June twentieth, with the help of Father Vigano, I try to persuade some English sailors, whose duty it is to bury the dead from the city and other hospitals, to let me take the bubos from the dead before they are buried. A few dollars conveniently distributed and the promise of a good tip for every case have a striking effect. The bodies, before they are carried to the cemetery, are deposed for one or two hours in a cellar. They are already in their coffins in a bed of lime.
The coffin is opened, I move the lime to clear the thigh region. The bubo is exposed. Within less than a minute. I cut it away and run to my laboratory. I see a real mass of basillia, all identical from the bubou I inoculate agritubes, mice and guinea pigs. My basillis is most probably that of plague, but I am not certain. June twenty first, I go on cutting and
examining bubos. I always find the same basillistly abundant. My animals inoculated yesterday are dead and show the typical plague bubos. I love that I was really nerdy.
It was so perfectly like I can imagine the exact scientist he was.
Like, you know, well, the exact scientist was Alexander Yerson in the year eighteen ninety four, which is when he discovered Yep, that's right, you're sinia pestis. Oh my god, the causative agent of plague. Yoursin yourson.
I never knew where it got its name.
Now I know, a Swiss scientist. And also, even though he probably was the first to actually describe and identify the bacterium, he did not get credit for a while because he did not publish in English, which is very interesting.
Oh interesting, So what in Switzerland? What what language? Did he publish in? German or French?
Probably German?
Cool? Interesting?
Yeah?
How fun? Hi and welcome to episode six. Yes, this podcast will kill you. My name is Aaron Welsh and I'm Erin Alman Updike and this is Plague Part two.
Yeah. Before we start off, we want to tell you guys about a few other podcasts that are awesome and you guys should totally check out.
Yeah, as if you know you have all the time in the world to listen to all the podcasts, let's tell you about some of our favorites. Yeah.
Yeah, So, our friend Matt Candais, who's also a student with us, produces a podcast called In Defensive Plants and it's an awesome, awesome botany podcast. It's like top rated on iTunes.
He interviews really awesome people and it's just a really great podcast in general. You know, dot dot dot lookout for a crossover episode in the future. We also made a Twitter friend, which to me is the most exciting thing in the world. I don't know if that's nerdy, but when we got our first Twitter friend, I was like, I wanted to die of excitement.
Yeah, as someone who doesn't really do Twitter at all, I was in the dark about this, but it was Aaron was really excited.
I was. I almost like, I squealed so hard. But anyways, we made friends because I found this podcast called The Fems of STEM, which is this amazing podcast all about the history of women in science, technology, engineering, and math, which is STEM and each episode focuses on a different woman and all of her amazing accomplishments in the field. It's super interesting. It's hosted by a badass lady named Michelle.
It's great.
You should definitely check it out.
There's also another super cool podcast we want to tell you about, and it's created and produced by our friend Shane Campbell Stayton and his and his friend Arian Darby. It's called The Biology of Superheroes, and in it they talk about some of your favorite comic book heroes and the biological principles underlying their superpowers.
It's gonna be amazing. The first episode is being released on Too Number first.
So it'll already be out by the time this episode is Oh cool, great, I was gonna say, the first episode just dropped and it's all about Peter Parker and his spidy physiology.
My god, I can't wait to listen.
Yeah, it's gonna be really good.
I'm thrilled about.
It's going to be super high quality.
Yeah, Mage, Mage, what are we chatting about today? Erin, Well, this week.
Just like last week, we're doing something a little bit unusual. So the topic of plague is so huge that we needed to split it up into two weeks. So this is part two.
So if you missed part one, pause here, go and download episode five and then meet us back here in like an hour.
Yeah that that that Episode five will give you the biological background and historical context that you may need for this next episode. Yeah, so this episode we're gonna be talking all about the plague in modern times and ending with the discussion of the an outbreak in Madagascar and what that means for the rest of the world.
Cool.
I guess we should start though, with our quarantinies.
It's quarantine time.
What do we have on the menu for this episode?
Erin another boobo baby though?
Oh? Okay, is this one the mnemonic variety?
Yes? Absolutely, okay, okay, Yeah, so this one's made with vodka.
