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Bubonic plague looming on the horizon?

India’s situation regarding COVID-19 is becoming ever more dire by the day. Among the consequences of the pandemic are an already substantial list of healthcare issues being sidelined even as they push India’s healthcare system to its limit. In another development that carries grim portents for public health, China has recently announced that bubonic plague is potentially circulating.

bubonic plague
Image attribution: Wellcome Trust.
Female patient with bubonic plague seated on charpoy in Karachi, India. Photograph, 1897.

The COVID-19 pandemic originated in China. The country has now said that a strain of swine flu is circulating with the potential to cause another pandemic. The announcement of bubonic plague could not come at a more inopportune moment. As countries across the globe struggle to control COVID-19, resurgence of a disease as deadly as the bubonic plague could pave the way for utter devastation across the globe if left to spread unchecked across nations with already overburdened health systems.

The suspected bubonic plague case was reported on Saturday by a hospital in Bayannur, located in the Inner Mongolia Autonomous Region. “At present, there is a risk of a human plague epidemic spreading in this city. The public should improve its self-protection awareness and ability, and report abnormal health conditions promptly,” news agency PTI quoted a local health authority as saying.

The epidemic of bubonic plague, commonly referred to as the Black Death, was one of the deadliest in human history. The disease killed approximately fifty million people across Africa, Asia and Europe in the fourteenth Century. Smaller, yet significant, outbreaks have occurred since. Bubonic plague killed roughly a fifth of London’s population during the Great Plague of 1665, while more than twelve million died in outbreaks during the nineteenth century in China and India.

While on the surface news of such a catastrophic disease resurging may be viewed across the media as an all but apocalyptic scenario, fears may be overblown. While the disease could be devastating if left unchecked, given the mortality rate of between thirty to sixty percent, it is treatable.

There is also a modern precedent for small numbers of cases of bubonic plague to occur from time to time. Madagascar saw more than 300 cases during an outbreak in 2017. Fortunately, this outbreak never broke out of the confines of the country. As such, it never neared the pandemic proportions of the COVID-19 crisis. 

In addition to treatment through antibiotics, we are well-versed in the infection routes which the disease takes. The disease is transmitted through fleas carried by animals such as rodents. Rat populations permeating cities and towns and carried in trading vessels were thought to be a driver behind the widespread of the disease in previous centuries. Diseases transmitted by such a method are far less prevalent — particularly in more economically developed nations — than in previous centuries. 

It is unlikely that the bubonic plague will show another mass-scale resurgence. The utmost concern is necessary for diseases such as swine flu, which can develop into strains that can transmit between humans – much like COVID-19. These diseases, coupled with modern international travel, are a cause for concern that extends far beyond just COVID-19.

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