The CMD pandemic was a pandemic of Cariappa-Muren disease (CMD) caused by piscine transmissible amyloidotic encephalopathy (PTAE). It was spread through farmed tuna contaminated with PTAE between 2034 and 2040. The number of confirmed infections stands at
1,623,2451,625,370 with a current death toll of 39,72239,723. More cases continue to be appreciated because of CMD’s long incubation period.
The World Health Organisation (WHO) has determined that the feeding practices of Lassgard Bioteknik, the company that developed the contaminated tuna, were the likely origin of the PTAE epizootic that led to the CMD pandemic, though this remains a controversial matter of debate amongst a minority of researchers.
Aggravated by a disinformation campaign and China’s initial censorship of CMD, the CMD pandemic resulted in severe social and economic disruption, and is seen as directly responsible for the establishment and international rollout of G6 in 2041.
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The majority of researchers agrees that the pandemic of Cariappa-Muren disease (CMD) resulted from an epizootic of piscine transmissible amyloidotic encephalopathy (PTAE) in Lassgard tuna, which was introduced to the food chain in 2034 and went undiscovered until 2039. With Lassgard tuna accounting for roughly 80% of worldwide tuna consumption by 2039, it is considered to be the primary infection vector of the CMD pandemic.
The increased use of implantable multielectrode arrays (MEAs) is also seen as a contributing factor to the CMD pandemic, as PTAE prions are resistant to conventional chemical and physical decontamination methods, and can be transmitted through reusable neurosurgical equipment.
The first victims of the PTAE-infected tuna were domestic cats who became symptomatic much quicker due to their lower body mass and brain weight.  In November 2038, Sunil Cariappa linked the cat mortalities to diets that included Lassgard tuna, which he suspected of being infected with a novel prion agent.
Cariappa reached out to Connie Muren, who had co-authored an article on the medical case of Deng Yixing, a patient of atypical variant Creutzfeldt-Jakob disease (vCJD) in Hangzhou, China. Since Deng’s young age fell outside established incubation periods and no vCJD-specific treatments had any effect, Muren had proposed that a new sporadic prion mutation was the cause.  Cariappa suggested to Muren that Deng had contracted the same prion agent responsible for the outbreak in cats. Deng, who died on November 29th 2038, has posthumously become known as the index case of the CMD pandemic.
In December 2038, Muren’s team analysed brain samples of preprocessed Lassgard tuna sold in East Asia, Europe, Africa, and the United States (US), finding that a significant proportion of the samples displayed characteristics of amyloidosis. They described this amyloidosis as PTAE, though there was some uncertainty regarding its origin. At the time, the most likely candidate was considered to be an inherited prion mutation attributed to Lassgard Bioteknik’s practice of genetically modifying its fish stock.
The team reported its discovery to the Global Foodborne Infections Network (GFN) in January 2039, but with only a single suspected case in humans at that point, no immediate health hazard to the population was considered. The only concession was a notice issued in the monthly Bulletin of the World Health Organisation (WHO) to advise against feeding tuna to pets.
Muren believed that the WHO was underestimating the long-term implications of PTAE’s discovery and publicly critiqued the organisation’s inaction, which prompted GFN officials to convene an Outbreak Control Team (OCT) in February 2039. Muren decided to focus the OCT’s efforts on determining PTAE’s transmission potential to humans while Cariappa developed several epidemiological models.
Passage of infected brain material collected from Lassgard tuna to transgenic mice revealed that they could develop a clinical disease consistent with the pathology described in Deng’s case. By the time this test was completed in July 2039, more suspected human cases had been detected, all showing similar symptoms and dietary habits. When the OCT reported its additional findings to the WHO, the decision was made to formally declare a Public Health Emergency of International Concern (PHEIC) on July 20th 2039 and allocate more resources to the OCT. 
The WHO faced initial difficulties in convincing authorities that the discovery of CMD represented a public health threat. This has been attributed to the perceived lack of immediacy when compared to other foodborne disease outbreaks, in that significant fatality rates would only gradually become apparent in the coming decades. In addition, the WHO was met with pressure from Lassgard Bioteknik, which refused to reveal any details about its closely guarded production process, and the Aquaculture Advisory Council (AAC), which lobbied heavily against any efforts to halt the sale of Lassgard tuna pending the investigation.
These hurdles continued until October 2039, when a leak of internal Lassgard Bioteknik correspondence reflected that William Lassgard had been aware as early as March 2037 that the company’s tuna stock was exhibiting erratic behaviour due to the PTAE epizootic. The leak and the resulting scandal turned public opinion against Lassgard Bioteknik and allowed the WHO to successfully ban the sale of Lassgard tuna.
The WHO elected to classify the outbreak of CMD as a pandemic despite its low contagion level, arguing that CMD had managed to spread to multiple continents in the years it went undiscovered. In coordination with the Global Outbreak Alert and Response Network (GOARN), the WHO issued a global alert on October 25th 2039.
When the WHO declared a PHEIC in July 2039, the Chinese Communist Party (CCP) began to censor all CMD-related news in China, blocking access to foreign data and declining any cooperation with the WHO.  As CMD became more prominent in international media and Lassgard Bioteknik intensified its disinformation campaign, Chinese citizens gradually became aware of distorted facts about CMD, leading to rumours that “an exceedingly dangerous pathogen” had been spreading unchecked for years. The lack of immediate fatalities due to CMD’s long incubation period created the impression that the CCP was covering up thousands of deaths, and that China was “walled off from a world that had descended into chaos.” 
