The Rosalia Virus

The purpose of this "essay" is to provide further analysis of an important and key element in the plot of Trauma Team, the Rosalia virus. Out of the 3 (perhaps four) strains that have appeared in the Trauma Center series so far (GUILT, Stigma, Rosalia and perhaps Neo-GUILT), I find Rosalia the most interesting out of them. This is in fact, because it's based on something that exists in our world and shows that not only "toxins" like GUILT are scary. In this world, there are a lot of scary and incredibly interesting diseases. I'll try to keep this as entertaining and lighthearted as possible, keeping down with scientifical ridiculous words that can make us go "LOLWUT". After all, what I want is that is to help provide another look at Rosalia, which may change a bit your view of the game, for something better. Also, while I won't be completely addressing the whole plot and the ending, I advise you to have finished it first, as there may be serious spoilers mentioned around this.

Virus
The Rosalia virus. That's the name of our newest Eldrich Abomination in this game, a super, Ebola-like virus that makes people bleed. As hilarious as it seems, the definition isn't that inaccurate. So, in order to start, we have to ask ourselves some questions: Why a virus? What makes them so scary enough to be the final "enemy" on this game? Heck, what is a virus, anyway?

Well, a virus is something special. If you remember your Biology classes, we have Domain and Kingdom classifications for plants, animals, and fungi. Even things like bacteria, as small and uninteresting as they may seem, have a kingdom. Bacteria have two domains for themselves, humans are part of a Kingdom. Fungi even have a whole Kingdom for themselves, those selfish bastards. But what about viruses? We don't hear of a "Virus" Kindgom and we don't even hear of a virus "Domain". You might think that it's because they are not special at all. Perhaps you might be right. Or perhaps not.

The thing with viruses is... that they aren't alive per se. We can have philosophical debates about whether they are alive or not. Whether they are living organisms or not. Yes, viruses are that weird. They could also be like the equivalent of vampires in Biology, something that lives but doesn't. But enough of that, let's just learn what these ridiculous things are anyway.

Viruses are a strand of some nucleic acid, like DNA or RNA, covered in this "capsid", made of proteins. And.... that's it! They don't have other things with funny names like "endoplasmic reticulum" or stuff like that. Some lucky viruses have this extra layer, the "envelope". Think of it as something that helps viruses do their "job". In a way, they are like us. After all, we living things have DNA in each of our cells. But there's this little, tiny issue. They don't have metabolism at all. They don't eat, they don't breathe, they don't poop. They are just... there. They are unlike us, living organisms, who have to eat something in order to transform what we ate into energy and (waste)use that energy to play videogames, go to school, write ridiculous essays about fictional viruses... So that doesn't make them like.... alive. But if we get picky, viruses evolve, just like Rosalia. Of course not every virus evolves into a freaking caterpillar in our hearts, but it comes close. Somewhat. And from those evolutions courses everyone has heard of, living things also evolve. So, let's just leave the things be "viruses", whether they are alive or not. After all, the real point of this is to show that they are incredibly simple. Bacteria are more simple than us, humans. Well, viruses are even more simple! At least we don't have to learn lots of names of their parts for our next exams. That's a plus.

Now that we're done with how stupidly simple these things are, let's go over some special "qualities". Viruses are really small. They are measured in nanometers. Basically, for us, they aren't worth anything at all. At first glance. You'll eventually understand. Also, viruses can't have baby viruses. You don't have a mother virus and a father virus and they can't have virus kids. Sure, some bacteria don't need fathers as well, the bacteria just reproduces asexually and has its kids. The thing is... bacteria does it by itself. It's an independent individual. Good for it, because viruses are complete parasites.

First of all, viruses replicate, they copy their DNA/RNA. The thing is, they don't do it by themselves. They need a living cell that does all the dirty work for them. That means that viruses are only "active" when they are inside a cell. They just sit down, give orders and watch the cell do all the work. (Like some bosses) Pretty neat life, huh? When the virus is not on a living cell, a host cell, they are just there... not caring about the world and whatever that happens to it.

