Someone may accuse me of trying to take advantage of the current GoT hype to make this blog post popular… and they would be right. But I must point out that I’ve discussed the GoT universe twice before: once when discussing the Targaryen’s freakish complexion and eye color in my evolution of pigment post, and another time when I hypothesized that the GoT universe was in a Dyson sphere.
I found myself, like most people, screaming while watching the scene where Samwise… ahem I mean Samwell Tarly… operates on Jorah’s greyscale. But, I was screaming for a different reason, and when Sam shook Jorah’s hand I about lost my shit. I had always been confused about the epidemiology of the disease, but this episode just confused me more. How could a disease with 100% virulence, little to no cure, and that is spread through contact be so rare? How did removing the physical greyscales result in being cured? Was this disease caused by a pathogen, or more hand-wavey magic?
That pie transition was probably the best transition I’ve seen. (Sorry Star Wars scene wipes).
Okay, just a little background about greyscale. The disease has casually shown up in multiple seasons afflicting mainly Princess Shireen Baratheon and later Ser Jorah.
In Season 5, Shireen tells Gilly that she was diagnosed with greyscale as an infant, was thankfully cured, but has a disfigured face due to it. Gilly mentions she had sisters that were diagnosed with a similar affliction, but unfortunately, their greyscale covered their entire bodies until they were no longer coherent and were mercy killed/burned by Craster. Later in the season Stannis embellishes the story of Shireen’s contraction as he explains she contracted the illness from an infected doll that he bought somewhere in Dorne. Dolls: 2, humanity: 0.
Everyone told him to send her away to the Narrow Sea (it is unclear if this was to prevent an epidemic, or allow her to die among the Stone Men in Valyria), but he ignored them and recruited every healer to help his daughter. Somehow, vaguely, she was cured, but left forever disfigured.
This foreshadowing of the dangers of greyscale happens just in time for a season end Ser Jorah cliffhanger. Jorah and Tyrion are sailing through Valyria when they are attacked by stone men. Jorah fights them off and saves Tyrion, but is secretly touched, and infected, in the process.
In Season 6, Jorah’s disease is spreading, but only Daario seems to notice. Jorah goes to his queen Daenerys (a scene that had me screaming: DO NOT GO NEAR HER WHEN YOU’RE INFECTIOUS!) and tells her that he’s going to emo around and kill himself before the disease progresses and wishes to be released from his service. She refuses and commands him to find a cure… which is sweet, I guess? But mostly just douchey…
In Season 7, Samwise… ahem I mean Samwell Tarly… is wiping up poop at the Citadel when Jorah comes seeking a cure. Samwell finds instructions on how to cure Jorah in books from the restricted section… oh darn, wrong fantasy series…
Samwell decides to try the procedure on Jorah despite:
- Never performing a serious medical procedure before.
- Putting himself at serious risk of greyscale infection.
- Putting the entire Citadel, and the world, at risk of an epidemic.
- Putting his patient at risk of extreme pain, infection, and death.
- Slughorn explicitly telling him not to… darn wrong universe again.
For some reason getting the greyscale literally off his body satisfies everyone enough, including Maester Marwyn, that they LET A POTENTIALLY INFECTIOUS patient go back into the world. Sam even shakes hands with Jorah. Thank god he gives up on being a doctor after this episode.
Then Jorah goes on to reunite with Daenerys. While everyone else was probably tearing up a bit, I was screaming “Don’t touch her, don’t touch her… dear god he touched her.”
Okay, I think we’re caught up now on the plot, and hopefully, some of you are starting to understand why I’m so frustrated. But to really understand how little sense this disease makes let’s sum up what we know about it.
Let’s first discuss the etiology of this disease: where did it come from? Is it intrinsic, extrinsic and idiopathic? Intrinsic diseases occur due to a change or problem within the body, these include genetic diseases and predispositions, hormone dysregulation, cancer, and autoimmunity. Though a genetic predisposition may explain how such an easily spread disease hasn’t infected the whole world, there isn’t specific proof of this in the show/book. Extrinsic diseases occur due to an individual’s exposure to a harmful substance/organism in their environment. This is a better description of greyscale as all of the infections described can be traced back to touching an infected person or object. Idiopathic etiologies of diseases are the kind that gets sent Dr. House, when there is no clear cause of the disease. This may be an even better way to describe greyscale as there seems to be some unrealistic, nonbiological, even magical element to it that we may never get a good explanation for.
