Rosalia Virus

Rosalia Virus-related images.
1: Imaging of Rosalia tumors.
2: Darkened "bruise".
3: Spinal tumor.
4: Gastric colony.
5: Hemorrhage caused by Rosalia.
6: Imaging of affected liver.
7: Bone tumor.

"Beginning..." -Rosalia Rossellini

The Rosalia Virus is the main disease featured in the game Trauma Team. It is a Group V RNA virus of the Filoviridae family, similar to other hemorrhagic fever-causing agents like the Marburg and Ebola viruses.

The Rosalia virus causes severe viral hemorrhagic fever, meaning that death happens extremely quickly. The virus has the side effect of affecting the mental stability of its victims if it infects the nervous system, causing auditory and visual hallucinations.

History

The virus is named after Rosalia Rossellini, the asymptomatic host of the blood in which was first found by Albert Sartre. The virus is capable of surviving in the body of its host long after death, while also multiplying and retaining its virulent nature. This is assumed to be because of its unique composition of nucleic acid, making it a new type of organism. This quality was what piqued Albert's interests, and he hoped to reengineer the virus to selectively attack only malignant cells, effectively putting an end to all disease.

However, in its original and fundamental state, it spreads ruthlessly, attacking both healthy and infected cells. In researching this possibility, Albert accidentally caused the Cumberland College Incident, after which his adopted son and lab assistant, Erhard Muller (known as CR-S01 by his prison serial no.) was left to be framed and convicted of causing the "bioterrorism attack" at Cumberland College. Albert likely did this out of desperation to escape to Mexico with Rosalia and continue researching the virus, believing the incarceration of his son to be a small price to pay if he could successfully finish his work on the virus. Another reason could be to escape with Rosalia to help stop anymore Rosalia infections, however, he was unable to harness it before becoming infected by it, causing him to lose his sanity. Realizing there was no hope to redirect the virus' malignant nature, Albert shot and killed Rosalia in the fields outside their home, believing that her death and the extermination of the host would prevent the spread of the virus.

Ironically, this did not halt the spread of the disease, but rather jumpstarted the pandemic which later followed; the virus was not transmitted by air, but instead spread through contact with mucous membranes. When Rosalia was shot, her infected blood was absorbed into the soil and Asclepias flowers around her, which served as a new host for the Rosalia Virus. Monarch butterflies feeding on the flowers became the vector of the disease, and on their migration route north along the eastern coast of the United States, showered the virus as they shed their scales.

During the course of the game, odd symptoms crop up in patients in the initial chapters, with symptoms such as severe hemorrhaging, vomiting blood, convulsions, cardiac arrest, unexplained tumor formation, and a unique, almost-claw shaped black bruise that forms over affected areas.

By Chapter Seven, the Rosalia virus turns into a deadly pandemic.

Progression of the Infection

The Rosalia Virus, being a hemorrhagic fever, is capable of killing patients in a matter of days. It has two stages in development, both a dark (undetectable) and active phase.

Rosalia Virus escapes from host cell; end of Dark Phase

The Dark Stage involves the cells fragmenting, slowly infecting its host. This stage cannot be confirmed by any means, making treatment virtually impossible. However, unexplained or abnormal tumor formations can act as an indicator for this stage, as exhibited in two of the patients in the Diagnostics section of the game. The tumor suppressant gene is inhibited at this stage, allowing these barely noticeable tumors to form. Then, the virus-infected cells replicate, forming unique, malignant tumors, generally on the outside of the organs.

Once the virus replicates itself enough, it then moves onto the active phase. The virus, which was fragmented in the Dark Stage, merge together to recreate its full form. This form attaches to organs and blood vessels, forming colonies on the body. These colonies have a distinct, smooth, gem-like texture which are black, red and purple in color. A concentration of these colonies develop into bruise-like clusters forming on the exterior and interior of organs in the later part of this stage. Once a colony reaches a certain size, the tumor bursts, metastasizing and further infecting other parts of the body. This metastasis spreads the virus uncontrollably and indiscriminately, causing it to travel all over the body. Massive bleeding begins from any orifice in the body, including the eyes. This mass infection, as well as the loss of organ control and vital signs that follow, ultimately kill the patient. It is stated that the patient will only last three days at most after the colonies' explosion, since tumor/colony excision will not eradicate the virus.

Treatment

Treatment methods vary in the stages of the viral infection, along with the methods and body areas involved. The table below shows the treatment procedures by game mode.

