In 2020, news of a bubonic plague outbreak (while fitting) is stirring up new dread.
“Welp, here’s to July… bubonic plague,” said one Twitter user, as the hashtag started trending Monday.
The bubonic plague is not making a comeback, nor is any panic necessary, said Craig Janes, director of the School of Public Health and Health Systems at the University of Waterloo.
“This is kind of normal,” he told Global News. “It’s not really an issue. It’s expected, and we can treat it.”
Chinese authorities reported a suspected bubonic plague case in the Inner Mongolia Autonomous Region on Sunday.
China has largely eradicated plague, but occasional cases are still reported. The World Health Organization (WHO) says the outbreak in the city of Bayan Nur is “well managed” and not considered high-risk.
For other parts of the world, the risk is far lower, experts say, if not non-existent.
Here’s what you need to know.
What is the plague?
The plague is a disease caused by the bacteria Yersinia pestis.
The bacteria is transmitted through flea bites and infected animals, usually small mammals like rodents. A human can become infected by the bite of an infected flea, through direct contact with an infected animal or by inhaling infected respiratory droplets.
The disease comes in three forms: pneumonic, which affects the lungs; bubonic, which affects the lymph nodes; and septicemic, which affects the blood.
The bubonic plague is the most common form, according to the WHO. Patients typically develop fever, headache, chills, weakness and one or more swollen and painful lymph nodes, called buboes, which tend to be a hallmark sign of the disease.
In China and parts of the Asian steppes, marmots are often a culprit for infections, said Janes.
“The meat is considered to be a delicacy,” he said. “So skinning the animals and coming into contact with infected tissues is how the disease is often contracted. It’s fairly common in that part of the world.”
In May 2019, a Mongolian couple died from the bubonic plague after they reportedly ate raw kidney from a marmot as part of a local folk remedy thought to promote good health. It led to a six-day quarantine in that region. Months earlier, 28 people in China’s Inner Mongolia were under quarantine after a hunter caught the plague after eating a wild rabbit.
However, it’s not unique to Asia. “It’s been around for a long, long time,” Janes said.
In the United States, states like New Mexico, Arizona and Colorado have seen cases. More than 80 per cent of plague cases in the U.S. have been bubonic form, according to the Centers for Disease Control and Prevention (CDC).
An average of seven human cases has been reported each year in the U.S.
In Canada, it is extremely rare. There have been no known cases of human plague since 1939, though the Public Health Agency of Canada continues to monitor for it.
“It’s not transmissible human-to-human. It’s transmitted by the bite of a flea,” said Dr. Timothy Sly, an epidemiologist and professor emeritus at Ryerson University’s School of Public Health.
“We don’t tend to live in that kind of squalor and filth that encourages living alongside hordes of rodents who are carrying hordes of fleas. … Even if an infected rat containing the fleas entered a city, we can treat it.”
“Easily treatable,” Janes emphasized.
“Fairly common and inexpensive antibiotics” treat bubonic plague patients effectively, he said.
Pneumonic plague is far more fatal than bubonic. This type can spread rapidly and can be deadly within 18 to 24 hours of disease infection if left untreated — which is why the WHO says early diagnosis and treatment are “essential.”
But it hasn’t always been this way.
The bubonic plague was responsible for one of the deadliest epidemics in human history, known as the Black Death. It killed about 50 million people across Africa, Asia and Europe in the 14th century.
Large outbreaks have occurred since, including the Great Plague of 1665 in London, and outbreaks during the 16th century in India and China.
In the pre-antibiotic era (between 1900 and 1941), the death rate among those infected with plague in the United States was 66 per cent, the CDC said.
Nowadays, with the emergence of antibiotics, it’s “very treatable,” Janes said.
The most recent statistics from the WHO show that between 2010 and 2015 there were 3,248 cases reported worldwide. Of those, 584 people died.
The Democratic Republic of Congo, Madagascar and Peru are currently the three most endemic countries.
Since Canada doesn’t have a “resident population” of the disease in its rodents, it would have to be brought into the country, Sly said. Even then, “there are all kinds of precautions in place,” he said, “this is exactly why we haven’t seen a plague appearing.”
What’s the difference now?
Nothing really, experts agree.
“It’s deeply integrated into ecology. It’s nothing new,” Janes said. “You’re going to see these outbreaks whenever humans handle or come into contact with these infected animals.”
Both Janes and Sly believe the arrival of COVID-19 is driving increased interest. Since the novel coronavirus first took hold in Canada and much of the world back in March, it’s dominated headlines and the psyches of millions of people.
COVID-19 is a respiratory virus, not a bacterial disease like the plague.
“Right now, people are really sensitized to infectious diseases. We’re alert, we’re scared. We’re paying a whole lot of attention to this stuff,” he said.
The connection to China also plays a role, he added.
“If this report was coming out of, I don’t know, Uzbekistan, I doubt it would carry the same sort of significance or associated fears as something out of China.”
China was once considered the outbreak’s epicenter. It’s where the virus is believed to have originated before spreading around the world, bringing xenophobia and racism towards Chinese people along with it.
A similar situation developed during the SARS outbreak in 2003, said Sly.
“We’ve got this sort of strange, racial backlash akin to southeast Asia against diseases at the moment that’s totally inappropriate,” he said. “We have an identifiable group that is visibly different. Fingers start pointing. It’s just sort of ignorance.”
Ultimately, the plague and COVID-19 can’t and shouldn’t be compared, Sly said.
“The plague well under control. COVID is now in more than 188 different countries. It’s not the kind of thing that can spread like COVID-19, anyway,” he said.
“If you have bubonic plague, I’ll go to lunch with you and we’ll talk and shake hands and hug. You can’t transmit it.”
— with files from the Associated Press and Reuters