In a lot of ways I don't think the SR writers fully comprehended the massive impact that something like VITAS I & II would have had on the world and glossed it over as being just 'numbers', not an uncommon problem in sci-fi and RPG projects I suppose but its an interesting discussion.
Big numbers
VITAS I by all accounts in 2010 wiped out 25% of the population, which going by population of roughly ours puts that at around 1.725 billion people, VITAS II in 2022 managed to scrub about 0.9billion.
Projected numbers for the worlds population if we kept it going as-is would be about 9.1billion people by 2050, which is about a 25% increase give or take a couple, but by my thinking the SR-world population is roughly slightly lower than it is now at around 6.1 to 6.3billion people. That isn't factoring in all the other crap which killed people wholesale aside from just VITAS, multiple wars- some on a global scale, famine, large scale riots, few NBC-strikes in the middle east... cranky dragons, shadowrunners with machine guns, etc.
Bit hard to put accurate numbers on that but all in all, its really not looking real chipper for the (meta)human population of earth, in fact I'd imagine there would be some pretty large tracts of it through developing and 3rd world nations with high density populations that just got absolutly wrecked to the point they are unrecoverable.

What it means?
I think essentially if we where to compare VITAS to the Bubonic plagues of 1347 to 1350 and the smaller one of 1360-63 is that there was a number of changes to society that I think where missed in creating the SR backstory and not taking into account the social and economic ramifications of such a huge dent in the population.
The Neo-Feudalism of the mega corporations I think would be the first casualty if it was to mirror the Black Death. For starters the mega-corps couldnt afford to be as utterly brutal to their common employees as it is often described, because they simply run away just like the serfs abandoned their tenent lots under their lords and went off to find greener pastures (literally) or hired out their labour to much better employers, struck out on their own and in many instances gained a large amount of upward mobility in their social status.
People may have initially run off under the corps wings for protection from the chaos of the disease, but their eyes get opened pretty quick when they figure out that it is no protection.
Literally 1 in 3 people over the space of 12 years copped it.
Didn't matter if they where the CEO or the tea lady, *bang* dead... and thats a massive hole in a skilled labour force when trained, qualified people are going out feet first faster than they can be replaced. It means anyone with some kind of skills will have a job, because there is literally NO ONE left to do it and in some cases large parts of Europe took about 120years after the passing of the Black Death to fully repopulate the decimated areas and come back to what they where economically prior to the plague. By 2070s, 50 years after, its probably about half-done in some cases (Balkanised Europe) and completely busted (Africa) to the point it'll not be fixed in living memory.
Robots, drones, nanites, magic, skillwires and happy thoughts aren't going to fill the void either, some dumb gronk living in bumhole Redmond without a SIN is probably there because he doesn't want to get a job and a SIN, with 1/3rd of the worlds population dead barely 2 generations ago, he's still going to have pick of the job market. Be that a government or a corp or anyone else, they'll probably pay him much better than we expect and actually do a fair bit to maintain him as an employee... crap if he actually 'has' as skill then there is a good chance he'll get an even bigger incentive to stay there!
So the business of 'Extractions' is probably actually booming for runners, which brings us to the next point.

