Infectious diseases are a constant threat looming over humanity. Diseases have shaped our past and will forge our future. It is thus no surprise that diseases have been a major theme of extreme metal music for decades. Pestilence is one of the Four Horsemen, after all. My name is Carl Nick Keiser and I have been listening to heavy metal since I was 12 years old. I was in a melodic death metal band in high school called “Sixth Century Epidemic” named after the plague of the year 541 (the first recorded plague pandemic). Now, I am an assistant professor of behavioral disease ecology, so I see the parallels between infectious disease and extreme metal every day.
Given that we are currently living in a global pandemic, I wanted to reach out to the metal community to share knowledge and dispel myths regarding Coronavirus. To help, I created a Spotify playlist made up of pandemic-themed extreme metal. The songs follow the course of a disease outbreak, from patient zero to pandemic to recovery. Throughout the playlist, I will provide some information on how these songs relate to viral epidemiology. At the bottom of the article, you will find a glossary of bolded terms and references for further reading, if you’re a nerd like me.
Infected by Obituary
An easy choice for the first song. You can’t have a pandemic without the first infection. How do viruses infect human hosts? Coronaviruses use a protein, called Spike, on their outer membrane attach to and fuse with respiratory cells in their host1. Then, they use their host’s cellular machinery to replicate more viruses which can infect new cells, and eventually leave the host body to infect someone else.
Patient Zero by Hollow World
“Patient Zero” is a colloquial term for the first individual infected in an outbreak. In epidemiology, we use two terms: the index case and the primary case. The primary case is the first individual infected with the causative agent of that disease (whether it’s a virus, bacteria, or something else). The index case is the first infected person recorded by health officials. As you can imagine, these two are not always the same person, as many early infections go unrecognized2.
The Origin of Disease by Aborted
What was the origin of SARS-CoV-2? Many early cases were linked to a market in Wuhan, China, though the original animal reservoir remains unknown. Most evidence points towards a bat, but this is not definitive. One myth circulating the internet is that this virus was manufactured in a laboratory for whatever nefarious outcome. Recent genomic work has shown that this is not the case3. This virus evolved in nature.
Angel of Disease by Morbid Angel
This one is self-explanatory.
Spreading The Virus by Skeleton Pit
Our current understanding is that SARS-CoV-2 is spread by droplet transmission. That is, living viral particles leave an infected host in a liquid droplet from a cough or sneeze. These droplets don’t hang around in the air for long, like the do with other viruses (like measles – but you should already have that vaccine, right?). Instead, these droplets land on surfaces and are moved around by your hands, onto objects like handrails, doorknobs, and ATM screens (these objects are referred to as fomites in epidemiology). A recent experiment showed that the virus can survive up to 72hrs on stainless steel and potentially up to 24hrs on cardboard4. Skeleton Pit is a German thrash band that sounds more Bay Area than Teutonic. They just had a couple of shows, including one festival, cancelled due to COVID-19, so if you dig this song go buy it or some merch to help them out!
Bring Back the Plague – Cattle Decapitation
The plague (caused by the bacterium Yersinia pestis, carried by fleas, carried by rodents) is actually still around. Plague-causing bacteria is present in Prairie dogs in the western United States reliably every year. This is what we call an endemic disease. Seasonal influenza is another example. These diseases are present is predictable numbers over time. This differs from epidemic diseases, which we’ll learn about later.
Ridden with Disease by Sinister
This song is sick. Please note: The pathology described in the lyrics (peeling skin, rotting flesh) does not relate to COVID-19 at all. Infection with SARS-COV-2 occurs in the respiratory system, so there is no worry about “flesh deteriorates until the bones are bare”.
Infectious Hospital Waste by Demolition Hammer
If you know a healthcare worker, go thank them. They’re putting in countless hours, risking themselves and their loved ones, to fight this pandemic. You know what, if you know anyone who is working right now to keep our society afloat (custodial staff, food service workers, delivery drivers, etc.), THANK THEM.
Sterilized by Gatecreeper
This song is a reminder to regularly sterilize surfaces that you touch often, like your phone, your doorknob, and shopping cart handles (though you should limit shopping to once a week at most). And remember to wash your hands often and well! Gatecreeper was set to be on Decibel Tour 2020 with Mayhem, Abbath, and Idle Hands – but that has been cancelled. Go support them here, perhaps buy a 2020 tour shirt that they already had printed.
Bacterial Contamination And Overheating Of The Matter Caused By The Irreparabile Alteration Of DNA by Ophiocordyceps
What a song title… Ophiocordyceps is a slam/brutal death metal band from Italy. I added this for two reasons. One, Italy has been experiencing some horrific circumstances due to a massive COVID-19 outbreak (see description to song #17). Two, Ophiocordyceps is the genus of fungus that infects ants, manipulates their behavior, and uses them as living spore-production factories (see this video on zombie ants). This is one of the most metal parasites on the planet. I have a metalhead friend who studies the biology of this parasite, go check her lab out for more research.
Deranged Epidemic by Disgorge
I feel like everyone remembers the first time they heard Disgorge. This was the first brutal death metal band I had ever encountered and it blew my mind. Are these lyrics relevant to viral epidemics? Maybe. I can’t tell. If anyone else can, let me know. Since we’re here, what is an epidemic disease? Epidemics are a rapid increase in the prevalence of a disease in a specific region relative to historical values.
Pandemic by Plague
Now let’s talk about the term pandemic. When epidemics occur simultaneously or sequentially across a broad geographic range (i.e., in several countries or continents) then we call that a pandemic. For COVID-19, the first case was on December 31 2019, and the World Health Organization declared a global pandemic on March 12 2020. For reference, the last time the WHO announced a global pandemic was in 2001 for the H1N1 influenza virus.