In order to properly "funcion", these lazy bastards enter a cell and they steal the whole cell machinery. They start making copies of themselves using the elements the host cell has to do its work. And then, they assemble and you have lots of viruses inside this cell. Think of them as making cars. Cars don't reproduce. You need a blueprint (DNA/RNA), you get the items to make the car, like the motor, wheels, seats, doors (the capsid) and once you have all the parts, you assemble them and have a car. A single blueprint allows you to create hundreds of cars. Viruses are exactly the same. Luckily for the poor chap who wants to study Virology, he doesn't have to learn another reproduction cycle for viruses with "prophase", "metaphase", "anaphase", and "telophase". The bad news is... the replication cycle is different for each type of virus. Ah, well. We can't have everything, can we? Oh, and when viruses get out of the cell, they happen to kill the cell they used to do their work. Lovely, right? That's what I meant with parasites.

So, in short, summarizing long paragraphs worthy of tl;dr: Viruses are really small particles that replicate themselves using another cell. Viruses don't have metabolic functions and they are really simple: a strand of RNA/DNA inside a capsid, and sometimes they have an envelope. And they happen to kill cells when they get out of them. I even bold this so as to help those who wanted to skip all that. Aren't I so sweet?

So, now that we have the basics of what viruses are, we can go on with... THE ROSALIA VIRUS! Yay!

The Rosalia Virus
Why Rosalia Virus? It's so unoriginal. Well...Viruses are quite simple to give names. You can either give them the name of what they do: Human immunodeficiency virus; or you can give them the name of where you first found them: Hantavirus was found in Hantan Riven, in South Korea. The only thing you need, when you are refering to new Genus is that they end in –virus. Because of this, we have the Rosaliavirus. But viruses are also fun because they have acronyms, saving you the trouble of writing the long names and you can sometimes drop the whole –virus thing. So we can talk about "HIV" or "Marbug" or "Ebola". And we can talk about "Rosalia" as well. Of course, this kind of name doesn't give us any clue on what it does. But that's why we were given this:

"A Group V virus of the Filoviridae family", according to RONI.
A whole sentence full of "lolwut" material for children who shouldn't really be playing this simply because of the rather brutal scenes of blood pouring out of people's eyes, mouth and nostrils. But everything shall be explained in a bit.

Group V
This whole "group V" means something important. This actually reveals us what kind of virus Rosalia is. Viruses are classified on groups depending on how their structure is. Whether they have DNA, RNA, whether it's a double helix or a single strand, and so on. Group V refers to viruses whose genetic material is RNA. This RNA is a single strand and it is in negative-sense. Negative-sense refers to how RNA is in relation to how it can be read in comparison to other nucleic acids. The normal "order" is positive-sense (which are the ones in Group IV), while here, these viruses are "backwards". Because they are backwards, they can't start giving instructions so easily. They need some proteins (which the virus has or must have) in order to have a mirrored copy. This copy then allows the virus to do whatever it pleases.

With these in mind, we can have a general idea of how it works: It's a virus that targets ribosomes, in order to make the proteins it needs. It doesn't necessarily inserts itself in the DNA of the host cell. Other groups of viruses have another place to "attack". DNA viruses (groups I and II) attack the nucleus, as they insert themselves in the DNA of the host cell.

Filoviridae family
The funny name has its meaning as well.
Filoviridae can be divided in two parts: Filo and -viridae. The suffix –viridae refers to a family of viruses. Filo (from latin, filum) is the name of this family, whose members look like thread in electronic microscopy. There's also a fun fact here. Maybe some of you already knew this family, even if you didn't know how it was called. You see, there's a really famous virus from this family. Its name makes people scared and it means death to however that hears it. Got an idea?

Why yes! I'm talking about Ebola. Ebola, and its less known brother, Marbug, are two Genera in this family. And guess what? They BOTH cause viral hemorragic fevers. I couldn't have found a much more fitting family to include Rosalia. We should give a pat on the developer team's shoulders, as they did their homework. Or had incredible good luck.

Alright, so we have a faint idea of what it does in the cells, we now know what that silly classification meant. So, our next logical step is: What the hell does this do to our body!?

How Rosalia works
As Gabe said, Rosalia has two stages. The first stage is where Rosalia replicates and the second is when the colonies form. According to them, the first stages involves Rosalia "fragmenting" and entering the host cell. While this may tell that Rosalia virus was more complex than other viruses, the important fact is that it remains undetected. Usually, normal viruses are undetected when they are "naked", that is, when they have undressed from their envelopes (if they have them) and their capsids. Because they are naked, we can't really see them, not even with electronic microscopy. The only thing that's there is some nucleic acid, and it's pretty much impossible to say if the nucleic acid is our virus' or our host cell's. That's why the only effects we can see are the ones that the virus provokes as well.