Okay, so it's just another it's a extra dry martini with vodka and and.
This time we used an olive just to mix it up first. Maybe olives are more pneumonic.
Well, how about we start with an overview of the biology just as a refresher.
That's a great idea. So just to review, Plague is a disease that is caused by a bacteria known, as we mentioned as your Sinia pestis. It is spread in several different ways and the root of transmission determines the type of disease that you get. So the most famous form is bubonic plague, and that disease is acquired when it is transmitted by the bite of an infected flea. Pneumonic plague, on the other hand, is when a bubonic plague spreads to infect your lungs and then can be
transmitted via respiratory droplets aka coughing. And then the third type of plague is known as septostemic plague, and that means that the bacterium has infected your bloodstream and proliferated in your blood.
And there are different mortality rates associated with each of these forms, right.
Absolutely so. Bubonic plague is the least fatal of the three. It has mortality rates of thirty to sixty percent if untreated, and then mneumonic plague is the most virulent and it has up to add percent mortality rate if left untreated. The good news is all three of these types of disease are treatable with antibiotics as long as you get to them fast enough.
Super super dupes. Okay, I think that's a good I think that's a good little.
Biology in a nutshell.
So now let's pick up where we left off last week, which is more or less at the beginning of what historians called the third pandemic. So we talked about last week, the first pandemic, which was the Plague of Justinian, the second pandemic, which was the Black Death, and then the local epidemics that followed that in the centuries after. The third pandemic began in eighteen fifty five in China and
spread to India and some other places as well. Over the course of that one year, more than twelve million people died in those two countries alone.
Wow.
Yeah, twelve million, twelve million. Although the death toll of the third pandemic could not hold a candle to that of the Black Death.
Right, nothing can no the Black Death. It's the mother of all plagues, Yeah, definitely.
One of the significant outcomes of it was that by the early nineteen hundreds, plague was endemic and wild rodent populations all around the world.
Wow.
And by this time both the black rat and its flea had a global distribution. This was thanks to the widespread rapid global travel that was now possible. Infected rats brought infected fleas onto boats which would enter every port town. At the edges of these port towns, you would find human dwellings encroaching onto natural areas, which allowed for the intermingling of domestic and wild rodents, and the rat fleas had no preference. They were just happy to have so
many available hosts. If humans and wild rodents came into close contact, as they did following deforestation, or whenever human settlements were built in previously natural areas, plague could make the jump from rodent to human hosts via the bite of an infected flea, and this is what the Third pandemic saw, pockets of plague, some larger than others, popping up in parts of every continent except for Antarctica, and also most of Western.
Europe actually, which is interesting.
Funny considering the Black Death was most impacted a lot of Western Europe. It was during this pandemic in the late nineteenth century that substantial medical research was finally done on the plague. Its root of transmission via infected fleas was identified, the importance of rat populations was realized, the causative agent little Basilli Rcinia pests was described. Even with all these pretty monumental advances in the medical underpinnings of plague,
there was still a long way to go. The earliest vaccines and antibiotics used to prevent or treat plague infection were developed in the late eighteen hundreds, but these weren't all that great. If you received either, your chances of dying were reduced by about twenty or thirty percent. Wow, it's it, yeah, gosh promising, but not really that reassuring.
No.
No, improvements continued to be made, and now there is a functional plague vaccine, but it still has its problems, mostly with longevity in the protection it offers, and on the logistical side it takes multiple courses to immunize. Antibiotics, on the other hand, are still effective against plague.
Than now, goodness for now, for now, but fake goodness, thanks for now.
In the nineteen forties is when streptomycin, which is usually used to treat plague now it was discovered. Even with all of these ways to combat plague, it persisted. But actually that verb tenses is wrong. It continues to persist in many regions of the world, including Madagascar. Plague is considered to be an endemic disease. And what is an endemic disease?
Erin, an endemic disease is a disease. It is sort of constantly occurring at low levels in a population.
Thank you You're welcome. Although the pandemic was declared to be over in nineteen fifty nine, so the third pandemic was according to the WHO done thirty nine, that was, by no means the last year that plague caused an epidemic.
Oh, definitely not.