Type	Information
First Response	Treating the Rosalia bruise with an antiviral drug. When the Rosalia Virus is first seen, patients with the bruise will have no other wounds. These patients just need to have their vitals maintained, but they will periodically experience convulsions, which cause a sharp drop in vitals. Keep these patients alive while treating other wounded patients. Later on, with the help of CR-S01, the virus itself can be controlled and suppressed with existing antiviral drugs. Injecting the white immunoglobin reagent will cause it to change color. This will take a few moments, so during that time, you may work on the current patient's injuries or switch patients, but remember to go back to the patient before the color reagent wears off. When the color becomes apparent, use an antiviral drug of the same color to suppress the virus' activities for a while. Be sure to check on these patients frequently as patients will be convulsing from time to time. Be careful not to inject the wrong antiviral drug on the patient as it may cause convulsions and a sharp drop in vitals. You do not have to inject the color reagent if you already know the color that the reagent will produce, allowing you to save the time it takes for the reagent to take effect. Stabilizing a patient, on top of treating wounds, will usually require several injections of the antiviral drug.
Endoscopy	Preparing to spray a virus colony in the lung. The Rosalia Virus is encountered in endoscopic procedures as a virus colony, as CR-S01 states that a surgical procedure will stimulate the virus colonies and cause them to all burst at once. Touching a virus colony will cause it to burst, and form its signature bruise with various affected areas like hemorrhaging wounds, tumors and ulcers. Treating affected areas will cause the bruise to shrink, and repeated treating of the affected areas produced by the bruise will cause it to disappear. Eventually, the player will receive an antiviral drug which must be sprayed onto the colony to prevent it from bursting. The more drug is sprayed, the longer it will remain in effect. The colony can then be injected with fluids and excised like a normal tumor, without fear of having it burst. When the player is faced with a giant colony, they must inject equal amounts of fluids into each segment of the colony - injecting too much will cause a large bruise to form and vitals to plummet. If too much is injected into a colony but it has yet to burst, the drain can be used to remove some of the fluids. In the final endoscopy mission, the player receives the antiserum which can be used to treat the Rosalia bruise replacing the snare. The serum, however, will not work when other injuries are present, thus the player must first treat all ulcers and bleeding before being able to inject the antiserum. Like a normal injection, be careful not to inject too much antiserum. After the injection, the bruise will start to recede and more injuries will appear, and so the procedure must be repeated until the bruise is completely removed. Watch the vitals as they will sharply drop after each injection.
Orthopedics	Severing blood vessels supporting a Rosalia focus on the spinal cord. The Rosalia Virus is also known for creating tumors either on the bone or in the spinal cord. Any tumors on the bone surface must be chiseled off, and the chiseled tissue replaced with synthetic bone where needed. Rosalia foci are also encountered when treating spinal ependymona. After removal of the ependymona, the focus will come into view. First, the blood vessels supporting the focus must all be severed with the scalpel, before the focus can be removed safely. Some foci will constantly change shape, causing the path needed to trace with the scalpel to constantly move, while other foci will regenerate severed blood vessels if the player takes too long. Quick and precise movements are required to safely remove the foci. Finally, the Rosalia Virus can also create an altered version of the soft spinal tumor. Just like the other foci, the supporting blood vessels needs to be severed before the tumor can be extracted. Extract it cautiously to avoid tearing the membrane, but take too long and the blood vessels will regenerate and need to be severed again.
Surgery	Rosalia focus and bruise on the liver Foci created by the Rosalia Virus are also encountered once in surgical operations, on the liver. It resembles a shadowy claw grasping the organ. The focus is covered in mucus which first needs to be drained. Then it needs to be injected with the blue vasoconstrictor and the orange sodium hypochlorite in order to deactivate it. This leaves the focus ready to be excised and removed. The affliction is treated once all foci are removed. Over time, foreign objects will begin moving throughout the vessels in the liver - if they come into contact with the focus, vitals will drop and the focus extraction procedure will need to be repeated from the start for all unextracted foci. They also cause some minor vital damage if they pass through the liver completely without touching any foci. The foreign objects will need to be detected with the ultrasound first. Then, an incision can be made over them, allowing them to be drained out. Antibiotic gel will be required to seal the incision. Furthermore, the foreign objects can also begin moving in the reverse direction at regular intervals during the operation, so quick removal is required to minimise risk of collision with the foci.

Twisted Rosalia

When Naomi Kimishima is infected with the virus, it interacts with her terminal genetic disease that resulted from her earlier exposure to GUILT, mutating into the Twisted Rosalia superinfection. As such, it has been labeled as a hybrid of Rosalia and GUILT, and there is actually a track on the soundtrack that plays during the final stage of the operation if successful and hints at that with its title, "Rosalia's GUILT". Specifically, its location in the heart and its wormlike nature are reminiscent of Paraskevi, while the virus's shell on the heart and the increasing colonies atop the shell that appear during the operation are reminiscent of Pempti. In addition, destroying the shell in later portions results in the fragments of the shell to cause lacerations to the heart, similar to Savato.

However, the pervasive nature of the Rosalia Virus does have one drawback for itself and the disorder/disease it comes into contact with. Because Rosalia effectively incorporates the existing disorder - in this case, the GUILT dormant within Naomi - and makes them into one entity, removing one removes them both. When CR-S01 successfully treats the Twisted Rosalia with some advice from Derek Stiles, Naomi is fully cured.

Treatment

The outer shell of the Twisted Rosalia. The cursor here is hovering over a colony extension.

Naomi's Twisted Rosalia is a giant virus colony within the heart, and first has to be treated in the four chambers of the heart to prevent the colony from bursting. To begin treatment in each chamber, an incision needs to be made similar to the initial entry incision of the operation.

