Speaker 1: June twentieth, with the help of Father Vigano, I try
Speaker 1: to persuade some English sailors, whose duty it is to
Speaker 1: bury the dead from the city and other hospitals, to
Speaker 1: let me take the bubos from the dead before they
Speaker 1: are buried. A few dollars conveniently distributed and the promise
Speaker 1: of a good tip for every case have a striking effect.
Speaker 1: The bodies, before they are carried to the cemetery, are
Speaker 1: deposed for one or two hours in a cellar. They
Speaker 1: are already in their coffins in a bed of lime.
Speaker 1: The coffin is opened, I move the lime to clear
Speaker 1: the thigh region. The bubo is exposed. Within less than
Speaker 1: a minute. I cut it away and run to my laboratory.
Speaker 1: I see a real mass of basillia, all identical from
Speaker 1: the bubou I inoculate agritubes, mice and guinea pigs. My
Speaker 1: basillis is most probably that of plague, but I am
Speaker 1: not certain. June twenty first, I go on cutting and
Speaker 1: examining bubos. I always find the same basillistly abundant. My
Speaker 1: animals inoculated yesterday are dead and show the typical plague bubos.
Speaker 1: I love that I was really nerdy.
Speaker 2: It was so perfectly like I can imagine the exact
Speaker 2: scientist he was.
Speaker 1: Like, you know, well, the exact scientist was Alexander Yerson
Speaker 1: in the year eighteen ninety four, which is when he
Speaker 1: discovered Yep, that's right, you're sinia pestis. Oh my god,
Speaker 1: the causative agent of plague. Yoursin yourson.
Speaker 2: I never knew where it got its name.
Speaker 1: Now I know, a Swiss scientist. And also, even though
Speaker 1: he probably was the first to actually describe and identify
Speaker 1: the bacterium, he did not get credit for a while
Speaker 1: because he did not publish in English, which is very interesting.
Speaker 2: Oh interesting, So what in Switzerland? What what language? Did
Speaker 2: he publish in? German or French?
Speaker 1: Probably German?
Speaker 2: Cool? Interesting?
Speaker 1: Yeah?
Speaker 2: How fun? Hi and welcome to episode six. Yes, this
Speaker 2: podcast will kill you. My name is Aaron Welsh and
Speaker 2: I'm Erin Alman Updike and this is Plague Part two.
Speaker 1: Yeah. Before we start off, we want to tell you
Speaker 1: guys about a few other podcasts that are awesome and
Speaker 1: you guys should totally check out.
Speaker 2: Yeah, as if you know you have all the time
Speaker 2: in the world to listen to all the podcasts, let's
Speaker 2: tell you about some of our favorites. Yeah.
Speaker 1: Yeah, So, our friend Matt Candais, who's also a student
Speaker 1: with us, produces a podcast called In Defensive Plants and
Speaker 1: it's an awesome, awesome botany podcast. It's like top rated
Speaker 1: on iTunes.
Speaker 2: He interviews really awesome people and it's just a really
Speaker 2: great podcast in general. You know, dot dot dot lookout
Speaker 2: for a crossover episode in the future. We also made
Speaker 2: a Twitter friend, which to me is the most exciting
Speaker 2: thing in the world. I don't know if that's nerdy,
Speaker 2: but when we got our first Twitter friend, I was like,
Speaker 2: I wanted to die of excitement.
Speaker 1: Yeah, as someone who doesn't really do Twitter at all,
Speaker 1: I was in the dark about this, but it was
Speaker 1: Aaron was really excited.
Speaker 2: I was. I almost like, I squealed so hard. But anyways,
Speaker 2: we made friends because I found this podcast called The
Speaker 2: Fems of STEM, which is this amazing podcast all about
Speaker 2: the history of women in science, technology, engineering, and math,
Speaker 2: which is STEM and each episode focuses on a different
Speaker 2: woman and all of her amazing accomplishments in the field.
Speaker 2: It's super interesting. It's hosted by a badass lady named Michelle.
Speaker 1: It's great.
Speaker 2: You should definitely check it out.
Speaker 1: There's also another super cool podcast we want to tell
Speaker 1: you about, and it's created and produced by our friend
Speaker 1: Shane Campbell Stayton and his and his friend Arian Darby.
Speaker 1: It's called The Biology of Superheroes, and in it they
Speaker 1: talk about some of your favorite comic book heroes and
Speaker 1: the biological principles underlying their superpowers.
Speaker 2: It's gonna be amazing. The first episode is being released
Speaker 2: on Too Number first.
Speaker 1: So it'll already be out by the time this episode
Speaker 1: is Oh cool, great, I was gonna say, the first
Speaker 1: episode just dropped and it's all about Peter Parker and
Speaker 1: his spidy physiology.
