“The Real Reason to Panic About China's Plague Outbreak - Foreign Policy” plus 3 more

The Real Reason to Panic About China's Plague Outbreak - Foreign Policy
The First Time the Plague Broke Out in the US, Officials Tried to Deny It - History
The plague: In China, 2 patients are diagnosed with pneumonic plague - Vox.com
Pneumonic Plague Is Diagnosed in China - The New York Times

The Real Reason to Panic About China's Plague Outbreak - Foreign Policy

Posted: 15 Nov 2019 10:44 PM PST

The Chinese government's response to this month's outbreak of plague has been marked by temerity and some fear, which history suggests is entirely appropriate. But not all fear is the same, and Beijing seems to be afraid of the wrong things. Rather than being concerned about the germs and their spread, the government seems mostly motivated by a desire to manage public reaction about the disease. Those efforts, however, have failed—and the public's response is now veering toward a sort of plague-inspired panic that's not at all justified by the facts.

On Nov. 3, Li Jifeng, a doctor at Beijing Chaoyang Hospital, the capital's key infectious diseases treatment and quarantine center, attended to a middle-aged man who was struggling to breathe and his wife, who was also running a high fever and likewise gasping for air. The couple had been ailing for at least 10 days by the time Li saw them. They had initially sought care some 250 miles north of China's capital in Inner Mongolia, a frigid cold region that straddles the borders of China, Mongolia, and North Korea, before being sent to Beijing for observation.

So far, so good, for China's response. More ominous, however, was what happened next. Li's WeChat social media posting describing the couple was quickly deleted. Meanwhile, the government officially informed the World Health Organization (WHO) about the cases, as it was required to do, but only on Nov. 13—after they were already reported by journalists around the world.

If the goal was to avoid stirring panic at home, the effect may have been the opposite. In the absence of clarifying, calming information from their government, Chinese people have been venting fear and concern on Weibo and other social media platforms. Their fear may be fueled by the role played by Chaoyang Hospital, which Beijing residents remember well from the 2003 SARS epidemic, when the authorities hid victims of that epidemic in the hospital, denying for weeks that the virus had even reached Beijing.

Amid the growing panic about the plague, the irony is that it far outstrips the real risks. Despite its devastating impact on human history, Yersinia pestis need not inspire fear or death in 2019. That it still causes the latter in the age of antibiotics is proof of public health and political failures, not to the inherent virulence of the microbe. That it causes the former is mostly due to misunderstandings about the relevant history.

There have been three great plague pandemics in human history caused by the bacterium Y. pestis, spreading from Siberia and Mongolia, across Asia, and into Europe, the Middle East, and Africa. The first began in A.D. 541 within the Roman Empire, lasted two centuries, and was dubbed the Justinianic Plague. The second, the Black Death, spread from Asia into Italy in 1346 and persisted for 400 years, infecting most of the European population with such devastating outcome—50 million people died on a continent then inhabited by 80 million—that for centuries historians referred to it as the Great Mortality. The third pandemic began in the 1850s in China, spreading across Asia with such ferocity that India, alone, lost 20 million people.

Since the invention of antibiotics, the threat of a fourth pneumonic plague pandemic has dissipated, but the microbe continues to evoke profound public fear. For example, in 1994 I was in the Gujarat epicenter of a pneumonic plague epidemic in India, where the actual numbers of laboratory-confirmed infections were relatively small. But panic sparked a national hysteria in which every cough and fever seen from the Himalayas to the beaches of Goa were diagnosed as plague, filling hospital beds nationwide, causing a run on antibiotics, and spawning dark conspiracy theories about Pakistani, American, and Russian bioterrorism.

From 2010 to 2015, there were 3,248 plague cases reported worldwide, with 584 deaths. Those numbers jumped with the Madagascar outbreaks in 2017 and 2018. Tragically, modern plague epidemics too often go unrecognized, and individuals are left untreated until Y. pestis has so devastated the human body that antibiotics cannot reverse the damage to the lungs, kidneys, and cardiovascular system. Then, according to WHO, fatality rates are between 30 and 100 percent, with blood (septicemia) and pneumonic cases having the highest death rates. Which of the three forms of plague an individual will experience—bubonic, pneumonic, or septicemic—is usually determined by how the person was initially infected. The milder bubonic form is usually the result of bites from Y. pestis-carrying fleas. More dangerous pneumonic plague is inhaled, typically from the coughs of another infected person, and swiftly spreads inside the lungs to cause life-threatening pneumonia. And the very rare septicemic form, which is almost always fatal when untreated, occurs when plague bacteria enter the bloodstream, sometimes through an opening in the skin, rapidly spreading throughout the body.