Sociologically, the world and its inhabitants are in a state of shell shock.
By now they've been clubbed with a problem that won't go away through all the normal means people deal of horrible events-
Throwing money at it
Running away and living in the hills
Joining a corp/church
Praying to Jesus/Allah/Satan/Hubbard or joining any other popular religious cult
Going to a doctor
Staying at home and shooting anyone on yer lannn'
They tried all those things and it didn't work, nothing works and it does create a massive fracture in peoples psychology when they realise that no matter what the heck they do, there is nothing that can be done and just sort of get used to coping with the fact that if you're numbers up, then its up. Even the optimists, the glass half full bastards got the other half of the glass shoved up their collective arseholes as VITAS II came along and put the boot in, then people started turning into 'monsters' and hey, that guy over there can shit fire out of nowhere with magic...
I think you can probably safely say that for a long time, quite a lot of society was collectively wandering around going "meh f*ck it, its all bullshit anyway" with 1/3 of your relatives, workmates, friends, immediate family and everyone else being dead and probably a better than average chance of yourself being dead or twisted into some kind of weird meta-human shape.
Anyone claiming to still believe in anything, was probably just doing it out of force of habit for something to do rather than any actual conviction.
Comparing this to the Black Death of Europe, religion, money, the arts and employment where twisted beyond recognition to what they where prior to the plagues, walking through streets full of dead-uns will kind of have that lasting effect on people for a very long time.
Like the Black Death, VITAS still pops up in some form or another every couple of years to say hi, hope you didn't forget me. People in 2070's are still getting wasted by it just like their grandparents where in the 2010-20's, not to the extent they once where, but its still there.
Socially the biggest impact is on the smaller communities where individuals have a greater impact on the community, when they're taken away, people have either the choice of making do or moving to larger population centres where they can get the services they need to survive. Compound that with some fairly signifigant other disasters (natural or magical) and we have the problems with urban sprawls of people being compressed together and massive refugee problems, probably not as bad as they're made out to be, after all there is a fair amount of people in cities that got wiped out too and labour shortages to be filled.

The countryside however, is fairly much vacant.
Aside from the mass-migration to city centres, its also full of cranky para-critters, anarchists, carpet baggers, survival nuts and goodness knows what else running around to the point that you wouldnt want to be there anyway, not when someone in a corporation or government is paying big money for hands ready to work. Countries dependant on agriculture and natural resources, both economically and for their own survival are going to be the hardest hit there, the added danger is that the corporations simply move in if they can get their act together and with the security forces they're capable of mustering, not going to be removed by the governments either. To the point that I would imagine they have annexed completely some very large parts of Asia and Africa.

That's my take on VITAS

the thing about corp behavior is that i suspect runners (and as such players) see a different side of it from the common "wageslave"...

[threadjack]
Aaagh, I can't take it anymore.

Quick grammar lesson - "canon" and "cannon" are two different words. Official printed material is the former; the latter is a BFG.
[/threadjack]

but hardcover books makes oh so nice projectiles

Is it not heavily suggested in some of the fluff that a fairly large percentage of those who died from both VITAS outbreaks were from the less developed parts of the world? By the time that the outbreak had killed off half of India/Mexico that they had discovered a treatment and that the people in countries such as the US and the EU were largely protected and that it was the unfortunates that kicked the bucket?

I would imagine that if that is so most of those killed would be the large untrained workforce that is, in all honesty, not that hard to replace. Most of the upper managment survives, anyone of any worth to one of the Megas almost certainly got treated and the untrained workforce got heavily replaced by the wonders of a mechanised factory. The entire world at the time was economically in turmoil, so anyone who actually had a job would probably want to keep it, and anyway your jobs the only think keeping you on a treatment list. Not a good time to go looking for work.

People seem to have a mythical belief in the immunity of first world nations to pandemic. Truth of the matter is, we're more vulnerable to secondary effects.

Let's look at Thirdworldistan. By definition, it has irregular electricity, virtually no communication grid, few vehicles, and a water supply system is something of a dream. If the 25% of fatalities in a random town includes the guy who owns the truck, odds are someone else can drive it. If not, well, there's only the one truck so they probably have a mule-based backup plan. If the normal mule drover is dead, well, most of the town can handle mules. Given that in Thirdworldistan that 1 hour's labor produces roughly 1 bushel of corn, the bulk of the populace is agricultural. That means the loss of any one individual doesn't impact the fundamentals of survival: farming, butcher livestock, preserve food using salt & smoke, and to draw water from the wells and streams. As for construction, that's carpentry and masonry, which is normally a community effort.