Upon zooming into each chamber, there will be a closeup of the main colony's outer shell, along with a few extensions of the colony. The outer shell can be damaged by the laser, but if a portion of the shell is destroyed while a colony extension is present, the shell will immediately regenerate. Thus the colony extension must be drained first, before being injected with the blue vasoconstrictor, then the orange deactivator. The player then needs to excise and remove the extension in order to safely destroy the outer shell.

Once the outer shell is destroyed with the laser, the main body can be injected with the purple gelator to reduce its activity. The gelator must be quickly injected into all portions of the main body, as the colonies (and the shell) will regenerate over time, nullifying your efforts at injecting the main body. As the player works around the main body, more colony extensions will need to be dealt with. Breaking pieces of the shell will create lacerations which need to be sutured, and will also leave behind shards which must be extracted.

While working on the main body, small colony cells will slowly drift towards the extensions in an attempt to extend the main colony. These can be treated using the drain. If they come into contact with the fragments of the outer shell, they will form a bruise, lowering the vitals cap slightly. The bruise will need to be treated with the pink antiviral drug.

The Twisted Rosalia's main body.

Once all other parts of the heart are treated, it is possible to treat the main body. It is suggested you stabilize the patient before proceeding. Once you make an incision in the middle of the heart, the procedure to treat the Twisted Rosalia is briefly covered. First, inject the black cardioplegic solution to stop Naomi's heart - this will cause both the current vitals and the vitals cap to begin plummeting. The protective membrane around the main body needs to be excised and removed quickly before Naomi fully succumbs due to cardiac arrest, and the finishing blow must be dealt with about two full syringes of the brown antiserum.

Trivia

• During most surgeries, Rosalia Virus resembles the shape of a claw.
• It is often wondered how some of the earlier victims (like Veronica Cage and Sandra Lieberman) infected with the Rosalia Virus know of "Rosalia". Since the virus affects one's mentality and sanity, it is possible that they know the name "Rosalia" through visual or auditory hallucinations.
• If one listens closely to the background music played during Rosalia treatment for the First Response, Surgery, Endoscopy, Diagnosis and Orthopedics fields, all 5 tracks have a recurring motif, noting the connection between the surgeries because of the same disease.
• The Rosalia Virus is likely based off the Ebola virus. Much like Rosalia, Ebola causes viral hemorrhagic fever, and spreads through contact with bodily fluids and is often hosted in animals.
  • It may also be inspired by the H1N1 virus, since both Rosalia and the H1N1 virus originated in Mexico. While the Swine Flu spread through out the whole world, the Rosalia Virus was only spread to America. Since Trauma Team was announced during the pandemic and was released after the news about the virus died down, it may be a either a coincidence or it might be paying a tribute.
  • Some symptoms of the Rosalia virus are similar to symptoms of different forms of the Black Death. The fluid in the lungs of Shelly Brooks are similar to pneumonic plague. And in septicemic plague blackening of the skin (like the Rosalia bruise) occurs.
• During the very first mission in the First Response episode, the Rosalia bruise can be spotted under the shirt of one of the patients. This is likely the cause for the mysterious convulsion that occurs during the episode. Strangely, the bruise looks different than what is seen through out the whole game.
• Even though most victims who are infected with the virus usually have only one bruise, some of them have several bruises. Samuel Trumbull has two bruises, Sandra Lieberman has six bruises and Veronica Cage may have two because of where the discoloring is on her skeletonized corpse.
• The track that plays after defeating the Twisted Rosalia core is a calmer, slower version of the song that plays during the operation Vulnerability in Trauma Center: Second Opinion.
• Since Monarch butterflies have spread all around the world, the Rosalia Virus could have spread worldwide with them. In Trauma Team, however it's only revealed to affect the United States. This suggests that the specific species of Monarch butterfly that carries the virus is Danaus plexippus, which is the only type of Monarch butterfly that makes the great North American migration, from Mexico to the U.S. and Canada, and back. The timeframe of the final chapters of the game spans only a few days, so it's possible further outbreaks could appear later, spread by lost butterflies, but the plot ends before any such event occurs.
• In the Forensics section (Chapter 4 : Behind The Lies), Alma Parker was likely infected with the Rosalia Virus, as stated in Navel's ("Little Guy") statement. The black bruise on her hand, as well as the 5 cm tumor on her brain causing her hallucinations suggest the same.
• The plane that delivered the antiserum has the callsign Leukocyte, which means the white blood cell.
• The other doctors that attempted to stabilize the incoming patients used interferon, ribavirin and other antivirals in order to halt the virus' progress.
• During the Twisted Rosalia operations at certain times when the outer shell is destroyed you can see the main body move, giving you a glimpse of what is to come in the final stage
• It should be noted that the Twisted Rosalia, when it uncurls after injecting and finishing it, looks very similar to a caterpillar. This, coupled with Maria's statement in the conference that the colony looks like a pupa, may be referencing the fact that the virus had been spread via Monarch Butterflies.
  • Additionally, the Rosalia Virus colonies seen during the final Endoscopy operations (Episodes 11 and 12 of the latter half of the game) resemble flowers. Coincidentally, they have five 'petals' that point outward, like Asclepias Tuberosa, the flower that housed the virus prior to the pandemic.