Northern Keltia respiratory syndrome

Northern Keltia respiratory syndrome
(NKRS)

Field	Infectious disease
Symptoms	Fever, cough, shortness of breath
Complications	ARDS
Onset	2 to 14 days post exposure
Duration	1738 AN-ongoing
Causes	Northern Keltia respiratory syndrome-related virus (NKRS-V)
Risks	Contact with infected humans and mosquito's bites
Diagnosis	rRT-PCR testing
Treatment	Symptomatic treatment and supportive treatment
Prognosis	34.5% risk of death (Vegno)
Frequency	1.122 cases (as of 1738 AN)
Deaths	392

Northern Keltia respiratory syndrome (NKRS) is a viral respiratory infection caused by Northern Keltia respiratory syndrome Virus (NKRS-V). Symptoms may range from none, to mild, to severe depending on age and risk level. Typical symptoms include fever, cough, diarrhea, and shortness of breath. The disease is typically more severe in those with other health problems. It is believed to have played part in the collapse of Cerulea and Normark, 1736–1737.

The first case was identified by lucidese physician Mark O' Munn at the San Pepinho Hospital in Santa Markovia, San Lucido, Vegno. As it stands, 1.122 documented cases were reporte and about 35% of those who are diagnosed with the disease die from it.

NKRS-V is a virus in the Filoviridae family believed to be originally from bats. However, humans are typically infected from mosquitoes that are part of the typical fauna at these latitudes, and for this reason, the disease is currently limited to this geographical region. From the first scientific findings, it is thought that this virus is a mutated version of the Alexandrian flu virus; the animal reservoir of this virus seems to have been cattle, in which the virus has no pathogenetic potential, subsequently spreading to other species, up to bats, in which the mutation occurred which allowed the virus to be pathogenic and transmitted to humans . Spread between humans typically requires close contact with an infected person. Diagnosis is by rRT-PCR testing of blood and respiratory samples.

As of 1738 AN, there is no specific vaccine or treatment for the disease, but a number are being studied and developed on the basis of the AndeVax by Farmacéutica del Ande, used in the Alexandrian flu.

Signs and symptoms

The first person, in 1738, had a fever, cough, expectoration, and shortness of breath. One review of 47 laboratory confirmed cases in San Lucido gave the most common presenting symptoms as fever in 98%, cough in 83%, shortness of breath in 72% and myalgia in 32% of people.

There were also frequent gastrointestinal symptoms with diarrhea in 26%, vomiting in 21%, abdominal pain in 17% of people. 72% of people required mechanical ventilation. There were also 3.3 males for every female. One study of a hospital-based outbreak of NKRS had an estimated incubation period of 5.5 days.

NKRS can range from asymptomatic disease to severe pneumonia leading to acute respiratory distress syndrome (ARDS). Kidney failure, disseminated intravascular coagulation (DIC), and pericarditis have also been reported.

Cause

Virology

Northern Keltia respiratory syndrome is caused by the NKRS virus (NKRS-V), a species with single-stranded RNA belonging to the family of Filoviridae. It has been ascertained that this virus originated from a mutation of the Alexandrian flu virus, with which it shares many virological characteristics. Its genomes are phylogenetically classified into two clades, Clades A and B. The virus grows readily on Vero cells and LLC-MK2 cells.

Transmission

Mosquitoes

The bite of mosquitoes is the main transmission route for the disease and the reason why it is currently limited to this geographical area. Transmission is specific to a particular type of mosquito, Aedes, which is especially resistant to the region’s cold temperatures. The mechanism involves a healthy mosquito biting an infected animal, such as a bat, or an infected human and then, with its next bite, injecting the virus into the next healthy individual.

Between people

There has been evidence of spread of NKRS-V from person to person, in particular in health care settings like hospitals. At the moment most transmission has occurred "in the circumstances of close contact with severely ill persons in healthcare settings" but there are no evidences of transmission from asymptomatic cases.

Diagnosis

According to Vegnese Health Ministry, the interim case definition is that a confirmed case is identified in a person with a positive lab test by "molecular diagnostics including either a positive PCR on at least two specific genomic targets or a single positive target with sequencing on a second".

Centers for Disease Control

The Government of Vegno established Centers for Disease Control and Prevention in San Lucido recommend investigating any person with:

• Fever and pneumonia or acute respiratory distress syndrome (based on clinical or radiological evidence) and either:
  • close contact with a symptomatic traveler who developed fever and acute respiratory illness (not necessarily pneumonia) within 14 days after traveling from countries in North Keltia or
  • a member of a cluster of people with severe acute respiratory illness (e.g. fever and pneumonia requiring hospitalization) of unknown cause in which NKRS-V is being evaluated, in consultation with state and local health departments.
• Fever and symptoms of respiratory illness (not necessarily pneumonia; e.g., cough, shortness of breath) and being in a healthcare facility (as a patient, worker, or visitor) within 14 days before symptom onset in a country or territory in or near North Keltia in which recent healthcare-associated cases of NKRS have been identified.
• Fever or symptoms of respiratory illness (not necessarily pneumonia; e.g., cough, shortness of breath) and close contact with a confirmed NKRS case while the case was ill.

Laboratory testing

NKRS cases have been reported to have low white blood cell count, and in particular low lymphocytes.

