Today’s GTW Mailbag question comes from Lydia:

“I’m writing a trilogy that a disease/plague plays a major role in the story. Do you have any advice on how to make a disease/plague that sounds realistic enough to be in a dystopian novel?”

I do have some advice about this. In my dystopian trilogy The Safe Lands, the people inside the walled city all have what I called the Thin Plague. In book one, Captives, my outsider characters are taken into the city because they are uninfected and the city government is trying to find a way to safe their people. More recently I released Thirst, the first book in a duology that is a current-day prequel to The Safe Lands trilogy and tells the story of the pandemic that set off the future dystopia.

What is the disease?
Is is a virus, a bacteria, a parasite, or a fungus? Research each, then choose the one that best fits the needs of your story.

You also should know how far-reaching your disease is and how fast it moves. An epidemic is a disease that affects a large number of people within a community or region. An outbreak is when the number of endemic infections increases faster or to more people than anticipated. Outbreaks that are not quickly controlled can become epidemics. And a pandemic is an epidemic that has spread to multiple countries. And endemic affects only a particular people or place.

One of the scariest diseases I’ve read in a novel was the one in the beginning of Stephen King’s The Stand, in which 99% of the world’s population dies from a government engineered version of the flu that was created as a weapon.

Look to diseases on earth for inspiration. Study what they do to the human body, and think about how you might scale that into something larger or create a mutated version.

Make the symptoms consistent and logical. If it’s a respiratory disease, the afflicted likely aren’t getting sick to their stomachs. Do enough biological research so that your disease cause symptoms that make sense.

What does the disease look like?
What are the symptoms? Plan out a timeline for how the symptoms manifest and how long the disease takes. It usually a mistake to kill off people too quickly, so keep that in mind.

Is your disease deadly? Does it change a person in some way forever like solanum turned people to zombies in World War Z?

How is the disease transmitted?
Most infectious diseases are airborne, spread through contact from one person to another by bodily fluids like a sneeze or saliva droplets when talking. Airborne diseases can be transmitted in several ways: indirect contact, direct contact, or droplet contact. Foodborne diseases come from eating contaminated food. Waterborne diseases are transmitted in water through drinking, bathing, or eating foods that were exposed to contaminated water. Bloodborne diseases are transmitted through blood, amniotic fluid, semen, or contact with any potentially infections bodily fluid. Vectorborne diseases come from animals like mosquitoes, flies, fleas, ticks, rats, and dogs.

Or maybe your disease is spread in a fantastical way, like in The Andromeda Strain by Michael Crichton, which tells the story of an epidemic caused by an extraterrestrial microorganism—one that’s constantly evolving and has no precedent in human history.

Diseases can also mutate. You could create a disease that mutated from something on earth to something you make up. You can also have your fictional disease mutate from one strain to another. In my book Hunger, book two of the Thirst Duology, the waterborne HydroFlu mutates in a person infected with HIV, creating a new bloodborne strain that is the Thin Plague of the future dystopia.

Write a short description of your disease.
How does it work? what does it do? Write it all down, then find a doctor, a nurse, or a biologist to read it and give you feedback. You usually can find someone in every writers group who is either works in a medical field or who can connect you with someone who does. This kind of research is a must for writing a disease. You need to talk to someone who knows more than you do.

Who is at risk?
Can this disease affect everyone or only certain people? If the latter, who is susceptible and why? Sometimes a virus can be latent (resting), existing in the body long before it becomes active and causes any symptoms. Sometimes people who carry a latent infection are contagious. Sometimes they’re not.

Does your disease affect only humans or other living creatures too? In Daniel Ehrenhaft’s The Last Dog on Earth, a disease has turned all dogs into predators, except Jack, Logan’s dog. So, Logan and Jack go on the run, trying to find a safe place for Jack to hide from those who want to kill all dogs.

Is anyone immune?
Are there characters in your story who can’t catch this disease? In The Stand, those who survive to be the main characters in the book were immune to the flu and no one ever discovers why. In my Safe Lands trilogy, my outsiders were infected because they were from a different place and had never been exposed to the Thin Plague.

How might doctors and scientists try to help and cure this disease?
Again, look to other diseases and do your research. If your disease is similar to the chicken pox, find out what doctors do for the chicken pox. Even if there is no cure, those in the medical field are going to have procedures in place both to quarantine infected individuals and make those who are dying as comfortable as possible.

Where did the disease come from?
This is one that you don’t need to know to write a good story. However, pondering the answer to this question might lead you to some interesting story ideas. Was this disease accidental? Or was it engineered by scientists working for the government? You decide.

It doesn’t always have to be a sickness, either. In Delerium, by Lauren Oliver, love has been declared a dangerous disease. The government forces everyone who reaches eighteen to have a procedure called the Cure to keep them from accidentally succumbing to the horrible fate of love.

Is there a cure?
Does your disease have a cure? If not, is the search for a cure part of your story? If you’re planing to cure the disease, you’re going to need to do a bit more research so that the solution your characters discover is realistic.

How is the disease treated in society?
Are people afraid of getting the disease? Are the infected quarantined? Or are they treated like lepers were in ancient times? Think through the logistics and the reality of human behavior, keeping in mind that not all people will behave the same way. Your story might have someone who cares more about helping people than they do about protecting themselves from infection.

Don’t get too caught up in the science.
Just because you did a lot of research, doesn’t mean you put it all in the story. The research was for you to make sure you created a believable disease. Don’t try and put all your medical and biological information into the book because it will bog down the plot. Besides, more often than not, specifics will get you in trouble with readers who know more about such topics than you. Even if you’re writing science fiction, you don’t have to include all the technical information you find.

Know the story you’re trying to tell.
It’s important that you know what story you are writing. Just because there is a disease in a dystopian story, it doesn’t mean that disease has to be the central plot. It could be more of a subplot or the catalyst that sets the characters in motion. While my Safe Lands trilogy is a dystopian story that is very much about a plague and its impact on an entire population, its prequel Thirst is post apocalyptic. I didn’t include very much information about the hydroflu in Thirst since that story was more about what the survivors did to get themselves to safety than it was about the disease itself.

Read other books to learn.
Read other books in your genre, other books about plagues and pandemics, and nonfiction books too. Another option is to read historical fiction about real plagues, like Fever 1793 by Laurie Halse Anderson which tells the story of the 1793 yellow fever plague in Philadelphia. From books like these you can learn how other authors handled the tough topic of infectious diseases. 

How about you? What books have you read that had a sickness or disease, whether dystopian, historical fiction, or other. What did you like about them? What worked? What didn’t work? Share in the comments.

Jill Williamson is a chocolate loving, daydreaming, creator of kingdoms, and the author of several young adult fantasy novels including the Blood of Kings trilogy. She loves teaching about writing. She blogs at goteenwriters.com and also posts writing videos on her YouTube channel and on Instagram. Jill is a Whovian, a Photoshop addict, and a recovering fashion design assistant. She grew up in Alaska without running water or electricity and now lives in the Pacific Northwest with her husband and two kids. Find Jill online at jillwilliamson.com or on Instagram, YouTube, Facebook, Pinterest, and Twitter.