Since 1990, the African island nation of Madagascar has suffered bubonic and pneumonic plague outbreaks every year, occurring seasonally between late August and March, with an annual average of 200 cases, about a quarter of which prove fatal. In 2017, the so-called "black year," Madagascar recorded more than 2,400 cases, with 200 deaths, despite the bacteria's vulnerability to antibiotics. The seasonality of the disease in Madagascar is likely linked to surges in the island's rat population during heavy rains. Some scientists think that plague's life cycle in rodents and fleas will be affected by climate change, leading to increased outbreaks amid global warming, but the picture is complex and heavily debated.

The bacteria are endemic across much of Mongolia and the former Soviet countries in central Asia. As part of Mao Zedong's Great Leap Forward, more than 1.5 billion rats were killed in huge peasant campaigns in hopes of eradicating plague. During the mid-20th century, the Soviets conducted hundreds of programs, employing tens of thousands of people in hopes of eliminating the rodents and fleas that carry Y. pestis—all without lasting success.

In late April, a Mongolian couple contracted plague near Ulgii, not far from the Russian border, after eating the raw meat of an infected marmot—a squirrel-like animal that burrows in the steppes. A quarantine was put in place after the couple's deaths, when lab results confirmed the couple had the plague, and nearly 150 people were isolated or quarantined, including airplane passengers arriving from the region in Ulaanbaatar, the country's capital. The couple, according to local health authorities, died of multiple organ failure caused by septicemic plague.

Russia for decades has claimed invention of a successful plague vaccine, but it has never been available to the rest of the world, and its efficacy is dubious, according to Paul Mead, the chief of the Bacterial Diseases Branch of the U.S. Centers for Disease Control and Prevention (CDC) in Fort Collins, Colorado. Several antibiotics are very effective in lieu of a vaccine, taken to prevent infection—chiefly, doxycycline and fluoroquinolones. The drugs very successfully treat infection if they are administered within the first hours after infection. It is also easy to prevent person-to-person transmission of Y. pestis with hand-washing and use of basic face masks. But without these inexpensive measures in place—low-cost prophylactic antibiotics, hand hygiene, and masking—the bacteria can be very contagious with proximity to a coughing victim of pneumonic plague.

Lowering the risks, however, requires transparency on the part of public health authorities. China's National Health Commission has assured WHO, according to an agency spokesperson, that a robust effort is underway to find and monitor all individuals who have been in contact with the Beijing couple, both in Inner Mongolia and during their travel to Beijing. The Chinese Center for Disease Control and Prevention, modeled closely after the U.S. CDC, has indeed proved skilled in disease surveillance. But given the Chinese government's public health history—covering up the 2003 SARS epidemic even as it traveled to 30 other nations, denying the spread of the dangerous H5N1 influenza in the country for years, and stifling social media accounts of outbreaks—a fair amount of caution and skepticism is merited.

The First Time the Plague Broke Out in the US, Officials Tried to Deny It - History

Posted: 15 Nov 2019 11:47 AM PST

In 1900, newspapers and politicians claimed the doctor trying to stop the plague had made the whole thing up.

At the turn of the 20th century, the world was gripped by a plague pandemic that had spread from China to port cities around the globe. So when a 41-year-old San Franciscan named Wong Chut King died of a particularly violent disease in March 1900, there were worries that the pandemic had finally reached U.S. soil.

After examining samples from King's autopsy, the head of the city's Marine Hospital Service confirmed those fears: the plague had come to America. And unfortunately, it never left.

King's death marked the beginning of the United States' first plague epidemic, which infected at least 280 people and killed at least 172 over the next eight years (the actual numbers of cases and deaths may be higher). The disease was likely introduced by rat–infested steamships arriving at California's shores from affected areas, mostly from Asia. But instead of alerting the public, city and state officials—including the governor of California—denied there was any plague outbreak at all.

The Plague Presented a Threat to California's Economy

Group portrait of health workers with brooms, sprinkling cans, axes, hoses, rakes, shovels and other equipment used to destroy rat habitation areas, standing in front of the storeroom (on left) and U.S. Public Health Marine Hospital Service District Headquarters during the San Francisco plague campaign.