Prevention

While the mechanism of spread of NKRS-V is currently not known, based on experience with the Alexandrian flu, the Vegnese Health Ministry currently recommends that all individuals coming into contact with NKRS suspects should (in addition to standard precautions):

• Wear a medical mask
• Wear eye protection (i.e. goggles or a face shield)
• Wear a clean, non sterile, long sleeved gown; and gloves (some procedures may require sterile gloves)
• Perform hand hygiene before and after contact with the person and his or her surroundings and immediately after removal of personal protective equipment

The duration of infectivity is also unknown so it is unclear how long people must be isolated, but current recommendations are for 24 hours after resolution of symptoms.

It is believed that the existing Alexandrian flu researches may provide a useful template for developing vaccines and therapeutics against a NKRS-V infection.

Treatment

As of 1738 AN, there is no specific vaccine or treatment for the disease. Neither the combination of antivirals and interferons nor corticosteroids improved outcomes.

Political actions

In response to the rapid spread of the Northern Keltia respiratory syndrome and the increasing concerns among the public, the government implemented drastic measures to combat the epidemic by launching a large-scale disinfestation campaign. This operation aimed to completely eradicate the species of mosquito identified as the primary carrier of the disease. Experts had concluded that without prompt and decisive action, the proliferation of this mosquito would continue to fuel virus transmission, further endangering public health.

However, the decision to carry out such an extensive disinfestation raised serious concerns about its impact on citizens' daily lives and the environment. The fumes produced by the powerful chemical agents used in the disinfestation, while lethal to mosquitoes, posed potential health risks to humans. Government medical and scientific advisors warned that prolonged inhalation of these vapors could have side effects, including respiratory problems and potentially long-term damage to the immune and respiratory systems, particularly for vulnerable groups like the elderly and children.

To minimize the risk of exposure, the government organized structures and centers with every basic necessity service where to gather citizens without symptoms, previously screened by a throat swab. The government launched an extensive information campaign to keep the public updated, reassuring them that the relocation would be temporary and that every effort would be made to allow them to return to their homes as quickly as possible. For those who, for personal or family reasons, preferred to remain in their houses, the government strongly advised staying indoors, keeping windows and doors closed, and minimizing contact with the outside world during the entire duration of the disinfestation. This recommendation was accompanied by the distribution of protective masks and air purifiers to help limit exposure to the disinfestation fumes and reduce the risk of accidental inhalation.

Immediately after those procedures were completed, the government gave the green light for the massive disinfestation, covering an extensive area of San Lucido. Specialized operators, equipped with advanced technology, dispersed powerful insecticides throughout every corner of the affected area, ensuring that no area remained untreated. This operation, according to experts, should have completely eliminated the mosquito population responsible for the disease transmission. The government has also promised further monitoring of the area in the following weeks to ensure that residents can return to a safe, risk-free environment.

Aftermath

However, in the aftermath of this massive evacuation and during the operations of disinfestation, a new crisis emerged: the Confederacy of the Dispossessed saw an opportunity in the emptied regions of San Lucido and moved swiftly to exploit the vulnerable situation. As thousands of citizens evacuated their homes and left behind largely abandoned territories, the Confederation initiated an incursion into San Lucido, throwing the remaining population into disarray and chaos. The faction took advantage of the reduced security presence, as the government’s focus and resources had been heavily committed to the disinfestation and evacuation efforts.

Following the disinfestation, while government forces were still reorganizing and re-establishing control over the region, the Confederation escalated its actions into a full-scale invasion of San Lucido. Their forces moved decisively, seizing large swathes of territory and consolidating power across strategic locations in the region. This aggressive expansion further destabilized San Lucido, leaving those who had chosen to remain in their homes under constant threat of violence and displacement. Chaos reigned across the affected territories as the Confederacy of the Dispossessed pressed forward, using the post-evacuation vulnerability to fortify their position and gain influence over the land.

Due to the sudden invasion, the disinfestation procedure was not completed across the entire territory, thus leaving the issue of the disease unresolved. Even now, with the attacks underway, it is not possible to know how much effect this procedure of the Vegnese government had, and how effectively the disease has spread and whether the mortality is actually that predicted by the first studies conducted.

International Response

•  Aerla: Starting in 1738 AN, it was decided that the border between Aerla and San Lucido would be temporarily closed until the pandemic subsided. However Aerla was (for the most part) unaffected by the pandemic, as much of the country sat at an altitude above the mosquito line, and many peoples in the lower-lying areas having developed immunity from the disease from previous outbreaks of NKRS in the preceding centuries. Despite this, the disease heavily affected the refugee communities of Norse refugees living in camps in the Transcaledonian Territory. This led to voices in the National Assembly, especially among Conservative Bloc, to call for the closure of the borders to Norse refugees.
•  Constancia: Intelligence reports reaching the Imperial Constancian Government and the ESB Group necessitated the formation of a Task Force NKRS to serve as lead agency for the crisis, with Minister for Public Health Ioannes Flavius as Chairman, and Minister for Civil Defense Edgar Sadat, the Director-General of the State Protection Authority as co-vice chairmen.
•  Lac Glacei: Lac Glacei responded to news of the syndrome by announcing that it would send medical aid to Vegno but would also place a temporary travel ban on the country until the situation could be resolved. Lac Glaceian scientists offered their services to help find a cure.
•  Moorland: Moorland placed an immediate travel ban on all persons entering or exiting Vegno and halted all flights to the country. King MacMartin said in a statement that while the situation was unfortunate, the lack of a cure for the disease meant that Moorland could not risk infection spreading to the homeland. As a precautionary measure, aerial insecticides were sprayed over various areas to help reduce mosquito populations.