This article on curing pandemics in fiction is part of the Science in Sci-fi, Fact in Fantasy blog series. Each week, we tackle one of the scientific or technological concepts pervasive in sci-fi (space travel, genetic engineering, artificial intelligence, etc.) with input from an expert. Please join the mailing list to be notified every time new content is posted.
About the Expert
Morgan Bernard grew up with a fascination for all things science fiction and fantasy. Following her love of science, she pursued her Doctorate of Pharmacy at the University of Wisconsin Madison and now works as a registered pharmacist, focusing on geriatric and psychiatric medicine.
Pharmaceutical Fiction: How to Cure A Pandemic
Your evil corporation, rogue terrorist organization, or hostile alien race has created the perfect pandemic which is now sweeping the planet, wiping out society as we know it. Now it’s time for your team of scientists to arrive in the nick of time with the cure and save the day.
But what is this miracle cure? Some novels gloss over terminology or use words like antibiotic, antidote, and inoculation interchangeably—and often incorrectly. One popular YA series I recently finished has a scene where the heroine tips a single vial of antidote into the lips of a dying plague victim, who then immediately recovers. Later in the series, the heroine ingests the same antidote to “immunize” herself against the plague.
That’s not exactly how it works in real life…
Antibiotics, Immunizations, and Immune Globulins
When healthcare workers react to pandemic situations, it’s important to triage patients, separating infected victims from healthy patients. Not only because quarantine limits the spread of disease, but also because we use specific methods to treat the sick and other options to prevent healthy people from contracting illness.
Treatments for ill patients vary based on the cause of the pandemic. If the pathogen is bacterial in nature, the treatment will probably be antibiotic-based or possibly an antitoxin. If your pandemic is virus fueled, antibiotics will do NOTHING against it. But healthcare providers might be able to use an antiviral along with additional supportive care (IV fluids, blood transfusions, etc…). Parasitic infections are treated with anti-parasitic drugs, fungal infections are treated with antifungals, and so on.
As mentioned above, antibiotics are used to fight against bacterial agents, either by killing the bacteria outright (bactericidal), or by restricting their growth and preventing replication (bacteriostatic). Antibiotics target bacteria in several ways, depending on the physical structure of the pathogen.
Some bacteria have a thick protective wall of peptidoglycan surrounding the cell membrane. These are known as gram-positive bacteria (Streptococcus, MRSA, etc.). An antibiotic agent might work by interfering with the synthesis of this cell wall (i.e. penicillin), effectively killing the bacteria.
On the other hand, bacteria that are gram-negative (E. Coli, Salmonella, Legionella, etc.) have an additional outer bacterial membrane that can make them near-impermeable. Antibiotics that target peptidoglycan aren’t as effective. Instead, we look to antibiotics that can penetrate the outer cell membrane. Besides destroying the cell wall, antibiotics can also kill bacteria by inhibiting the synthesis of proteins (i.e. azithromycin), interfering with DNA replication or transcription (i.e. ciprofloxacin), or by interrupting RNA synthesis.
Unlike the “single vial” example from our YA novel noted above, there are very few antibiotics that are effective as a single dose. Most treatment courses are given over several days, weeks, or occasionally even for months at a time, though 7-14 days is a typical duration.
In some cases, antibiotic courses can also be given to healthy patients who have been exposed to certain pathogens (Lyme Disease from tick bites, MRSA colonization pre-surgery, etc.) to prevent the development of illness. But this treatment doesn’t lead to long lasting protection.
When it comes to protecting healthy patients, we typically turn to immunizations. Immunization is the process of developing resistance to a disease prior to exposure, typically through vaccination. Vaccination, sometimes referred to as inoculation, induces active immunity by stimulating the production of an immune response to antigens.
Typically, this means the proliferation of B-cells—white blood cells that produce antibodies. But it also refers to the sensitization of T-cells—white blood cells that destroy infected cells and release proteins to assist with active immune response. Exposure to antigens through vaccination allows the B-cells and T-cells to “remember” the antigen and respond quickly to fight against future illness.
Vaccines may be derived from live bacteria or viruses that have been attenuated—altered to become harmless or less virulent (i.e. shingles vaccine). They can also be created from killed bacteria (i.e. pneumonia and influenza vaccines) or from toxoids—toxins modified to become nontoxic (i.e. diphtheria and tetanus vaccines).
But developing protection through immunization is not instantaneous. An active immune response takes approximately two weeks to develop, though some vaccines require boosters for sustained protection. So, please don’t immunize your fictional heroes and send them into the field right away assuming they’ll be protected.
When you need instant protection for someone who has been or will be exposed to a pathogen, you might consider immune globulin. Immune globulin is essentially pooled antibodies, derived from human or animal serum, which can be delivered to offer short-term protection, also known as passive immunity.
The use of immune globulin is not typically recommended in healthy adults, since they can develop longer lasting active immunity through vaccination, but it can be useful in the case of certain disease exposures (i.e. rabies). The term antidote often refers to an antibody containing serum that can combat poison, bacteria, and other disease-causing agents.
Now that your team of scientists has developed a treatment, it’s time to deliver it to patients. We’ve all seen this part in movies like Hunger Games, Star Trek, and Divergent—patients cringing while a scientist uses a shiny contraption to inject some substance directly into their necks.
Again, this isn’t quite right. There are actually very few reasons to inject a substance into the neck. It’s usually only done in the case of steroid injections to treat joint inflammation or when a nerve block is needed. Otherwise it’s kind of a silly place to inject medication. With the tendons, airway, nerves, and other important structures in the neck, it’s easy to do more harm than good.
When it comes to the administration of your pandemic cure, we have many delivery methods to choose from. Oral, IV, injection, transdermal, rectal, inhalation… Oral options like capsules or liquids are often preferred if a patient is conscious and able to swallow. But many substances aren’t absorbed well through the digestive tract or might be destroyed by acids and enzymes, so we turn to intravenous and injectable options.
Intravenous (IV) administration bypasses the enzymes and membranes of the digestive tract and is an effective option for patients that are already hospitalized and on supportive care. If your scientist is working out in the field though, setting up an IV might not be the easiest or most sterile option.
Intramuscular or subcutaneous injections might be a great alternative. Intramuscular injections are delivered by a hypodermic needle, usually one inch long, directly into the muscular tissue of the deltoid muscle of the arm, vastus lateralis of the thigh, or the gluteal muscles of the hip and buttocks. Subcutaneous injections are delivered using a shorter needle directly into the fatty layer beneath the skin, typically in the abdomen, thigh, or back of the arm. Immune globulin is delivered intramuscularly and immunizations are usually given by intramuscular or subcutaneous injection.
Cures Aren’t Perfect
Now that your team of scientists has managed to create a proper cure and deliver it to patients, it’s time to celebrate! Or maybe not yet.
No cure is perfect. There will be allergic reactions and other side effects. These might be as minor as some redness at the injection site or uncomfortable nausea. Or they could be almost as bad as the pandemic itself—cancer, permanent nerve damage, or reactions like Stevens-Johnson syndrome which causes the victim’s skin to slough off.
And sadly, no treatment is effective 100% of the time. Patients will continue to die even after a cure is found, and some might even die because of the treatment. But don’t lose hope. Researchers, doctors, pharmacists, nurses, and your fictional team of scientists will keep fighting to save the world!
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