In Rosalia's case, it has this unique ability: it creates tumors by inhibiting the tumor supressor gene. Normally, cells have this gene that protects them from dividing too much and creating an unreasonable number of cells. This gene exists to make proteins which control cell division: If the cell has damaged DNA, they either stop the whole cycle or tell the cell to go and die (no, really). The point is to stop the cell and have damaged, abnormal cells spreading. Rosalia's such a bastard that it destroys this mechanism. Without this gene there are no proteins. Without these specific proteins, cells which are damaged and should have died continue growing and dividing. These abnormal cells then proceed to destroy the tissues surrounding them and chaos ensues.

To make matters worse, let's take a look on the places where these tumors are. Kaposi's Lady (Shelly Brooks) had lung, skin and intestine tumors. Mr. Soldier (Samuel Trumbull) had lung and liver tumors. A lot of these tumors are in special areas: these tissues are in constant cell division. Skin is probably the most obvious. Because it's in contact with the environment, cells normally die after a short time, so you need to constantly rechange them. Which means BAD NEWS to us. Constantly rechanging is a perfect recipe to create a lot of tumors. So, that's the first thing to worry about: Tumors. LOTS OF THEM.

As if things weren't bad enough, Rosalia just happened to have another stage. A stage where the viruses form colonies and attack tissues. While Gabe said that the viruses "eat nearby cells", I think that what they really meant is one of the effects that viruses provoke: cytophatic effects. These range from causing the cell to explode and die to making holes in lots of cells and the damaged ones "fuse" on something non-functional. Normally, cells just explode and die. Now, having one cell dying is not much of a problem. The problem is this: we're having colonies of viruses. Remember how small viruses are? Even if the colony is "small", I really wonder how many thousands of nanometric bastards are in it? Oh, and viruses don't really die when they infect a cell and then leave it. In fact, when several viruses are "mature" viruses, their way out of the cell is to destroy the host cell. Simple as that. So, with a single colony, we have thousands of viruses which may have replicated and thousands of dead cells, which can't be easily replaced. This is obviously NOT GOOD.

Infection and Prevention
A key point of the game is figuring out how this thing was spread. The virus, thankfully for many, isn't airborne. That means it can't be spread in the air, like flu or influenza viruses. So, originally, the means of transmision from person to person would be much lower. The problem was how Albert Sarte mistakingly screwed things up for everyone, despite his good intentions. The road to hell is paved with good intentions, indeed.

Sartre killed Rosalia because he figured out that the virus was too dangerous and the risks of an epidemic (maybe even a pandemic) were too high. After all, the Rosalia virus is not something you can toy with. The thing he didn't consider was that after killing little Rose, the virus would not only "live" after Rosalia's death, but also it'd be "stored" in the flowers that surrounded her, her death bed. What happened then was a transmission route, from Rosalia's body to the flowers and then to butterflies. In this point, the butterflies are the main reason this whole mess began.

In microbiology, in order to have a disease we need three things: We need the microorganism, the susceptible host and something called a vector, a means of transport. If we erase one of the three factors, there's no disease. In this case, the microorganism is the Rosalia virus, the susceptible host are human beings and the vector are butterflies. The main thing with this triad are the butterflies.

Let's think a bit: Rosalia has the virus, but, as long as her blood or any fluid of hers doesn't touch anyone, they are basically safe. The proof is that no one in Maria's orphanage was mentioned to have died because of this. Also, Rosalia and Albert fled to Mexico and lived alone. With no other susceptible hosts, other than Sartre, we're realy stopping the epidemic. After all, there's no one else left to infect. Even if the virus was still "alive" long after Sartre's death, if he had died in that unknown and deserted place, there wouldn't be risks of infections. This means that Rosalia could have led a sheltered, happy life with her father, had Sartre stopped his research. However, he didn't do so, and the tragedy began.

We've noticed how if Rosalia and Sarte had died of natural causes, this mess might have been avoided. The thing is that with Rosalia's death, the butterflies carry the virus and the virus survives in dead bodies for a while. Monarch butterflies fly from the US and Canada to Mexico and then fly back. The fact that we have a vector that can travel lots of distances is terrible, as there are lots of places that they can infect. This was the reason why the quarantine failed spectaculary. While no one in Portland can "leave", the butterflies don't really care and keep spreading their dead scales, full of the virus, to every place they go. The virus, which wasn't spread airborne, magically became "airborne"-like. And chaos ensues.