The disease’s pathology is pretty narly. Some of the best descriptions come from the books where the disease is actually talked about in depth. The disease begins pretty mildly and symptoms become more dramatically at a pretty consistent pace, for a more scientific description we will describe it in four phases. The first phase begins days after the initial infection: the extremities are the first to be affected as fingertips begin to blacken and feel numb. If a patient thinks they have been exposed they should prick their fingers and toes with a knife preferably a sterilized one) daily, if the prick hurts they have not contracted the disease. For some reason in the show they show Jorah immediately shows symptoms after being touched. The second phase of the disease is when the skin of the body begins to turn grey, stiff, and cold. This is the phase the stonemen that attack Jorah and Tyrion are most likely in. The third phase results in blindness/deafness/muteness as the disease reaches the face and turns it to stone rendering it non-functional. In the final stage, the disease starts to affect the organs and death follows shortly after. Though we haven’t seen a character experiencing the last two phases, it was described by Gilly and at the Citadel as always resulting in madness.
Virulence is a measurement of how much damage a pathogen does to a host. So in this case, um… 100% virulence if not treated. There is no reference in the show/book to anyone naturally curing themselves of the disease. Interestingly enough greyscale seems to confer complete immunity to a worst disease: the grey plague, which is a quicker and more intense form for greyscale. Perhaps the children of the seven kingdoms should be vaccinated with greyscale… imagine those anti-vaccination campaigns!
The transmission of the disease is probably the most unclear part for me. It is consistently stated that you can only get the disease from touching an individual. This seems to indicate that the pathogen cannot survive outside of the body, or that perhaps it’s not a pathogen at all. This is a pretty strange form of transmission and I can’t think of any real disease that follows this strict contact only transmission. For example, staph infections are transmitted by touching, but it’s also transmitted by using an infected person’s towel. However, Stannis mentions that Shireen was infected from a doll. This seems to indicate that the cause of the illness is some sort of organism or ‘germ’ that can be transmitted from people to objects. If this is the case it makes the pathogen way less difficult to control and once again makes me question how there aren’t more people infected, especially since those that are infected don’t know until days later after they’ve touched swords, food, THE MOTHER OF DRAGONS.
The infectivity of a disease is a measurement of how effective the pathogen is in establishing an infection. Though there isn’t any specific evidence, the infectivity seems to be pretty high as every character we’ve seen exposed has been infected. However, how we define “exposed” is very confusing (see above). If the disease can spread to objects the infected individual’s touch, then the infectivity must be very lower as a small amount of the population actually becomes infected. It is mentioned that the affliction is most common in children who live in cold climates, though this doesn’t seem to be represented in the show. This could mean that individuals with naive, or depressed, immune systems are most likely to contract the disease.
We discussed this briefly already, but it is established that treatment is very hit or miss and survival is very rare (most likely less than 1%). Some treatments recommended are: limes, scalding hot baths, praying, mustard, sacrifice, fasting, and vinegar. However, these seem to only slow the progression, not completely cure the patient. Severing the limbs afflicted, or literally removing the greyscale infected tissue is suggested, but explicitly said that it is not always effective. With our best case study (Shireen) now in ashes we have no way to know how she was cured, and how long it lasted for. Furthermore, she was largely isolated from the world, so we have no idea if she was still infectious.
If I was to assume that this disease does make medical sense, but we simply don’t have all information yet there are three hypothetical models of how the disease works.
- You can only contract it by touching an infected person. Most infectious people are killed or isolated, so this interaction only occurs rarely. This isn’t biologically common and may have a more magical origin.
- The disease can be spread airborne, through objects, and through contact, but most people with healthy, mature immune systems are immune to it.
- The disease is becoming more infectious, but due to the shunning of infected people and the relatively quick mortality, it has not caused a pandemic. Ser Jorah represents patient zero.