Pandemic Apocalypse by Guttural Slug
Danish Death Metal with a sick name. Their new album is called Plague of Filth.
Isolation by Viral Load
Isolation is something we should all familiar with at this point. So, what is a viral load? Often referred to as viral burden or viral titer, this is a numerical representation of the amount of virus in a host. This is estimated from samples like nasopharyngeal swabs, saliva, etc. This is important, because one’s viral load can influence their viral shedding, or the rate at which viral particles leave an infected host. It was originally thought that SARS-CoV-2 viral load peaked in the first week of infection, but apparently there is a lot of variation among infected people5.
Solitary Confinement by Cholera
The social distancing that everyone is talking about right now does not mean solitary confinement! It is important that we reduce the number of our social contacts to limit the spread of the virus. But social distancing doesn’t mean social isolation! You can still go outside, go on hikes, look at weird spiders in your backyard, use Netflix Party to watch movies with friends from afar. It may take some creativity, but the outcome will be worth it.
Incubation by Cist
I added this song because of another important term in epidemiology – the incubation period. This is the time between when a host becomes exposed to a pathogen and when their first symptoms appear. Why is this important? Well, the median incubation period of COVID-19 is 5 days and most infected people will develop symptoms within 12 days. The time from exposure to the time when you can transmit the pathogen (called the latent period) may be shorter than the incubation period, meaning you could be transmitting the virus before you even know you’re infected6! That’s a big deal.
Pull the Plug by Death
An absolute classic. Why did I include it? Some Italian hospitals have been so overwhelmed by COVID-19 cases that they unable to provide everyone with adequate care. They are faced with the equivalent of wartime triage, where they only have the resources to provide care to those who are most likely to survive7. This means denying care to patients over 60 years of age in some places. This is devastating for a healthcare professional. The whole goal of #FlattenTheCurve is not to reduce the number of people that become infected, but rather to keep the number of people infected at any given point small enough to not overwhelm the hospitals. If we run out of ventilators, or oxygen tanks, or ICU beds, it won’t just be COVID-19 patients that suffer, it will be every patient in need of hospital care at that time. You do not want to get into a car accident in a city whose hospitals are already past capacity with COVID patients.S. A search on Metal Archives turns up zero results for albums or songs called Wartime Triage. Just a hint.
Havoc by Pandemic Death
Pandemic Death is a Swiss death metal band whose first album was released on February 12, 2020. On February 12, there was nearly a 600% increase in the number of confirmed cases of COVID-19 globally. This was likely a product of rapid testing and changes in diagnoses, rather than a biological phenomenon, but it was still jarring.
The Answer To Infection by Cholera
What will be the answer to this infection? Ed Yong recently wrote about three possible outcomes: (1) nations across the globe effectively eradicate the virus (very unlikely).
(2) the virus moves rapidly through populations, leaving behind enough survivors with immunity to suppress any further outbreaks. This options includes a very high death count, unfortunately.
(3) As a global population, we experience a prolonged back-and-forth of outbreaks and interventions, depending in part with the development of a vaccine. Only time will tell. What has been clear is that the federal response to this pandemic has been astoundingly disappointing. We are depending on individuals to do the right thing to protect themselves and everyone else. Stay home as much as possible, do not touch surfaces that others have likely touched, limit shopping trips to essential items, and wash your hands well and often!
That’s it for now. I hope you had fun, learned something, and maybe found some new bands along the way. In addition to this playlist, there is an expanded list with over 3 hours of extreme pandemic-themed metal content on my Spotify account, please feel free to make suggestions for songs I’ve overlooked! I hope to follow up with a Global Pandemix Part II for traditional/epic metal and more to describe new updates regarding the pandemic as well as general terms in epidemiology. Stay tuned.
Important note: Many of these bands have experienced tour cancelations due to Coronavirus, and they are taking a big financial hit. You can help support these bands by purchasing merch online!
SPREAD THE MUSIC, NOT THE VIRUS!
Nick Keiser is an assistant professor of behavioral disease ecology in the Department of Biology at the University of Florida. His lab studies how animal behavior influences infectious diseases and host-parasite dynamics in systems like spiders, ants, mites, ticks, and flies. Follow him on Twitter at @HiDrNic for more metal-laden disease content.
Infection: When a microorganism (bacteria, virus, etc.) invades and begins replicating inside the host.
Endemic: A disease that persists in populations reliably over time at predictable numbers.
Epidemic: A rapid increase in infection prevalence within a host population that exceeds historical expectations.
Pandemic: Multiple epidemics of the same disease occurring across large geographic distances.
Coronavirus: A family of viruses that infect a diversity of mammal hosts. Some coronaviruses can also cause respiratory tract infections in humans. Examples of coronaviruses include the causative agents of SARS and MERS.
SARS-CoV-2: Severe Acute Respiratory Syndrome Coronavirus 2. The name for the virus that causes Coronavirus disease in the 2019-2020 pandemic. Named after the virus that caused the SARS outbreaks of 2002-2003.
COVID-19: Corona Virus Disease 2019. The disease (i.e., set of symptoms) caused by SARS-CoV-2.
Incubation period: The time between exposure to a pathogen and the point at which symptoms arise.
Fomite: An inanimate object where pathogens can be deposited by an infected host and then picked up by a susceptible host. Common fomites include doorknobs, handrails, and keyboards.
Density-dependent transmission: Transmission of a pathogen that depend on the density of the host population. For these diseases, when hosts interact more closely together, transmission is increased.