The Black Death still lurks all over the world

By Dr. Liji Thomas, MDNov 17 2019

Beijing, the capital of the economic giant, China, is in the news currently for a far different reason – two patients have developed pneumonic plague. The patients, who hail from Inner Mongolia’s northwestern corner, are being treated at a high-level hospital there, amidst 21 million other people. The health authorities say they have put in place adequate protection and control measures to keep the plague from spreading.

3d representation of the Yersinia pestis bacteria better known as the bubonic plague. Image Credit: MichaelTaylor / Shutterstock

The plague

Pneumonic plague is capable of killing within 2-3 days, and is termed “the most virulent form of plague” by the World Health Organization (WHO). The symptoms of pneumonic plague include fever with chills, nausea and vomiting.

Pneumonic plague spreads like wildfire, through close contacts. Transmission is via droplets, which are carried through the air to infect persons in the vicinity, to cause huge epidemics. In this case, the contacts of the patients have been screened and are being managed appropriately.

The other forms of the illness are bubonic plague, which is also dangerous, but relatively less so, and septicemic plague. Both are caused by the bacterium Yersinia pestis, which jumps from rats to fleas and then to humans. The bacterium has been lurking in several animal populations in Asia, Africa and the American continents. The plague is popularly known as the Black Death, and is often thought to have caused the pandemic which ravaged Europe in the 14th century, killing half of the population in just six years. it spread from the Mediterranean area, where it is thought to have been first brought by shipborne rat.  Another major outbreak was in the Shakespearean period when about 25% of the people in his town died.

Today, such high mortality is unlikely, because bubonic plague responds to antibiotics with fairly good recovery rates – although plague is still a lethal illness if not treated.

Plague in China

The last high-profile case was in 2014, when a man died of the disease in Gansu, China, leading to the quarantine of 151 people who had been in contact with him. The town of Yumen, where he died, was also cordoned off as a whole, police manning the perimeter roadblocks to prevent any of the 30,000 inhabitants from leaving or anybody from outside entering the town. Since then, 5 people have died of the plague in China, until the present time – including a couple who died of bubonic plague in Mongolia.

The WHO has been notified of the disease, and its China coordinator Fabio Scano confirmed that all efforts were being made to contain and treat the cases identified, and to intensify surveillance measures. Chinese authorities are also, typically, censoring social media, to prevent panic from spreading. For instance, on Weibo, the local equivalent of Twitter, the hashtag “Beijing confirms it is treating plague cases” was removed to prevent discussions around this topic.

Weibo users wanted to know how the patients reached Beijing, while another reached back into folklore to prophesy the coming of the plague, saying, “Bird flu in the year of the rooster... swine fever in the year of the pig. Next year is the year of the rat...the plague is coming.”

Plague over the world

However, plague has not suddenly risen from the ashes. In 2015, there were 11 cases in the US, with 3 deaths, between April and August, in six different states. In fact, every year there are about 12 or so deaths from plague in the US, especially in rural settings.

In 2017, there was a much larger outbreak in Madagascar, with over 2400 cases of which over 200 died. In fact, plague epidemics strike every year in this country, and it is also endemic in the Democratic Republic of Congo and in Peru.

Plague cases have popped up in other countries too. According to WHO estimates, up to 1,500 cases are reported each year – and that doesn’t even take into account unreported cases, of which there are many. Plague is very much a current concern, in other words, and scientists stress that we need to prepare for a pandemic of respiratory disease – now!

In September 2019, scientists warned grimly that should a pandemic happen, as is quite possible, due to plague or any other quickly-spreading illness, the outcome could be devastating. They say, “There is a very real threat of a rapidly moving, highly lethal pandemic of a respiratory pathogen killing 50 to 80 million people.”