The National Library of Medicine

The reason for this cover-up was partly economic. There was a fear in San Francisco and the state capital of Sacramento that if news of the plague spread, it would hurt California's economy, says Marilyn Chase, a lecturer at the UC Berkeley Graduate School of Journalism and author of The Barbary Plague: The Black Death in Victorian San Francisco.

"There was a very real threat that California's $40 million fresh produce industry…would be lost," she says. With that in mind, "the state actually appealed to and secured the collaboration of the surgeon general of the United States" to keep word of the disease silent.

Official silence about the disease also entailed undermining Dr. Joseph J. Kinyoun, the head of the Marine Hospital Service in San Francisco who had identified the plague bacteria in King's body. As a public health official, he was determined to stop the disease from spreading. At the same time, local politicians, business owners and newspapers were determined to discredit him, says David K. Randall, a reporter for Reuters and author of Black Death at the Golden Gate: The Race to Save America from the Bubonic Plague.

"You had the local newspapers calling [Kinyoun] a fake, calling him suspicious, implying that he was just trying to take money from the public coffers and this was all a big scam," he says. These newspapers even suggested "he was injecting dead bodies with plague so that he looked like a hero." Business leaders and politicians echoed this rhetoric. "A state senator in Sacramento stood on the senate floor and said that Kinyoun should be hanged for what he was doing," he says.

New Field of Medical Science Met With Skepticism

Dr. Joseph Kinyoun — Dr. Joseph J. Kinyoun.

National Institutes of Health History Office/Flickr Creative Commons

This large-scale denial of the plague was also, in part, a rejection of a new type of science that few understood. Kinyoun, who is now known as the father of the National Institutes of Health, was at the forefront of the field of medical bacteriology. Unlike doctors from an earlier era, Kinyoun used a microscope to study microorganisms his patients couldn't see. California Governor Henry Gage was particularly averse to this new science.

"[Gage] basically said: If you can't see the disease, if you can't see what's happening, then how do I know it exists?" Randall says. And like many others in California, Gage wasn't even sure white people could get the plague in the first place. "The idea was that if your ancestors had survived the plague in Europe, then you somehow evolved immunity," he says.

Contrary to this misguided belief, the plague did infect white San Franciscans; but in the beginning, it hit residents of Chinatown the hardest. Many white residents initially remained unconcerned since they attributed the outbreak to the racist perception that Chinese immigrants were disease-ridden and dirty. Residents of Chinatown, in turn, sometimes hid the bodies of plague victims to prevent further discrimination against their community.

"People [in Chinatown] were desperate to keep it confidential, and there were very good reasons for this," Chase says. After the first confirmed plague death, "there was a blockade against Chinatown, at which time people could not go to work, they could not get goods in or out. The people were hungry." There was a real fear that the discovery of more plague victims would lead to more quarantines or building-burning, a crude method of fighting disease.

Knowledge of the plague outbreak eventually managed to spread outside of California. Out-of-state newspapers picked up news of the outbreak a few weeks after King's death, and Kinyoun sent federal officials regular memos about the plague's escalation. Just as California's political and business leaders had feared, states threatened to cut off trade with California to prevent the plague from spreading.

Still, California leaders stuck to their story. In a letter to the U.S. secretary of state cosigned by San Francisco jeans magnate Levi Strauss, Governor Gage blamed Kinyoun for the "plague fake," as he called it, and claimed San Francisco had "never seen a living case of plague." A year after the first plague victim died, Gage successfully convinced the federal government to relocate Kinyoun to Detroit. By then, there were about 100 known deaths from the plague.

Group portrait of P.A. Surgeon Rupert Blue (first row, fourth from right), members of his staff, and three men in civilian clothes, standing in front of the San Francisco Plague Suppressive Headquarters at Filmore & Page Sts. in San Francisco, California during the San Francisco plague campaign.

The National Library of Medicine

The man who replaced Kinyoun as head of the Marine Hospital Service in San Francisco was Dr. Rupert Blue. Though he too faced resistance in fighting the plague, he had advantages over Kinyoun. He was better at communicating scientific and medical information to the public, and also better at earning the trust of the city's Chinese community.

Blue helped end the outbreak with initiatives to clean the city and eradicate its rats, whose fleas were infecting humans with the plague. By 1908, San Francisco was essentially plague-free, and California newspapers reported this news even though they'd previously denied the plague's existence.

The Plague Persists in the United States

Two men dissecting rats believed to be spreading the plague.