Let's take a little detour to Vietnam in the nineteen sixties, in the midst of the Vietnam War, oh dear, when the US military was over there, fighting in a pointless war they never should have started, and devastating entire communities.
Getting political not really, sorry though, well getting factual.
Side note. Did you know that in Vietnam this war is referred to as the American War either resistance war against America.
I did hear that? Yes, I did know that.
Anyway, One of the tactics employed by the US military during this time was using chemical warfare to destroy crops and sterilize the land. They did this to try to weaken the North Vietnamese army by depriving them of food.
The problem with that, besides being morally bankrupt and evil, is that the army would just come into your food from civilians, so it mostly had the effect of starving entire communities and villages to death, which honestly was probably the intention of the US military all along to weekend the army by terrorism.
Yeah, it sounds like the point.
The US Department of Defense estimates that about twelve percent of the farmable land and forest was sterilized during this bombing campaign, although the Vietnamese government puts the amount closer to forty five percent. Jesus, what this destruction did was to drive the wild rodents out of these deforested, destroyed areas into human settlements where there was at least still some food.
Whoa.
As you might expect, this resulted in a massive outbreak of bubonic plague.
Oh my god, that is not something you learn about in like seventh grade history class.
It's not.
Holy crap.
Between nineteen sixty five and nineteen seventy, over twenty five thousand plague cases were reported in South Vietnam. That's just the reported ones, not actual.
Wow, the actual.
Total was probably closer to one hundred thousand to a quarter of a million. Not not joking, not exaggerating. That's what I found.
Holy crap.
In a country where, prior to US invasion there were only about fifteen cases a year. Reported.
Oh my god.
Most of the cases occurred in small, isolated villages where I couldn't find exact figures, but I'm sure the death rate was really high.
Yeah, because if you don't have access to medicine, then even if you're getting bubonic plague, that's still a sixty percent mortality rate. You know, that's ridiculous.
Some American soldiers also came down with the plague, but they were able to get treatment right away, surprise, surprise, and most of them were vaccine it. Anyway, this is just one of the many, nasty, shameful chapters of American history.
That is a whole other podcast. There are multiple, many other podcasts about that. Yeah, Okay, back to plague. Back to plague.
A lot of you, particularly those listening in the US, may think of plague as a thing of the past, a medieval disease that has been gone for centuries. Although you'd maybe have to be living under a rock if you still think that with this latest outbreak in Madagascar. But even with this plague outbreak, you may think that you don't have to worry about plague living in the US.
Wrong. Well, you're probably mostly right to think about that. Wrong, We'll get into the details of that more later, but in terms of natural infections, yeah, yeah, that's true.
Did you know though, that there have been over a thousand cases of plague in the US since the early nineteen hundreds. A thousand, that's it, but.
Still still still still that's a thousand people.
In the early nineteen hundreds, plague tended to pop up in port towns when plague infected ras disembarked from ships and their fleas headed into town for a little barfing. Fund outbreaks were reported in San Francisco, Oakland, Hawaii, some Oregon coastal towns, and several of these outbreaks were dominated by the pneumonic, more deadly form of the disease. The fleas then headed east overland, transmitting plague into the wild
rodent populations of the Southwest and West. After about the nineteen twenties, plague ceased to be a port city disease in the US and instead became one of incidental contact with dead or infected animals. Every year from the nineteen twenties until now, cases of plague were reported YEP. One boy from New Mexico died after skinning a dead coyote. He came across. Same for another, but this time it was a squirrel instead of a coyote. Another with a rabbit, because, like we.
Mentioned before, the dead bodies remain infectious, right because they're basically just full of bacteria. So especially some rodent species, but especially carnivores, are very hard hit by plague and so they have very high back to your loads. So basically we're saying, don't play with roadkill, guys, I.
Know, which is kind of a shame because roadkill can be really a useful study thing.
Sure, yeah, but just wear gloves.
Wear gloves when you play with roadkill.
Yeah.
Several people also got sick when their pets contracted plague from infected wild rodents, like the cats that we mentioned last episode. So sad sorry for you cat people out there, just like.
Trying to love on your cat and they're sick and they're like coughing, and you're like, oh, poor baby, and then they cough in your face and then you both die of plague. Yeah.