On January 25th 2040, then-CCP General Secretary Xi Jinping warned that China was facing “a grave situation” and held a Politburo meeting to discuss a response to the CMD pandemic.  In February 2040, the CCP opened talks with the WHO for the adoption of its contact tracing strategy, and for its investigators to assess the CMD pandemic in mainland China.
The subsequent negotiations were fraught, with the CCP refusing to deploy the medical colloids supplied by Zhupao in favour of Huawei‘s design for implantable medical devices (IMDs). In lieu of an investigative team, the CCP asked for then-WHO Director-General Yang Jinglei and Muren to visit China, with Cariappa taking Muren’s place following her disappearance on March 4th 2040.
Following accusations that the CCP was misrepresenting the purpose of Cariappa’s presence in China, Xu Shaoyong invited him and Li Qiao Fan to Zhupao’s headquarters in Shanghai in April 2040, and accused the CCP of using the CMD pandemic as an excuse to “turn temporary health measures into permanent fixtures of the surveillance state.” 
On April 12th 2040, the CCP authorised the National Health Commission (NHC) to cooperate fully with Cariappa and the WHO. After the OCT issued its official report to the NHC, Yang declared the CMD pandemic contained on April 19th 2040.
Accounting for 90% of all tuna consumption by 2039, China and Japan were identified as the epicentres of the CMD pandemic, though Sweden is considered to be the location of its origin. After the global alert was issued in October 2039, the WHO coordinated with Zhupao and local, regional, and national health agencies to distribute information packets and medical colloids with CMD-specific sensors to physicians and hospitals, with all positive diagnoses logged by GOARN.
Based on product tracking data of Lassgard tuna and CMD-specific susceptibility rates, the WHO estimates that approximately three million people were infected with CMD during the five years Lassgard tuna was sold for human consumption. A more defined estimate was complicated by lingering issues with enforcing the ban of Lassgard tuna. Not all vendors with surplus stock immediately complied with the ban, leading to contaminated tuna still being sold until full compensation was offered in late 2040. Lassgard tuna was also available on the illicit market until 2041.
Continued G6 monitoring has tallied the number of confirmed CMD infections up to a current total of
1,623,2451,625,370. The yearly incidence rate has steadily tapered off since 2047, but extrapolated epidemiological models from the bovine spongiform encephalopathy (BSE) epidemics indicate that a second wave of CMD cases in individuals with a specific genotype is likely to be observed in the coming decades.
The origin and evolution of the CMD pandemic remain a source of controversy and debate. In his influential appendix to the WHO report on CMD, Cariappa argued that its spread constitutes a “reversal” of how pandemics disproportionately affect the most vulnerable in society. The OCT’s epidemiological models have demonstrated that CMD mainly infected billionaires and other wealthy individuals who had otherwise been in a position to ignore or escape the societal effects of pandemics. As a result, they initially dismissed warnings about CMD as alarmism or a hoax, which was amplified by Lassgard Bioteknik’s disinformation campaign and China’s censorship. 
After the WNW reporting that conclusively linked Lassgard tuna to CMD in October 2039, the wealthy began to experience an excessive level of worry about the disease and its spread in their circles, leading to a backlash against the WHO for not taking CMD seriously. Others considered CMD part of an orchestrated plot against them, providing fuel for conspiracy theories that painted CMD as a deliberately engineered disease.
Sofia Peña has characterised this class solidarity as the “epicentre” of CMD phobia, which led to a “trickle-down panic” that saw mainstream media promoting footage of biohazard labs and people in full protective equipment, making CMD seem more infectious than it really is. 
Pandemics are commonly caused by airborne pathogens, which has engendered a standardised response that includes physical distancing and national lockdowns. The news that CMD was able to spread unchecked for five years created the impression that these measures were inadequate, which made people more accepting of colloid implants to allay fears that they were infected. Peña has argued that this contributed to the rise of a social stigma against people who are not subscribed to G6, which has become synonymous with its ability to track individual CMD infections.
The political discourse around the adoption of G6 was generally framed along the lines of practical issues related to public health and biorisk. Peña’s analysis of mass media sources and political campaigns during the 2041 referendums indicated that these issues, while not immaterial, played a secondary role to the overriding concerns stemming from CMD phobia. Referendum appeals that directly referenced the use of colloids to continuously monitor individual CMD infections were more successful in leveraging votes in favour of installing G6.
- Abdellatif, G. (December 2039). “Captain Thunderpaw, patient zero of the CMD pandemic.” Toronto Star. ↩
- Muren, C; Kobl-Thissen, G; Matthes, B et al. (November 2038). “A Novel Type 5 Sporadic Prion Mutation in Humans.” News Medical. ↩
- Cariappa, S; Muren, C. (July 2039). “Acquired Prionopathic Neurodegeneration Syndrome (APNS): Pathology, Transmission, and Epidemiology.” Bulletin of the World Health Organisation. ↩
- Daems, A. (December 2039). “Cariappa: China is a ‘black hole’ in global CMD data.” World News Wire. ↩
- Peng, H. (February 2040). “Awareness of Cariappa-Muren disease in China: slowly, then all at once.” South China Morning Post. ↩
- Huang, K. (January 2040). “Chinese New Year celebrations cancelled as foodborne illness spreads. “ Xinhua. ↩
- Lee-Cohen, B. (April 2040). “Xu Shaoyong offers Sunil Cariappa and Li Qiao Fan ‘asylum’ at Zhupao headquarters.” Bloomberg. ↩
- Cariappa, S. (April 2040). “Situation report: CMD pandemic transition plan and mitigation strategy.” World Health Organisation. ↩
- Desai, H; Ariyawansa, P; Hazelden, A. (April 2041). “Elite Panic.” World News Wire. ↩