilians infected with ASC-CoV and one to be a super-spreader. Once gathered in the Black Citadel, participants can spread out within the city before being instructed to walk around. Over ten minutes, participants interact with each other and any infected or super-spreaders can inform peers if they are infected. Each infected volunteer can only pass ASC-CoV infection to a set number of individuals while the super-spreader infects a larger amount. At the end of the period, participants can illustrate a detailed map of infection originating from the infected and super-spreader based on whom they interacted with.

If supervisors appoint volunteers to be infected with other viral pathogens, they would integrate the concept of co-infection to describe how the presence of different viruses can make civilians more or less susceptible to ASC-CoV. Additionally, participants can establish how the infection spreads in a group of populations, or a metapopulation, if they travel within the Black Citadel and to settlements like the Ashford Forum and the Village of Butcher’s Block. As a result, participants develop an awareness of infection within a population through the video game while understanding case studies surrounding super-spreaders, co-infection, and metapopulations.

The Theatre of Contagion

Robert MacFarlane stated in his introduction to John Christopher’s The Death of Grass that “we live in an age of epidemics” and have become acquainted with “the language of contagion”¹⁴. From the bubonic plague, smallpox, influenza, AIDS, SARS, MERS, Zika, Ebola and now COVID-19 joining the long list of epidemics we have experienced over time, perhaps it is opportune for us to be more acquainted with that language. Dr Balicer commented in a TEDx Talk at the Ben-Gurion University of the Negev that a great challenge modern medicine faces is not focusing on prevention and being reactive rather than proactive. Patients usually seek help when they develop symptoms of disease or feel pain and discomfort but these problems could be averted, and harmful effects associated with illness diminished if preventative measures were reinforced.

Ran Balicer’s talk at TEDxBGU detailing the Corrupted Blood incident and being proactive in healthcare.

This made me think of storytelling in fantasy when heroes rise to the occasion and take on perilous quests to save the world from impending doom. In J. R. R. Tolkien’s The Lord of the Rings, Frodo Baggins’ adventure with the Fellowship was reactive; he embarked on his journey to Mordor because Isildur chose to keep the One Ring when Sauron had fallen, allowing the Dark Lord’s power to survive for millennia. The same can be attributed to players assuming the central role in fantasy video games. Obsidian Entertainment’s Pillars of Eternity II: Deadfire has the Watcher who is pursuing a resurrected god to uncover his true motives for returning to Eora, and FromSoftware’s Bloodborne has the Hunter who is investigating – rather befittingly – an endemic plague that transformed the citizens of Yharnam into monstrosities¹⁵ ¹⁶. In these instances, the heroes react only when the villains’ actions affect the world state or the protagonist’s personal story. I am not advocating that dealing with the problem earlier in the story would make a great book or video game, but when disease threatens the well-being of loved ones, Balicer’s point of being proactive instead of reactive is valid for deterring poor health and illnesses.

We cannot ascertain if everyone can enthusiastically use a video game as a teacher would a whiteboard in a classroom, yet there is potential for this venture to bear fruit if carried out successfully. Emulating epidemic research in video games places an emphasis on the people, a key driver in the emergence of disease. Dr Lofgren stated the Corrupted Blood incident was “a good illustration of how important it is to understand people’s behaviours” during public health crises. Through the virtual environment of Ascalon or Azeroth, participants can be proactive in their learning of pandemics and think critically of viable courses of action to take in controlling infection in the population. Whether those threats are viral pathogens transmitted by birds or dungeon bosses lurking in the abyss, MMORPGs are a domain where guilds of adventurers and scientists play instrumental roles in the theatre of contagion.

This article was specialist edited by Ross Laidlaw and copy-edited by Caitlin Duncan.