Since nineteen sixty five, there have been over four hundred and sixty cases of plague in the US. Wow, with sixteen percent of those infected dying.
Geez, that's a really high mortality rate.
Yeah, with the use of antibiotics and everything.
Yeah, I wonder if that is largely to do with people not being able to recognize it or doctors not wanting to die I know, something like plague.
Right, So there's that kind of begs the question why is plague still killing people when there's a vaccine, when there's antibiotics, And probably that depends on where you are geographically, definitely big time. But overall, plague is still a very nasty disease. Yeah, And antibiotics, even if administered early, can't always save you or even save you from the nasty side effects that you will get from from plague infection.
Plus, even if you can, you know, even if you live in a place like the United States where if you have health insurance at least, then you in theory have access to a physician to get antibiotics. And even if you have a physician that diagnoses it early, we don't always go to the doctor when we're feeling sick until and with something like plague that can come on so rapidly, you might not get those antibiotics until too late, even if you had access to them.
Yeah, So and so in some areas, it could be that it's underdiagnosed. Definitely, we're not diagnosed early enough. But in other areas where plague is endemic, such as Madagascar, getting antibiotics to people who need them is often a huge logistical struggle and there is a lot of underreporting
of the disease, which can prolong an epidemic. The story of the plague in Madagascar starts in eighteen ninety eight, when the disease first appeared after a ship from India full of rice rats and plague arrived at the island. Since then, there have been plague deaths every year, some years worse than others. The plague, usually in bubonic form, tends to pop up every year in Madagascar between September and April, but this year it was a little early.
Aerin Can you tell me a little bit about the plague situation in Madagascar today?
I would love to. So we're going to walk through this entire outbreak, and then we're going to talk about what, honestly a great job who has done in trying to contain this pretty.
Much, so I cannot wait to hear it.
I'm excited. So, the current plague outbreak in Madagascar begins on August twenty.
Third, twenty seventeen.
Twenty seventeen. Yeah, August twenty third of this day year, when a thirty one year old male reported malaria like symptoms. He started to come down with malaria like symptoms so headache, fever, malaise on the twenty seventh of August. So four days later, he began experiencing respiratory symptoms while in a shared taxi. Uh oh. He later died.
Uh oh.
His body was prepared for his funeral at a hospital without any safety procedures. Thirty one people who came into contact with this individual case, either directly or indirectly through like shared taxi contacts or contacts with the funeral people became ill and four of them died.
How many people became ill?
Thirty one people from that one person initially.
And he died how soon after showing symptoms within a few days. Okay, that's okay.
The outbreak was officially detected on September eleventh, after a forty seven year old female was admitted to the hospital with respiratory failure because of pneumonic plague. So that was when they first realized that this was an outbreak. By the twenty eighth of September, So this is just one month after that initial man. There had already been fifty one cases of pneumonic plague, the bad one the bad one,
and twelve deaths reported. There had been an additional fifty three cases of the bubonic plague and seven deaths elsewhere in the country.
Interesting, mm hmmm. I have questions about the origin.
Yeah, I do too. And so there wasn't at least what I found a ton of detail on, like the specifics of how many index cases there might have been. They had the details of this specific story.
And so this guy who was the index case right, had mneumonic plague, yes, and so those people.
Where he had bubonic plague, that became mnemonic.
For surekay okay, And so those people that got bubonic plague, that indicates that there was a bubonic plague outbreak exactly, not related to him, necessarily.
Necessarily exactly, yeah, okay, because bubonic plague is not transmitted person to person, that's transmitted by the bites of the fleet.
Gotcha.
By October second, just a few days later, that number fifty one cases of mnemonic had jumped to seventy three. By November second, and part of the massive increase in this numbers has to do with better reporting. But by November second, that number had jumped to one thousand, eight hundred and one cases of mnemonic plague.
WHOA, it's a lot of day in cases.
By the fifteenth of November, which is the most recent data that I found, the total count stands at two thousand, one hundred and nineteen over twoy one hundred total cases. That is, that is considering both what they call confirmed so laboratory confirmed cases, probable cases and suspected cases, and one hundred and seventy one deaths, which is an eight percent case fatality rate.
