The pig lies in its own waste, pressed against the metal grating of an industrial gestation crate in Duplin County, North Carolina. It’s March 2025, and she’s running a fever. Her lungs burn with two different viral infections—H1N1, the seasonal swine flu that routinely sweeps through factory farms, and a version of highly pathogenic avian influenza H5N1, which arrived via wild birds roosting in the ventilation system. The combination is killing her and, while it does, it’s mutating. A host infected with two different diseases can allow a genetic reassortment. Inside her cells, viral RNA strands are breaking apart and reassembling, trading genetic material like cards in a deck.
Three crucial mutations emerge in this viral shuffle. First, the hemagglutinin protein on the virus’s surface acquires the mutations that allow it to bind not to the sialic acid receptors deep in bird lungs, but the ones that line human upper respiratory tracts. Second, a single change in the PB2 gene lets the virus replicate at 98.6°F, human body temperature, rather than the 106°F it preferred in the dying pig. Third, modifications to the neuraminidase protein increase the virus’s stability in aerosols, making it more contagious through casual contact.
The pig dies on a Tuesday morning. The underpaid worker who removes her carcass doesn’t bother with the N95 mask hanging unused around his neck. The company stopped providing new ones months ago, and this one is caked with dirt and sweat. He coughs twice while dragging the corpse to the rendering pile. By Friday, he has a fever. He spends the weekend in bed, trying to keep away from the kids, and tended by a partner who’s covering extra shifts at the local diner to make up for the weekend’s lost earnings. By Monday, he’s back at work. Missing three shifts means losing SNAP benefits under the new work requirements. He handles hundreds of pigs that day, breathing heavily in the enclosed barn. He sees more and more fellow workers in distress, some coughing blood. Management is keen to keep it quiet, and they’ve got the law on their side. North Carolina’s ag-gag law, the Property Protection Act (NC General Statute § 99A-2), prevents video of the factory leaking out, or investigative reporters sneaking in.
The first cluster appears in the Kenansville emergency room in early April: twenty-six workers at the same facility, all with severe respiratory symptoms. The local health department takes eight days to notify the CDC, caught in a tangle of local pork politics and an understaffed North Carolina Division of Public Health. The CDC itself is unsure whether to begin an investigation. The CDC director delays the inevitable escalation to her boss, Secretary of Health and Human Services, Robert Kennedy Jr. Meanwhile, three workers have already died, their lungs destroyed by a combination of viral pneumonia and their own immune response.
The virus spreads through the poultry operations next. Industrial chicken farms stretch across North Carolina in a patchwork of fetid metal barns, each holding thousands of birds. When the first facilities detect H5N1p—the “p” designating this new pandemic strain—they begin culling. Millions of chickens are killed in May alone. The price of eggs triples. Grocery stores impose purchase limits: two dozen per customer, then one dozen, then none at all as supply chains snap. Dollar stores, which millions of Americans rely on for basic groceries, simply leave their coolers empty.
Shoppers, traumatized by Covid, empty the rest of the shelves if they can afford to. The grocery mirrors a political divide, amplified across social media, where opinion has long smothered fact. In Seattle, customers scan QR codes to enter, showing proof of recent negative tests. In Oklahoma City, “Medical Freedom Markets” advertise their refusal to require masks or limit occupancy. Food distribution ruptures along these lines: coastal cities implement rationing systems and price controls, while rural areas see prices spike as truckers refuse to deliver to “contaminated zones.” In Memphis, riots break out when a Walmart requires masks. In Portland, riots break out when a Walmart runs out of masks. Food banks, already stretched thin by inflation and cuts to federal assistance programs, start turning people away.
By June, the virus has reached the meatpacking plants in the Midwest. In Sioux Falls, South Dakota, corporate management delays shutting down even after thirty workers test positive. The firms can’t afford to stop production. Neither can the workers afford to stay home. They work twelve-hour shifts on the processing line, standing shoulder to shoulder, breathing hard in the cold air. After a call from industry leaders Trump has, again, invoked the Defense Production Act to release meatpacking plants from liability and exempt them from closure. This time, though, there’s no national lockdown, with states empowered to choose for themselves how to tackle the crisis.
PPE shortages have forced blue states into an Interstate Medical Compact, a buyer’s club that pays the tariffs on imports of basic medical equipment. America still depends on the rest of the world for antiviral medication, masks and respirators. The rest of the world quarantined the US early, but not quickly enough. They’ve now got their own pandemics, and while the WHO is sharing information, there’s no one to receive it in D.C.
Despite leaning into stringent public health measures across Illinois, the first cases appear in Chicago’s emergency rooms in July. The city’s public hospitals, already struggling with staff shortages, quickly become overwhelmed. Private hospitals begin requiring advance payment for ICU admission—$10,000 upfront for a ventilator bed. The mortality rate hits 22% in low-income neighborhoods.
Even the dead tell the story differently. Blue cities stack bodies in refrigerated trucks, carefully documenting each case. Red states pass laws making it illegal to list H5N1p as a cause of death, coding the fatalities as pneumonia, heart failure, or a delayed reaction to the Covid vaccine.
August brings the heat dome: fifteen days above 100°F across the Midwest. Cooling centers open in Chicago’s poorest neighborhoods, becoming superspreader sites as people crowd in to escape the apartments in which air conditioning doesn’t exist, or is too expensive to run. The National Guard deploys to handle civil unrest after fights break out at water distribution points. Three people are shot by police outside a pharmacy that’s run out of Tamiflu.
The virus reaches the coasts in September, just as schools reopen. Within two weeks, Boston closes all public schools. New York keeps them open—they serve as essential food distribution points now that so many grocery stores have shut down. Los Angeles splits the difference, operating schools as meal centers but suspending classes. Wildfire season sends smoke, and vectors for disease, into the air across the west coast. Teachers call in sick by the thousands. Many never return.
By October, the hospital system effectively collapses in several states. Travel nurses, the backbone of American healthcare’s just-in-time staffing model, are commanding $10,000 a week—when they can find hospitals still able to pay. The average wait time at urban emergency rooms exceeds fifteen hours. Rural facilities close entirely. People begin dying at home in large numbers, swelling the death toll in jails and senior homes.
Vaccine development, hampered by a lack of federal coordination, moves slowly. The first human trials began woefully late. Meanwhile, social media fills with miracle cures: chlorine dioxide, colloidal silver, ivermectin. A televangelist in Dallas sells “holy water vaccines” for $200 a vial. His megachurch becomes a superspreader site after hosting a healing service attended by 4,000 people. It’s a dark Christmas.
But all of this was predictable—was predicted, in fact. The virus emerged at the intersection of factory farming, worker exploitation, climate change, underfunded public health, profit-driven healthcare and a federal anti-state state. It found every crack in the system and widened it. It turned poverty into a death sentence and desperation into a transmission vector. The pig died on a Tuesday morning, but the system that killed her was sick long before that.