If you want a more local example, consider the amish. If you wiped out 25% of an amish community, they could still build houses, barns, and farm. Their skillsets are generally universal, although some people are better at some things than others.

Now look at a typical US community. Most people are specialized workers. Only a small percentage are agricultural (~0.5% of US population) and the overall economy is based on technology-dependent efficiency. FYI: horse drawn plow produces 1 bushel of corn/manhour labor. WWI tractor/combine produces 5 bushels of corn/manhour. Modern hybrid seed, fertilizers and equipment: 100 bushels of corn/manhour. That level of productivity is factored into every aspect of life. Blow holes in the supply chain and the impacts are much more severe.

The major metropolitan regions will likely have sufficient redundancy in their employee pool that they can make do in all but the worst cases. Even then, it's likely that any needed skilled workers will be poached from smaller communities under a kind of "Eminent Domain."

Let's look at the fundamental infrastructure for the bedroom communities to the major metropolitan regions. You've probably got a county government that provides utility services like water, sewer, waste pickup with support stations for the power, gas, and telecom corporations.

Think of the true experts at each utility, the engineers and plant operators for the sewage treatment, water treatment, and power plants. Most of the time those smaller facilities will only have ~3 full operators and a number of techs. The techs cover the night watch with an on-call operator/engineer. Well, except for the power plants where there're engineers always onsite.

Assuming these people are more of a priority and only have a 20% die-off, that means that two of the three will in fact die in about 10% of utilities. That pretty much kills that community. Assuming that you can live with a crappy sewer system and no phones, water, power, are the "must have" utilities. At, roughly 19% of communities dependent on small regional utilities will die when their water treatment or their power plants fail.


Now lets focus on people who work outdoors and are more likely to be relapse, let's kill off 25% of the utility maintenance crews (electrical linemen, water line repairmen, sewer maintenance, gas crews, phone techs, longshoremen, railroad workers). There's also a number of others who don't die but do get sick and probably lose 2 weeks to Vitas. Given a 25% die-off, assuming 75% of people actually contract VITAS gives a 33% mortality factor, which is probably high, but more conservative. That means that 25% maintenance workers die while another 50% lose 2-weeks of their life.

Y'know what happens when you permanently lose 25% of your electrical linemen and functionally lose another 8% of your manpower to illness for a year? You wind up shutting down around 20-30% of your power grid. If you don't it will cause fires and possibly blow the rest of the grid when the unmaintained areas start failing. Same goes for water. Breaks in the line result in contamination, which is more dangerous to the public than no water, especially when a large percentage of the populace has a weak immune system from fighting off VITAS.

Now you've got holes in your service areas as you start shutting down areas are less critical, or more likely, you let failed areas stay dark because you don't have the manpower (and possibly supplies) to repair them.

Sewer's less of an issue since you can neglect routine system maintenance for a year or three as long as you focus on the pump stations and key trunks. Telephone failures aren't as earth shattering except they cause other problems when people can't order food, medicine, gas, parts, etc.

The longshoremen and railroad crews are actually a bigger problem than you'd think. Maybe not for coastal shipping but IIRC they are the ones who operate locks and dams or rail switches. Guess how virtually all coal for power plants is shipped? Rail and barge.

Now you have cases where the core systems are working but the networks are starting to fail. Power plants may or may not be able to use the phone to call for coal deliveries, which may or may not get to power plants.

Extend that to food, fuel, and medicine. Remember those highly efficient farmers? If they get sick during planting week (fall down, nearly-dead sick) then yields will be lower. If the power kicks off a couple of days during the hottest times so that the irrigation pumps don't run yields drop more. If there fertilizer is late, lower the yields again. And again if the tractor runs out of diesel. And again if the phones are down and the harvest molds in the silos waiting for trucks to come and get it. And again if the distribution warehouses can't get orders in from their vendors.

Ignoring the dead farmers as the people buying their produce are also dead, the live farmers will be less productive, just like everyone else. Which helps explain VITAS II, since there was probably a vitamin-deficiency year or two for everyone.

