Playful pandemic

Author: Viktor Müller

Recommended age: 10-99

Number of players: 20-40

Space needed for the game: classroom or other open space

Difficulty level: 1

Playing time: 5-10 minutes per variant. It's better to play more than one version. 45 minutes, including 3 versions and some explanation seemed the best for us.

Preparation time: 5 (plus preparing the infection indicators previously)

Accessories: one dice for each player, one "infection indicator" for each player (a piece of paper, one side of which is white, the other side is red; you can punch two holes on the top side of the paper and use a string to hang it around the neck), and optionally a scarf to cover the eyes of the health officer

Short description: This game shows the course of an epidemic, using examples of real pathogens. There are numerous versions of this game with aggressive, mild, latent and mutable pathogens, fast and slow epidemics, in a changing and steady environment.

Preparations: Move the desk and tables in the classroom to create an open place. If we play in an open area it's necessary to mark the border of the playing area. For 30 people you need a classroom-sized place. The game leader draws the directions on the board as pictured in the following figure.

All the players get dice and an infection measurement that they hang around their neck showing the white side of it. The players scatter in the room.

Course of the game: There are numerous variants of this game. For getting familiar with the rules and the basic concept, play the first and the second variant.

Variant 1: The game leader chooses, or ask for a volunteer to be the “zero patient” who turns her infection indicator to red (infected). Then the epidemic begins. Everybody rolls their dice on the ground, and takes one step according to the number on the dice (1: forward, 2: backward, 3: left, 4: right, 5: stay, 6: your choice). Little kids could take two steps. When somebody reaches the wall (or the end of the gaming area), they rebound. When everybody took their step, the round of infection follows: Infected players infect everybody they can reach with their hands, without moving their feet. If you are touched by an infected person, you become infected. The newly infected people turn their infection indicator to red. Then, everybody rolls their dice again, takes one step according to the dice, infect others, and so on. The game ends when everybody gets infected. This variation is to get familiar with the rules, it’s also good to see whether the game area is big/small enough.

After every game variant, the players should move in the room randomly.

Variant 2 (recovery): When somebody gets infected she stays infected and infects others for two rounds, then she recovers and develops immunity. Players who reached immunity take off their infection indicators to indicate they can’t catch the disease again. Those players can’t infect others and can’t get infected. We can count the number of infected people. Is there anybody who didn’t catch the disease at all? Several rounds could be played to show the randomness of disease spreading. We can discuss that it’s impossible to predict the volume of an epidemic because of this randomness. What happens if the infected can infect others for only one round, then they develop immunity, as it happens with Ebola? The epidemic will die out quickly. Why didn’t Ebola (or the disease in the game) become tamer? To see this let’s play variation 3.

Variant 3 (probability of infection):

A more aggressive pathogen requires more energy from the host, therefore it could spread more effectively. Let’s include one more move in the game, after the dice rolling and the taking of one steps. When an infected person meets a healthy one, before infecting, she rolls her dice again. The infected person infects the healthy one only if the rolled number is higher than a given threshold.

Herpes: infected people stay infected and will not recover or develop immunity. Infected people only infect others when they roll five or six. The spread of the disease is slow, but it never stops, because nobody recovers. With recovery it would die out quickly. But if it were more aggressive, the host would invest more energy to defence and recover after a longer period of illness.

Chickenpox: Quick and very contagious. The infected people can infect for one round if they roll higher than two. It is likely that the epidemic ends quickly, and then we can discuss that a very contagious disease can die out quickly, depending on luck. In this case we can start a new game.

Take home messages: a ‘tame’ pathogen is usually less contagious, but it can stay in the host population for a long time, as the host doesn’t invest energy into defeating the pathogen (such as herpes). An aggressive pathogen could cause an epidemic if it spreads effectively. Moreover, being aggressive could help spread more effectively and that could be a reason why the pathogen does not disappear. What happens when a pathogen spreads effectively and everybody is either recovered or dead?

In the following versions the infected people automatically pass the infection, they don’t have to roll the dice twice.

Variant 4 (Flu): The influenza virus is changing rapidly, and therefore we can catch it more than once. The infected are ‘ill’ and can infect others for two rounds, and after that they turn their infection indicators back to white. This indicates that they are recovered, but can catch the new variant of the flu. The epidemic will remain wiht us for a long time.

Variant 5 (Cholera): Cholera is a serious infection caused by the bacterium Vibrio cholera. The bacterium can stay alive in the environment, too, not just inside the host. The infected people are ‘ill’ for one round and infect others. But then, instead of recovering and turning back their infection indicator to white, they sit down to the ground (or just stay at one place) and let their infection indicators on red. The sitting people indicate the place the bacterium is living in the environment. (Vibrio cholera can live in water, for example, making a drinking well the source of the infection.) After the others have moved and the infected people infected others, the sitting people stand up and infect as well, then sit back.

Take home message: for having a longer epidemic, either a long illness (like herpes) or variability (like the flu), or being able to stay alive in the environment (i.e. cholera) is required.

Variant 6 (medical person): The game master asks for a volunteer who will be the ‘health officer’. The health officer stands at the border of the game area, with her eyes closed, or turning to the wall (so he/she can’t see what’s happening). Then the players occupy the game area, and the game master chooses the zero patient. The disease in the first round is lurking and contagious: the infected people in the first round do not turn their infection indicators to red but infect others by touching them. In the second round, they turn their infection indicators to red and become ‘symptomatic patients’, and continue to infect others. They also infect in the third round, then recover, turning their infection indicators back to white. When somebody has recovered, they reach immunity: they can’t be infected again. Players who haven’t been infected, and those who have been infected and built immunity, look the same with their white infection indicators, just like in real life. After each ‘infection round,’ the health office opens her eyes or turns to the game area and decides who gets medicine and who gets a vaccine. Then the health officer closes her eyes or turns back to the wall.

Version 1: The health officer gives medicine that heals the ill immediately, even if the infected person is only in her first round and the infection indicator is white.

Version 2: The health officer gives vaccines. The vaccine can’t help the infected people who already developed symptoms (and their infection indicator is red), but heals the infected people in their first round (infection indicator is white) and make the non-infected people protected from the pathogen (they take off their infection indicators indicating they cant be infected anymore).

The health officer can talk with the symptomatic patients and can ask whom they met. In the beginning, the health officer has two doses of medicine or vaccine. If this is not enough to stop the epidemic, the health officer can raise the dose. After the game we discuss how an epidemic can be stopped.

Variant 7: We start with a setup where the disease can spread easily (infected people don’t recover, they infect without rolling their dice again, and if the game area is too big and the infected people don’t meet enough healthy people, we decrease the area). In this variant nobody takes steps, and the distance between the people should be small enough to reach neighbours with our hands. Then the extensive vaccination follows: Everybody rolls their dice, and those who rolled 1-5, get their vaccine, become immunised and take their infection indicators off. Then the pathogen arrives and the game begins. Discuss that in such a situation people who don’t get the vaccine are still protected. In the next round, the non-immunised people stand together. Even though the rate of vaccination is the same (the same ratio of people got the vaccine), the non-vaccinated people are vulnerable: in their ‘community’ the pathogen can spread. Nest immunity: a non-vaccinated person is surrounded by vaccinated players - the non-vaccinated person will not catch the disease, even though she doesn’t have her own immunity.

Biological background: See at the variations

References: Own idea