The National Library of Medicine

However, this didn't mean the plague had left the country. The United States still reports an average of seven human plague cases each year, according to the Centers for Disease Control and Prevention. Almost all of these cases occur in the western United States. In the summer of 2019, reports of prairie dogs with plague-carrying fleas forced parts of Colorado's Rocky Mountain Arsenal National Wildlife Refuge to shut down.

In reporting for her book, Chase learned that scientists at the Centers for Disease Control and Prevention in Fort Collins believe the strain that now exists throughout the west originates from the strain that was first carried to U.S. shores by ship rats around 1900.

Chase says, "It was very likely the delay in controlling the San Francisco plague" allowed it to spread—and persist.

The plague: In China, 2 patients are diagnosed with pneumonic plague - Vox.com

Posted: 14 Nov 2019 05:20 AM PST

If you thought it went the way of bloodletting and medicinal leeches, think again. Two people have just come down with the plague. Yes, the plague.

In China, two patients diagnosed with the infectious disease are receiving treatment in a Beijing hospital. Public health officials are working to make sure the disease doesn't spread to others. But the news has reportedly sparked panic among citizens.

The plague comes in three varieties: Pneumonic plague is an infection of the lungs; septicemic plague is a blood infection; and bubonic plague affects the lymphatic system. That last variety is the one we know as the Black Death, the epidemic that wracked Europe in the Middle Ages.

Pneumonic plague may be less famous than the bubonic form, but it's even more deadly. And it's pneumonic plague that has now been identified in China.

It's not clear exactly how the two infected people caught it, but they didn't catch it in Beijing: They came from Inner Mongolia and traveled to the capital seeking treatment, according to Chinese officials. A bacterium called Yersinia pestis, which is carried by wild rodents and the fleas that feed on them, causes all three types of the plague. Pneumonic plague is highly contagious and transmissible between humans — it can be spread when an infected person coughs.

That fact caused alarm among Chinese citizens on Tuesday, when the news broke. One user on the popular site Weibo wrote that the government should release information on how the patients traveled to Beijing — if they used public transport, they may have spread the plague to other passengers. "How many people have they encountered potentially?" wrote the user, per the New York Times. "Only 2 kilometers away from Chaoyang Hospital. I'm shaking and trembling."

Other users complained that the government should have announced the outbreak sooner (the patients reportedly sought treatment on November 3) and with greater transparency. Meanwhile, Chinese censors told online news aggregators in the country to "block and control" discussion of the plague, the Times reported, adding that China has a history of covering up infectious outbreaks. (The government keeps tight reins on the press, and media censorship could be a wild card in how a disease spreads or doesn't.)

The Chinese Center for Disease Control and Prevention, writing on Weibo, told Beijing residents not to panic because the risk of the plague spreading further is "extremely low." It also said that officials have disinfected any sites that may have been exposed to the bacteria.

Hopefully, there will be no further transmission of the infectious disease in China. But this is an important reminder that the plague, despite common perception, is not a thing of the past. And nor is it limited to China. In recent years, the plague has popped up in countries from Madagascar to the United States. This is a global problem.

And it's a reminder of the ever-present risk of pandemics — a risk for which experts say we're really not prepared. In September, experts warned in a major report that the risk of a global pandemic is growing. "There is a very real threat of a rapidly moving, highly lethal pandemic of a respiratory pathogen killing 50 to 80 million people," they wrote.

The plague is more of a concern than you might think — even in the US

When you think of the plague, you may think of Shakespeare's lifetime. In the Bard's day, the Black Death wiped out a quarter of his town's population.

And before that outbreak, back in the mid-14th century, the bubonic plague killed an estimated 60 percent of Europe's population. Sixty percent. It's hard to grasp the magnitude of such a catastrophe — or the speed with which the highly contagious disease spread over just six years. Here's a GIF to help you visualize it:

Thankfully, the infectious disease isn't decimating human populations at such an alarming rate anymore. Although it's lethal when left untreated, recovery rates are fairly good if it's treated with antibiotics soon after onset.

But the plague — bubonic as well as pneumonic — continues to affect people from Africa to Asia, from South America to North America. It afflicted 3,248 people and killed 584 around the world between 2010 and 2015, the WHO reported.

In 2014, China saw one man die and 151 people placed in quarantine because of the plague, with the city of Yumen sealed off. And just this year in Mongolia, a couple died from plague, reportedly after eating a marmot, leading to another quarantine.

In 2015, plague was making headlines in the US, with 11 cases and three deaths spanning six states in between April and August, according to the Centers for Disease Control and Prevention. Each year, the US records approximately a dozen plague deaths. It's more common in rural areas.