Wow.
Yeah, But what's interesting is that's quite low because the vast majority of these cases were clinically classified as mnemonic plague and not bubonic plague. So for neumonic plague, that's actually a fairly unusually low fatality rate.
Which indicates potentially that there was a rapid response.
It could indicate that it could indicate that for some reason, this was just like an unusually not virulent strain. But who has done an amazing job at responding to this outbreak. So let's talk about what happens in the case of an outbreak because I think it's thrilling. It's what I wanted to do for my job for a long time. Wanted, wanted, want to CDC Diami. Just kidding docs, Yeah, not kidding.
But so what happens when you have a suspected outbreak is a whole mass of people from the who from the CDC, from doctors without borders, Minisson san frontier, right. They're all sent to the place with the main goal of finding the index case, the initial person or persons who could have sort of started this outbreak. And in order to do that, you have to do what we've
referred to before as boots on the ground epidemiology. You have to go there and interview people who were either friends of the patient, family of the patient, healthcare workers, everyone who ever came into contact with that patient, and then trace their contacts back and back and back. And additionally, you have to do surveillance of all of those contacts to see who might develop symptoms in the future.
And so that means going back and checking with them every day to say, are you sick exactly, what is your temperature like r Are you showing any symptoms? Yes, it's a lot of man.
Hours exactly human hours, let's call it.
It's a lot of human hours. It really of work.
And so in the case of this plague outbreak, there have been over two thousand cases, but there have been over seven thousand contacts of each of these cases identified, and of those, ninety five percent of them have completed seven day follow ups. So that means they've been contacted every day for seven days to because, like we said, the incubation period tends to be between one to seven days, so you have to follow them up for a whole week.
You can imagine if this were a disease with a longer incubation period, it's just that much more work to follow up on these people.
Yeah, that is a lot of effort to put into that mm hm.
And they also we're all given prophilactic antibiotics. So one thing about the plague that's nice is that prophylactic antiboctic prophilactic antibiotics can help in reducing the chances that you end up showing symptoms of plague. Out of those seven thousand contacts, only nine of them actually ended up becoming suspected cases, which I think is interesting.
So imagine that you have plague in just you listener, you Aaron? Yeah, And how many people do you come in contact with and if you have mnemonic plague over the course of twenty four hours of a normal let's say work day, how many people Because we you know, just sometimes tend to hang in the house on Sundays, I think, yeah.
I actually went to a birthday party today, oh with her children? Yeah?
Oops? Sorry, yikes.
Yeah, I mean you'd have to follow up with each of those people that I interacted with at that birthday party. There was probably I don't know fifteen people there and then go to each of their families and everyone they contacted.
I mean, it's insane, especially radio. It's outward endlessly.
In twenty seventeen when we are so mobile, right Like this man, this index case, he shared a taxi with multiple people, So you need to find how do you even find if you're in an uber today? Can you even find if you do uber sharing and you are with a random person, like, how do you even find
those people? It takes a ton of real detective work to find all of these people and make sure that you're following up in order to sort of put a ring around the outbreak and try and contain it, and most of the reports that I have seen say pretty specifically, well, most of the news articles about the Madagascar outbreak specify that it has been limited to Madagascar. However, on October tenth, a man was reported to probably have no mumonic plague in Seychelles.
I saw that news article and then that was the last I saw of it. So is it possible that he was a traveler who came from Madagascar?
Right? So he did come from Madagascar, however, he Yeah, so he did. He had visited Madagascar and he returned to Seychelles on the sixth of October. They from that one person, they monitored three hundred and twenty contacts of this person. Eight of them ended up developing mild symptoms. But of those three hundred and twenty contacts, forty one of them were passengers on his flight from Madagascar back.
You imagine being on a flight and getting contacted by United Airlines. Knaknack, Hello, it's crazy, were on this flight. You may have neumonic plague.
It's just insane.
Thank goodness, they're antibiotics.
That's that should be the name of this episode.
I hope something a little bit better.
What else about that plague well, as of so, we're recording this on November nineteenth, twenty seventeen, and as of today, it has.
