The Pneumonic Plague Killed 50 Million People in the Middle Ages and Now It’s Back

By Daisy Luther

UPDATE Oct. 11, 2017: A man who was diagnosed with pneumonic plague escaped from the hospital and was seen working in the market that serves the capital city.

One of the traders there has already been diagnosed as a carrier of pneumonic plague.

The individual was hospitalised in a specialist clinic in Antananarivo—but discharged himself before completing his treatment.

“Following our efforts to raise awareness about the plague, a group brought in a 24-year-old man who was spitting blood,” said Rabenjaminahobianintra Harimanana, head doctor at the Isotry Central health clinic.

“Tests (for plague) came back positive, so after being given initial treatment he was sent to the Ambohimiandra Anti-plague Clinic.

“But he escaped from the centre and was seen once again trading in the market.”

Authorities sought to reason with him, but he fled again…Hanitra Randrianarison, a senior medical official in Antananarivo, said “this fugitive patient risks spreading the disease very quickly to anyone who gets within two metres (six foot) of him.” (source)

Very little sounds more unsettling than the risk of catching “the plague” but most of us think this is just something that was around during the Middle Ages because of poor hygiene. Unfortunately, that’s incorrect, and to prove it, there is an epidemic of the pneumonic plague in Madagascar right now.

We all remember reading about The Black Death during history lessons in school. It was a horrific pandemic that nearly wiped out Europe, killing a disputed number of people that ranges between 50 million and 100 million. Also known as the pneumonic plague, here is a quick video to get you up to speed on your medieval history.

It’s bad and it’s reminiscent of the Liberian Ebola outbreak in 2013, that alarmingly made its way to American soil. The New York Times reported on the situation in Madagascar:

Since August, the country has reported over 200 infections and 33 deaths.

The outbreak is beginning to resemble the early stages of the West African Ebola crisis in 2014: a lethal disease normally confined to sparsely populated rural areas has reached crowded cities and is spreading in a highly transmissible form.

Schools, universities and other public buildings have closed so they can be sprayed to kill fleas, which may carry the infection. The government has forbidden large public gatherings, including sporting events and concerts.

Fears that the outbreak could spread to other countries are rising.

Late last month, plague struck a basketball tournament for teams from Indian Ocean countries, killing a coach from the Seychelles and infecting another from South Africa. The players are being monitored, Malagasy health authorities told the W.H.O.

Madagascar typically has about 400 cases of plague each year between September and April, but they are usually focused in the nation’s central highlands and spread by fleas living on rats in rice-growing areas. This outbreak is unusually worrying because most new cases are in cities and are pneumonic plague, the form transmitted by coughing. (source)

Madagascar is a large island of 224,533 square miles off the coast of southeastern Africa. It has a population of more than 25 million people in an area that is approximately twice the size of the state of Arizona.

In comparison, Arizona has just over 6 million people, so as you can see, Madagascar is densely populated.

The biggest city on the island is Antananarivo, which has a population of 1,391,433, and concerningly, Patient Zero of the current outbreak traveled through the city by public transit, causing great concern of the possible ramifications.

The Madagascar outbreak started in August, when a 31-year-old man originally thought to have malaria traveled by bush taxi from the central highlands to his home in the coastal city of Toamasina, passing through the capital, Antananarivo.

He died en route and “a large cluster of infections” broke out among his contacts, according to a W.H.O. update issued Oct. 4. Those contacts passed it on to others.

Plague was not confirmed until blood samples collected from a 47-year-old woman who died on Sept. 11 in an Antananarivo hospital of what appeared to be pneumonia were tested at Madagascar’s branch of the Pasteur Institute. The samples came up positive on a rapid test for plague. (source)

Hasn’t Madagascar dealt with the plague before?

Madagascar is no stranger to the plague, with about 400 cases every year, but this time around, it’s the pneumonic plague, which is far more contagious and deadly.

…the majority of cases are of pneumonic plague, which affects the lungs and is transmitted through coughing. It is considered to be the most deadly form of the disease and can be fatal within 24 hours.

The less deadly bubonic plague is often spread by rodents fleeing forest fires. Humans usually become ill after being bitten by infected fleas.

Public gatherings have been banned in response to the latest outbreak.

A specialised hospital in the capital Antananarivo is struggling to cope with the influx of ill people, local media reported, with long queues outside for face masks and medicine.

This year urban areas have been affected, a development that has worried aid agencies in a country not renowned for a robust healthcare system. (source)

Of course, with urban areas comes public transportation, and even more alarmingly for the rest of the world, an international airport. There has already been at least one documented case of pneumonic plague leaving the island, causing Air Seychelles to halt service to Madagascar:

“Following the advice and request of the Public Health Authority of Seychelles concerning the plague epidemic in Madagascar, Air Seychelles will temporarily suspend its services between Seychelles and Madagascar from Sunday 8 October 2017.”

This is the content of the official communiqué of Air Seychelles which will no longer serve Madagascar from tomorrow 08 October 2017.

It is certain that the Seychelles authorities did not appreciate the death of the Seychellois basketball coach in Madagascar following a pulmonary plague he contracted on the spot during the basketball tournament in Antananarivo. It was only after this unfortunate death that the Malagasy authorities took action and began a thorough awareness campaign. (source)

Aside from this, I could find no other travel restrictions to or from Madagascar.