Treatment
So, quarantine failed, we have lots of sick, dying people everywhere. What do we do?
There's something serious about viruses. They don't have a cure per se. That's because viruses aren't really alive in order to kill them. With bacteria, fungus and parasites, what medicines do is interfering with their metabolism, destroying the cell's integrity, thus killing them. The thing is, viruses aren't that affected, especially since they are protected by the host cells. So, the goal of drugs in this case, rather killing the virus, is preventing it from entering the cell or preventing it from replicating. Sure, the virus is still in the body, but it's not causing harm, it's been "inactivated" in a way. That's why Albert Sartre was taking a ridiculous amount of antiviral drugs. He knew he had no chance against Rosalia and with the little time he had, he couldn't afford wasting it figuring out which antiviral drug was effective. Of course, none of them worked and he died because of the disease. As we learned from Tomoe's previous to last mission, antiviral drugs may work when extracting colonies. However, the thing is they don't fully help and in that operation, the lady there was almost dying. Even with some antiviral drugs and surgical procedure, Rosalia can't be really defeated.

Without the prospect of a good medicine, there's little hope of healing. But among all chaos CR-S01 thinks of another alternative to attack and eliminate Rosalia: an antiserum. He says that Rosalia (the girl) was sick with the Rosalia virus, but she didn't got ill. So, she's a natural host. Natural hosts have the illness but don't get ill because of it. I apologize since my knowledge in Immunology is pretty basic and not enough to explain all this. Because of this, I can't think of a plausible theory of explanation as why Rosalia didn't die of the virus other than "because CR-S01 says so". Still, I'll try my best at explaining how the antiserum works,

When our bodies don't recognize something that's in it, they immediately think of something foreign and begin to attack it. From bacteria, fungus to needles that fell in during operations, these all are foreign agents (antigen). What our bodies do is create antibodies, something that recognize and join these antigen things and start a response from the host. The host then tries to eliminate the antigen by using white blood cells and so on. After a while, the body finally eliminates the foreign agenst, through means of recognition and elimination. The antiserum contains antibodies specific to the Rosalia virus. Since they are specific, they recognize the virus, attach to them and the neutralization-elimination process begins. As we've seen, antiviral drugs have failed and the infection is too serious for the immune system to handle it (if you check Samuel Trumbull's analysis exam, his while cell count is below the normal parameter). Therefore, the only treatment is this antiserum.

Thanks to this antiserum, which was magically produced in enough quantity and in a short time to treat everyone that hadn't die at that point, Rosalia was actually defeated. Sure, the butterflies are still flying around, but we have this antiserum and a prospect of massive fumigation of Monarch butterflies and destruction of Rosalia's death bed. So, apparently, everything worked out well in the end. For now. Of course, there are still lots of question regarding Rosalia and the Cumberland College incident, so, perhaps all of them will be answered in a possible sequel.

Conclusion

From all this analysis we have talked about what a virus is, how Rosalia functions and we have deduced it's replication "style". We even expanded a bit on how it acts on the patient's organism, how it creates tumors and why it's in these areas.

As we can see, the developers have unintentionally given us some food for analysis in something like the Rosalia virus. Perhaps it wasn't their intention, but it's really amazing that we can explain a bit how the stuff we see in videogames to some point with some sort of analysis. While I was watching videos of this game (I have no Wii unfortunately and had to use these sort of things), I was really excited while trying to figure out Rosalia. While I know that the degree of realism is not meant to be taken at "how accurate with real life the game is" and there are a lot of things that aren't realistic at all, it's still fun trying to figure out some of the diseases that are introduced with this game, using real life knowledge. In a way, I think that this is what makes Rosalia even more terrifying, when you understand the way it works.


Also, as you have seen, while I talked about how Rosalia worked in the patient's body, I never really refered to what exactly it does, besides tumor making and cell killing to be bad enough to make this "viral hemorrhagic fever" thing. Because of this, and because this was already long enough, I planned to write this in a future text, "Samuel Trumbull's fate", in which we will not only look at how Rosalia affects analysis exams and so on, but what are the prospects of surviving the disease on your own.