Severance takes place in an alternate history of the United States up to the end of 2011, before and during a pandemic of the Shen Fever, a fictional fungal infection caused by Sheniodioides originating in Shenzhen, China.

In her twenties, Candace drifts through New York City, living on her inheritance from her parents following their deaths, before acquiring an unfulfilling job at a Manhattan-based publishing company called Spectra, overseeing the overseas production of elaborate design variations of the Bible.

In the early days of the pandemic in 2011, Candace discovers she is pregnant after splitting with her boyfriend, Jonathan, who is disillusioned with the city, consumerism, and capitalism, and plans to sail to Puget Sound.

Per Jonathan's parting suggestion to revive her old pursuits in photography, she documents the final days of a deserted New York City's collapsing infrastructure on a blog called NY Ghost, which outlasts major publications and news outlets.

In the present, a group of other immune survivors finds Candace near death in a New York taxi cab on the shoulder of a highway in Pennsylvania.

The survivors arrive to find that the Facility is an abandoned shopping mall in suburban Illinois, which Bob co-owns and spent much of his youth in, and begin to make a new home there.

The New York Times' review stated that Severance, "offers blatant commentary on 'dizzying abundance' and unrelenting consumption, evolving into a semi-surreal sendup of a workplace and its utopia of rules.

[11] NPR's Michael Schaub said it is, "A fierce debut from a writer with seemingly boundless imagination"[12] and "A stunning, audacious book with a fresh take on both office politics and what the apocalypse might bring.

"[13] It was included on annual Best Book lists at Elle,[14] Marie Claire,[15] Refinery29,[16] Buzzfeed,[17] BookPage,[18] Bookish,[19] Mental Floss,[20] Huffington Post,[21] A.V.