Been three weeks and one day since a case has been confirmed.
Right, the last confirmed case of bubonic plague happened on the twenty fourth of October, and the last confirmed case of mnemonic plague was the twenty eighth of October. However, like we've said before, plague is endemic to Madagascar, and plague season extends until April, so the surveillance efforts are not finished and the risk is not entirely done. However, it seems like the worst of this outbreak is hopefully over. Hopefully, Yeah, hopefully.
It's crazy, though, I mean it was a massive outbreak because it's over two thousand cases. From twenty ten to twenty fifteen, there was only just over three thousand cases of plague reported worldwide, wow, and five hundred and eighty four deaths.
So this is a big one.
Yeah, it's massive. Yeah, it's definitely one of the biggest there was. Plague is certainly noted limited to Madagascar. Madagascar does tend to be one of the countries that has the greatest burden of it. Year after year. But just in the two thousands alone, there have been outbreaks in Zambia, India, Malawi, Algeria, the Democratic Republic of Congo, China, Peru, and Madagascar. And those are just the outbreaks. That's not counting sort of
individual cases like we see in the West almost every year. Right. Yeah, so sheweg is definitely not over.
Should we talk about how scared we need to be today?
Oh my god?
If you listen to last week's episode, you might remember that the use of plague and bioterrorism is nothing new, right, this fact, it's many centuries old. When the Mongol army threw bodies of plague victims over the city wall of Kafa, they were hoping to bring down the city with this awful disease. While their efforts may have been ineffectual, there have been more successful attempts in the last one hundred years.
There's a true story from the early twentieth century of two half brothers in India who were joint heirs to an estate. Yeah do you know where this is going?
But I'm excited about it.
One day, one brother met the other brother unexpectedly at a train station and gave him a hug goodbye. During this encounter, the other brother, the one who was hugged, felt a pin prick on his arm. Eight days later, he was dead.
No way.
Turns out I'm not making this up.
Is this like verified?
This is from this book Plague and Ancient Disease in the twentieth century. So take it up with Charles Greg.
Charles Greg, you better be.
Right about this.
Is this like Wikipedia status nosca?
He's a he's a researcher or was a researcher at Los Alamos. All right, all right, so he guys what was talking about?
Tell me about it?
Anyway? So the guy who felt the pin prick on his arm, yeah, died eight days later. Turns out his brother had recently taken out huge life insurance policy on him and then teamed up with a microbiologist. I'm not making this up to get some plague basilla. While he was hugging his brother. The microbiologist injected some of the plague bacilla into the guy to kill him.
Oh my god.
They were both found guilty of murder.
Most microbiologists are not like this, And I would have got away with it if it weren't for you, pesky microbiologist. Oh my god, I can't believe that.
Is that crazy? That's like, I've got an idea.
I've got an idea of an elaborate way to kill my brother. I know, how did they really figure out that it was not just a naturally infected case of plague? Like?
Did he say they broke under questioning? Did I? I don't know. I mean, if I've seen one CSI case, I've seen them all. Yeah, Slash House Slash House a great crossover episode between the two. Yeah, yeah, you had potential. Guys, there's another story of plague as a bioterrorism agent in World War Two.
This is a fun one. Well, it's not.
Actually, this is a shocking one, I would say.
I would also say it's a really interesting one. And I want to talk about why so go.
Apparently the Japanese Army had been experimenting on Chinese prisoners by making plague bombs, intending to weaponize plague, particularly pneumonic plague, and cause epidemics of it. Apparently, around three thousand prisoners died, and the Japanese Army escaped prosecution by the Allied forces by turning over their research findings to the US. Wow that's interesting.
So I had read a slightly different story.
There are some yeah.
Yeah, what what is the more.
Well, there are also some reports from China that the American Air Force deployed some biological warfare agents in North Korea during the Korean War in the early nineteen fifties.
Huh, So I had read that a quote Secret Branch of Japanese Army Unit seven point thirty one, it's important to have actually dropped infected fleas all over populated areas of China. Yes, which what I think is really interesting about that is that not that we're trying to tell you how to do bioterrorism, but that's not a good way to do it.
Well, clearly they were experimenting.
