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roystgnr comments on Mini advent calendar of Xrisks: synthetic biology - Less Wrong
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Artificial plagues can be optimized to for maximum human deaths, something natural plagues aren't. Artificial plagues can contain genes spliced in from unrelated species, including the target. For example, human hormones.
If you believe the "trade-off hypothesis" then many natural plagues are optimized against human deaths - any time a pathogen mutation is virulent enough to get its host shunned or its host's tribe wiped out, that variant of the pathogen dies out too.
The "host shunned" version of that hypothesis still applies to existential risks from communicable disease. If stone age tribes can quarantine well enough to prevent contagion then so can we. But the "host's tribe wiped out" version is probably moot now. Transmitting a pathogen beyond one's immediate "tribe" is surely much easier in airports full of friendly people than it was on footpaths connecting sometimes-hostile neighbors.
It's still possible for a plague to be so virulent that it kills its host before he has a chance to spread it too widely. Ebola comes to mind.