People are obsessed with a game where you destroy humanity by spreading a disease. It's a way to work through coronavirus anxiety, according to an expert.
- As concerns about the Wuhan coronavirus spreads, downloads of the mobile strategy game Plague Inc are soaring.
- Users have reached out to Ndemic Creations, the company that created the game, to ask public health questions about the coronavirus and its spread.
- Michelle Colder Carras, a researcher who studies video games and mental health, told Insider distressing video games can be cathartic, acting as a form of "exposure therapy."
- Carras also told Insider that video games have tremendous potential to raise awareness on public health issues, including viral outbreaks like coronavirus.
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As the Wuhan coronavirus spreads and the death toll rises, so does demand for a video game.
Plague Inc., a game in which players act as a virus fungus, or bacteria, tasked with destroying humanity, has been one of the world's most popular strategy game apps since 2012, and in recent weeks it has climbed the Apple charts to become one of the world's most downloaded games right now.
The Wuhan coronavirus started in Wuhan, China in December, possibly from animals at a wet market. As of Tuesday, the virus had spread to 16 countries, infecting 4,600 people, and killing 107.
Plague Inc., created by UK-based Ndemic Creations, sees a spike in users every time there's a real viral outbreak, from the Ebola virus to the flu. It garnered so much traffic last week that it temporarily crashed.
The creators issued a statement on January 23, urging users not to remember that "Plague Inc. is a game, not a scientific model and that the current coronavirus outbreak is a very real situation."
And yet its popularity isn't waning.
Mental health expert Michelle Colder Carras, who specializes in video game use, told Insider it's hardly surprising. Years of research shows distressing games that mimic real-world events can act as a form of "exposure therapy," giving users a sense of control.
In Plague Inc., the players are the virus
The game begins with video-game voiceover veteran Elias Toufexis, rasping: "Once there were more than 7 billion people in the world. The human race ruled supreme." Then there's a cough. "I find it hard to picture that world now."
Players pick a pathogen and strategize on how to advance symptoms and transmit the disease to as many people as possible while thwarting counter-actions taken by scientists and the government.
When humanity is wiped out, you win. If humanity survives, you lose.
Distressing video games that mimic real-life events can be therapeutic
In 2009, the American Psychological Association warned that video games were violent, harmful, and were mostly played by susceptible young men. President Donald Trump routinely blames the popularity of first-person shooter games after mass shootings, though the nations with the highest rates of gaming also have some of the lowest rates of gun deaths.
But, increasingly, studies are showing that even the most distressing kinds of video games can act as a form of therapy for people suffering from post-traumatic stress disorder, or with clinical depression.
"It's certainly possible that people are playing [Plague Inc.] as a way to work through anxiety or put things into perspective," Michelle Carras Colder, a mental health researcher who has published research on video games with the Johns Hopkins Bloomberg School of Public Health, told Insider.
Her latest study of 20 military veterans using video games found that many liked violent war games as a way to make meaning of their difficult experiences. In another study, veterans told researchers that playing first-person shooter games activated their PTSD, but over time they felt better.
Indeed, on the Chinese social media site Weibo, one Plague Inc. player said the appeal of the game lay in "pretending to occupy the position of the perpetrator."
"This isn't the case for everyone," Carras told Insider. "For some people it could just make anxiety worse. But it seems like there are others for whom games could be a good way to play through the anxiety."
The surges of new players during periods of potential epidemics like Ebola, and now coronavirus, does seem to suggest that people are seeking something from the game, said Carras.
But, she says, it is worth it for developers to consider doing more than just issuing a statement.
"It's very responsible to issue a statement like this on the website, but I wonder whether there's anything in the terms of service for the game that makes it clear this is not medical information," Carras said.
"It might be worth it for the developers to consider a pop-up that has to be clicked on at times like this that reminds players that this is not medical information and that they should contact the appropriate health authorities for more information about specific diseases."
There are benefits to learning about viral infections through video games
Plague Inc. reached 135 million players in 2019. Public health officials are aware that it has the capacity to reach a diverse group of people; 40% of US video game players are women and 25% being over 65, according to Pew research.
That's why, in 2013, James Vaughan, founder of Ndemic Creations, was invited to give a talk at the US Centers for Disease Control and Prevention (CDC), where the game was lauded for using "a non-traditional route to raise public awareness on epidemiology, disease transmission, and diseases/pandemic information."
Just a year later, the Ebola outbreak hit, and the game soared in the charts.
There have been attempts to create more educational games - harnessing the "fun" aspect of the game to educate the general public.
The University of Cambridge made Killer Flu, Medical Mysteries, and Pandemic 2 (which accused Plague Inc of stealing its idea), and the CDC made Solve The Outbreak, in which players play "CDC detectives" attempting to stop a plague. Leading Dutch virologist Albert Osterhaus, who designed The Great Flu, an online game designed to raise awareness of the 2009 swine flu outbreak, told The Oklahoman at the time: "It is actually what is happening now, what is happening in the real world."
But few have come near the success of Plague Inc., which is about destruction, not protection - except in 2005, with the world famous "Corrupted Blood Incident" on World of Warcraft. The game was hit by a virtual pandemic caused by a system glitch, killing many lower level characters. It forced players to drastically change how they approached the game, with avoiding infection becoming a top priority.
In articles in medical journals Science, Epidemiology, and Lancet Infectious Disease, epidemiologists suggested it could be used as a model for how human populations responded to pandemics and a good way to teach people how viral infections work.
Ndemic Creations did not respond to a request for comment.
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