Now you start to see that while VITAS may claim fewer people directly in North Am, the secondary effects are going to be staggering.

The other element that was missed was assuming that having the fancy medical care means that you can handle a big upsurge in cases, so everyone infected gets the same level of care as the one person who catches bubonic plague today. Now there was some truth in that is the 60s-80s, but there is NONE now. Federal and private insurance has cut out that. Almost no hospital has much surge capability. Having unused patient rooms, idle nurses and under-employed physicians are luxuries that very few hospitals can afford.

I've seen our pandemic plan and we can add about 10% capacity by converting our day surgery center and an obsolete and underused inpatient building (planned for demolition - which also doesn't have any staff). So staffing will be pretty darn thin, as critical ill patients normally require about 3 nurses/RTs per to provide 7/24 coverage. We can't come up with 150 more nurse in the middle of a pandemic, and will be desperately shorthanded as staff and their families get sick.

We also don't have nearly that many spare ventilators, so if you can't breath without help you'll die unless you have a lot of really dedicated healthy relatives who will manually run a BVM for days on end.

Assuming you grab all the med students, ems students and nursing students (plus possibly largely shutting down EMS by stealing all the paramedics) in town and go to "alternate standards of care" it's perfectly possible to greatly expand the number of patients by taking over other buildings, but they lack useful things like labs, suction, oxygen, etc. But ASoC is an attempt to save the most people by reducing the chance of saving any given person.

"(i.e., triage efforts that focus on maximizing number of lives saved, triage decisions that affect allocation of available resources, need of current patients for resources that become part of the overall resource allocation, usual scope of practice standards will not apply, equipment and supplies rationed/used in ways consistent with saving most lives, inadequately trained staff and inability to use equipment without trained staff to operate them, treatment decisions based on clinical judgment without availability of diagnostic resources, delay in treatment due to patient backlogs, documentation standards impossible to maintain, lower standards of patient confidentiality, backlogs in processing fatalities)."

No country has the hospital facilities. Let's do a thought experiment. We'll presume that Vitas requires one week of trained medical treatment after which you live or die. The cases needing professional treatment are limited to potential deaths (25% of population) which is conservative. Vitas will also be unreasonably distributed, with each day of 2010 having the same number of infected, which is almost rediculously conservative.

So 25% of population over a flat 52 week distribution is 0.48% of the population in need of professional care for one week, which amounts to about 5 person in 1000 needing hospital beds all year.

But the CDC says we have less than 3 hospital beds per 1000 and that our occupancy rate is already ~67%. You would need to double total beds through triage conditions to reach 5 vitas-only beds per 1000.

So maybe you can double bunk every room in the hospital (you can't but let's pretend). What about staffing? There are ~300,000 doctors (including psychiatrists, surgeons, anesthesiologists, every MD) in the US. With ~300 millon citizens that comes out to 1.5 million hospitalized daily just from Vitas. That means if the doctors did nothing but work Vitas cases they'd each have 5 patients each day for the year.

If you think there's a big warehouse holding antivirals for everyone in the US prepare to be disappointed. Assuming VITAS even responds Tamiflu, the US has maybe 10 million doses between state and federal stockpiles. That's enough for doctors, nurses, first responders, and a select number of critical positions (e.g. nuclear power plant engineers). All in all, only 3% of the US. And a lot of that is due to Bird Flu scaring people four years ago. SR didn't get a virus scare, AFAIK, so they wouldn't necessarily have that much.

Doctors can't only treat vitas, the disease won't follow a flat trend curve and it won't spare the doctors, antivirals or not. Repeat exposure means the medical community usually suffers as much or more from epidemics.

It's probable that those who survived have a natural/genetic resistance to VITAS, so I think it might be less dangerous in 2070 that it was before.

Other than that, it's a very interesting post you wrote there.