Yeah, I mean, I guess, but it's just really interesting trial and it. Yeah, but bubonic plague is not as infectious and it's not as virulent, and so it's an interesting So it's very.
Possible that that endeavor dropping infected fleas on different towns was what led to their attempt to create pneumonic plague bonds.
Right, Yeah, so that is There are a list of a few diseases that the WHO and several other organizations have sort of a task force to look out for, and plague is one of the ones that is considered the most terrifying, the most likely.
It should be noted also that Russia has been working on weaponizing plague for decades now.
Interesting like confirmed.
Wow, it's confirmed as smallpox, all right, all right, so highly suggested in some of the dossiers that dossiers.
Yeah, what's interesting about plague in contrast to something like smallpox, which we've talked about the bioterism potential of that, is that your Sinia pestis is widely available, whereas smallpox is only whether it's in many different government's hands or only a few government's hands, it still is in the hands of governments worldwide, whereas your Sinia pestis is everywhere. You can go to Colorado, you can go to California. You can get plague bacteria quite easily from a flea, from
a rat, from whatever. Yes, And because it has the capacity to be mass produced and to be aerosolized and be transmitted in that way, it is a really terrifying prospect in terms of a bioterrorism agent.
In some ways. Yes, but also okay, so let's just say that someone manages to weaponize plague and makes it the pneumonic form and then makes it antibiotic resistant.
Right, scary, that's probably the scariest scenario that have definitely and then releases.
It into a city. Yes, pneumonic plague kills you so rapidly that the period of infectivity is relatively low compared to other diseases. And so while it is a very scary prospect, it's not. Let's say it's not the best or most effective bioterrorism agent and that an outbreak could likely be content hained pretty rapidly the way that it has been in Madagascar.
So what it sounds like you're talking about is the r not oh of plague. So are not, dear listeners. It's like a capital R with a subscript zero, right, and we call that are not? So are not? Is the basic reproductive rate of a pathogen. What that means is the number of secondary cases that happen from a
single primary case if everyone in your population is susceptible. Yeah, and so in the case of mnemonic plague, You're right, the r not is estimated to be only about one point three, which means, on average, only one point three people it's an average is actually infected from every person who has nemonic plague. That's in contrast to something like smallpox, which has an r not of guess what, I don't know, around six and a half.
Whoa, yeah, yeah, interesting.
Yeah, so that's something that because as I was reading this, I was like, why am I not more scared of plague? Do I need to be? What's the r not? And it was actually more difficult than I expected to find that number. But yeah, it's quite low compared to other potential bioterrorism agents that are maybe more scary, or even other infections like measles, which has an ar not of thirteen. Wow, it's one of the highest.
Oh we have to do an episode on that.
Oh, we definitely will, okay, but also just get vaccinated and then we don't have.
To worry about it. It's a little harder, I think in some areas than others. Yeah, yeah, like Orange County.
God unfortunately, mom kidding, she vaccinated us.
Overall, it seems like plague is still a scary organism and it's still clearly causing a lot of disease and deaths, definitely in certain areas of the world, But in terms of a bioterrorism agent. It's not the best one, not the one we need to worry the most about.
Right, it's on the list. I think that people who are in charge of worrying about those things are worrying about it. So like on the day to day, don't let it keep you up at night.
And let's just say also that this bubonic plague mnemonic plague is a disease that is once again mostly concentrated in countries that are economically poor or economically struggling, and with improved sanitation, with improved surveillance of disease and so on, that these diseases could be brought to very very low levels.
Yeah, especially with plague, it's all about surveillance and monitoring because if you are able to catch individual cases, you can prevent the spread so while and you also can prevent initial infection if you don't have houses that are infested with fleas. So with improving infrastructure you can help prevent things like that.
Okay, so plague, that was a big one. It was to your whole epithet Part two slightly shorter, but not any less. Sweet. I guess we want to, Oh, do you have any do you have any reading materials to cite or do you or do that.
I actually don't. I got all my information from who. Thanks so much for what you do.
Yeah, once again, I'll just do a shout out for Plague and Ancient Disease in the twentieth century by Greg Charles.
Greg got you, got you girl.
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