What is the plague?

There are three types of plague: bubonic plague, septicemic plague, and pneumonic plague.

Bubonic plague is spread via infected fleas and small animals. It can result from bites or exposure to the body fluids of dead, plague-infected animals. It can enter through the skin by a flea bite and travel to the lymph system. Treatment with antibiotics must occur within the first 24 hours of symptoms. The mortality rate for those treated ranges from 1-15%, but for untreated patients, ranges from 40-60%.

Septicemic plague is the rarest form of plague and is nearly always fatal without treatment. It attacks the bloodstream. Treatment must begin immediately after symptoms have shown or it will be too late. It is transmitted from flea bites, rodent bites, or mammal bites from infected creatures.

In septicemic plague, bacterial endotoxins cause disseminated intravascular coagulation (DIC), where tiny blood clots form throughout the body, commonly resulting in localised ischemic necrosis, tissue death from lack of circulation and perfusion.

DIC results in depletion of the body’s clotting resources, so that it can no longer control bleeding. Consequently, the unclotted blood bleeds into the skin and other organs, leading to red or black patchy rash and to hematemesis (vomiting blood) or hemoptysis (spitting blood). The rash may cause bumps on the skin that look somewhat like insect bites, usually red, sometimes white in the center. (source)

As awful as the other two versions sound, the pneumonic plague is the most contagious and worrisome. It causes a severe lung infection that is often confused with pneumonia, delaying essential treatment. It can be spread via rodents and flea bites.but also from the sputum of those infected. It can become completely airborne, making it far more difficult to avoid infection.

It must be treated within 24 hours or is nearly always fatal. People who have been exposed to pneumonic plague can be treated prophylactically with antibiotics.

What can be done to treat the plague?

The World Health Organization has sent over a million doses of antibiotics and has protective gear on the way. There are also other measures in place as reported by the BBC.

The authorities have also banned prison visits in the two worst affected areas to prevent the spread of the disease.

The risk of contamination is high in overcrowded and unsanitary jails…

Public gatherings have been banned in response to the latest outbreak.

A specialised hospital in the capital Antananarivo is struggling to cope with the influx of ill people, local media reported, with long queues outside for face masks and medicine.

This year urban areas have been affected, a development that has worried aid agencies in a country not renowned for a robust healthcare system…

On 30 September, Prime Minister Olivier Mahafaly Solonandrasana in a televised statement announced that all public gatherings would be banned in Antananarivo to prevent the spread of the disease following the death of the basketball coach.

In addition to school closures across the country, authorities on 5 October ordered the closure of the country’s two main universities in the eastern port of Toamasina and Antananarivo for disinfection purposes. Sports events have also been cancelled.

There have been concerted efforts to set up rat traps and spray insecticides in several neighbourhoods to prevent the spread of the disease. The government has also established a toll-free number to report any new cases. (source)

The local government is also cracking down on anyone who spreads information that is not in line with the national Ministry of Health.

The Ministry of Health in addition has also taken measures against social media users who it accuses of spreading “false news” on the disease to create panic. A Facebook user was arrested and investigated on 3 October for publishing a report which did not correspond to the toll given by the ministry. (source)

That’s unsettling, isn’t it?

Should we be worried?

At this point, we have no new cases of pneumonic plague in the United States. It has happened before, as one example, when there was an outbreak caused by an infected dog in Colorado in 2015 that then turned into human-to-human transmission. (source) A few months ago, fleas in Arizona were discovered to be carrying the plague. (source)

If untreated, people still can die from the plague, which in the United States occurs in the wild, primarily in rural parts of western states, at a rate of about 10 to 15 cases per year, according to the CDC. Most of the naturally occurring cases are bubonic plague, which can bring on pneumonic plague if left untreated and a person’s lungs become infected.

However, the disease is completely treatable with modern antibiotics if it is diagnosed early.

Worldwide, the World Health Organization reports 1,000 to 3,000 cases of plague each year.

Most infections in the United States have occurred after disposing of squirrels or mice that died from the infection or traveling in an area where infected rodents live. Health officials recommend staying away animals that are lethargic or appear sick. (source)

At this time, we have absolutely no documentation of this bout from Madagascar affecting the United States.

But that doesn’t mean it’s impossible. Never forget that people thought Ebola wouldn’t make it to our shores and it did. The reason it didn’t turn into a full-blown pandemic had absolutely nothing to do with a slipshod official response, either. Read this to learn just how easily an epidemic on foreign shores can turn into a pandemic that affects the whole world.

While the plague is not difficult to treat with antibiotics if caught quickly, one thing that concerns me is the overuse of antibiotics in the United States. They simply don’t work as well for us these days because of near constant exposure from meat and dairy products.

This is not currently a threat to us, but it bears watching. Preparing for a pandemic should start well before the illness shows up, or you run the risk of not being able to get essential supplies. This article can help you get a jump on prepping for a pandemic. If you want more information, this class contains a 90-minute interview, written information, and checklists. Keep in the loop with the Facebook page, Pandemic Watch, and follow Preppers Daily News for updates. Finally, be sure to sign up for my email list – when I know, you’ll know.

Think of it like a tropical storm, hundreds of miles out to sea. We have no idea if it will reach our shores or how strong it will be, but it’s important to be watchful and ready in case it heads our way. Don’t panic, but be ready to take action to protect your family.