In 2017, Madagascar suffered a terrible outbreak of plague, with 2,417 cases confirmed, and a death toll of 209.

The plague, then, is still a concern worldwide. It's something we'd do well to address — along with pandemic preparedness more broadly — before it's too late.

Sign up for the Future Perfect newsletter. Twice a week, you'll get a roundup of ideas and solutions for tackling our biggest challenges: improving public health, decreasing human and animal suffering, easing catastrophic risks, and — to put it simply — getting better at doing good.

Pneumonic Plague Is Diagnosed in China - The New York Times

Posted: 12 Nov 2019 10:54 PM PST

BEIJING — Two people in China were diagnosed with plague, setting off a panic on Tuesday about the potential spread of the highly infectious and fatal disease and prompting China's government to warn citizens to take precautions to protect themselves.

Beijing officials said the two infected people came from Inner Mongolia, a sparsely populated region of northern China. They sought treatment on Tuesday in a hospital in Beijing's Chaoyang District, where they were diagnosed with pneumonic plague, according to the government office of the district.

The Chinese Center for Disease Control and Prevention said on Weibo, the microblogging site, that there was no need for Beijing residents to panic and that the risks of further transmission are "extremely low." The authorities quickly isolated the patients, conducted epidemiological investigations on the people who could have been exposed and disinfected all the relevant sites, the CDC said. They have also strengthened monitoring of patients with fever, it added.

Pneumonic plague is one of three types of infectious disease known as plague caused by the same bacterium, Yersinia pestis. Patients diagnosed with pneumonic plague, which causes high fevers and shortness of breath, sometimes first contract the closely related and more well-known disease, bubonic plague.

Fears are mounting in China over a possible outbreak of the disease, once known as the Black Death, which killed tens of millions of people in medieval Europe, and spread through Asia and Africa.

Last month, the authorities in China said they would strengthen quarantine measures to prevent plague from entering the country after Madagascar was struck by a fast-spreading outbreak of the disease. It is unclear when the cases were first detected in China but residents are asking why the authorities took so long to diagnose and disclose the problem.

Li Jifeng, a doctor at Beijing Chaoyang Hospital where the two people sought treatment, wrote on WeChat, a social media platform, that the patients sought treatment on Nov. 3. That post, which has since been deleted, was published by CN-Healthcare, a website that covers health care news in China. Dr. Li could not be reached for comment and Beijing Chaoyang Hospital declined to comment.

Dr. Li wrote that the patient she saw was a middle-aged man, who had a fever and complained of breathing difficulties for 10 days. He sought treatment at a hospital in Inner Mongolia but his condition did not improve. His wife also developed a fever and respiratory problems.

"After so many years of specialist training, I'm familiar with the diagnosis and treatment of most respiratory diseases," wrote Dr. Li. "But this time, I looked and looked at it. I couldn't guess what pathogen caused this pneumonia. I only knew it was rare."

On why the authorities took so long to make the announcement, Dr. Li wrote that signs of any infectious disease need to be repeatedly verified and investigated, and such announcements cannot be "transmitted casually."

The police quarantined the emergency room in the Chaoyang Hospital on Monday night, the news outlet Caixin reported, citing residents.

On Tuesday, Chinese censors instructed online news aggregators in China to "block and control" online discussion related to news about the plague, according to a directive seen by The New York Times.

Skeptical Chinese internet users have charged the government with being slow to disclose news about the disease, which is transmitted between humans and kills even faster than the more-common bubonic form. China has a history of covering up and being slow to announce infectious outbreaks, prompting many people to call for transparency this time.

"The plague is not the most terrifying part," one user wrote on Weibo. "What's even scarier is the information not being made public."

If left untreated, pneumonic plague is always fatal, according to the World Health Organization. But recovery rates are high if detected and treated with antibiotics, within 24 hours of the onset of symptoms, the agency said.

Another user on Weibo called on the government to disclose how the patients arrived in Beijing from Inner Mongolia. If the patients traveled on their own using public transportation they could have spread the disease to many people.

"How many people have they encountered potentially?" the user wrote. "Only 2 kilometers away from Chaoyang Hospital. I'm shaking and trembling."

According to China's health commission, six people have died in the country from the plague since 2014. The most recent case was recorded earlier this year.

Officials have warned people to avoid traveling to infected areas and contact with rodents.

Elsie Chen and Zoe Mou contributed research.

Search This Blog

Plague

Featured Post

Urogenital tuberculosis — epidemiology, pathogenesis and clinical features