Speaker 2: My god, I can't wait to listen.
Speaker 1: Yeah, it's gonna be really good.
Speaker 2: I'm thrilled about.
Speaker 1: It's going to be super high quality.
Speaker 2: Yeah, Mage, Mage, what are we chatting about today? Erin, Well,
Speaker 2: this week.
Speaker 1: Just like last week, we're doing something a little bit unusual.
Speaker 1: So the topic of plague is so huge that we
Speaker 1: needed to split it up into two weeks. So this
Speaker 1: is part two.
Speaker 2: So if you missed part one, pause here, go and
Speaker 2: download episode five and then meet us back here in
Speaker 2: like an hour.
Speaker 1: Yeah that that that Episode five will give you the
Speaker 1: biological background and historical context that you may need for
Speaker 1: this next episode. Yeah, so this episode we're gonna be
Speaker 1: talking all about the plague in modern times and ending
Speaker 1: with the discussion of the an outbreak in Madagascar and
Speaker 1: what that means for the rest of the world.
Speaker 2: Cool.
Speaker 1: I guess we should start though, with our quarantinies.
Speaker 2: It's quarantine time.
Speaker 1: What do we have on the menu for this episode?
Speaker 2: Erin another boobo baby though?
Speaker 1: Oh? Okay, is this one the mnemonic variety?
Speaker 2: Yes? Absolutely, okay, okay, Yeah, so this one's made with vodka.
Speaker 1: Okay, so it's just another it's a extra dry martini
Speaker 1: with vodka and and.
Speaker 2: This time we used an olive just to mix it
Speaker 2: up first. Maybe olives are more pneumonic.
Speaker 1: Well, how about we start with an overview of the
Speaker 1: biology just as a refresher.
Speaker 2: That's a great idea. So just to review, Plague is
Speaker 2: a disease that is caused by a bacteria known, as
Speaker 2: we mentioned as your Sinia pestis. It is spread in
Speaker 2: several different ways and the root of transmission determines the
Speaker 2: type of disease that you get. So the most famous
Speaker 2: form is bubonic plague, and that disease is acquired when
Speaker 2: it is transmitted by the bite of an infected flea.
Speaker 2: Pneumonic plague, on the other hand, is when a bubonic
Speaker 2: plague spreads to infect your lungs and then can be
Speaker 2: transmitted via respiratory droplets aka coughing. And then the third
Speaker 2: type of plague is known as septostemic plague, and that
Speaker 2: means that the bacterium has infected your bloodstream and proliferated
Speaker 2: in your blood.
Speaker 1: And there are different mortality rates associated with each of
Speaker 1: these forms, right.
Speaker 2: Absolutely so. Bubonic plague is the least fatal of the three.
Speaker 2: It has mortality rates of thirty to sixty percent if untreated,
Speaker 2: and then mneumonic plague is the most virulent and it
Speaker 2: has up to add percent mortality rate if left untreated.
Speaker 2: The good news is all three of these types of
Speaker 2: disease are treatable with antibiotics as long as you get
Speaker 2: to them fast enough.
Speaker 1: Super super dupes. Okay, I think that's a good I
Speaker 1: think that's a good little.
Speaker 2: Biology in a nutshell.
Speaker 1: So now let's pick up where we left off last week,
Speaker 1: which is more or less at the beginning of what
Speaker 1: historians called the third pandemic. So we talked about last week,
Speaker 1: the first pandemic, which was the Plague of Justinian, the
Speaker 1: second pandemic, which was the Black Death, and then the
Speaker 1: local epidemics that followed that in the centuries after. The
Speaker 1: third pandemic began in eighteen fifty five in China and
Speaker 1: spread to India and some other places as well. Over
Speaker 1: the course of that one year, more than twelve million
Speaker 1: people died in those two countries alone.
Speaker 2: Wow.
Speaker 1: Yeah, twelve million, twelve million. Although the death toll of
Speaker 1: the third pandemic could not hold a candle to that
Speaker 1: of the Black Death.
Speaker 2: Right, nothing can no the Black Death. It's the mother
Speaker 2: of all plagues, Yeah, definitely.
Speaker 1: One of the significant outcomes of it was that by
Speaker 1: the early nineteen hundreds, plague was endemic and wild rodent
Speaker 1: populations all around the world.
Speaker 2: Wow.
Speaker 1: And by this time both the black rat and its
Speaker 1: flea had a global distribution. This was thanks to the
Speaker 1: widespread rapid global travel that was now possible. Infected rats
Speaker 1: brought infected fleas onto boats which would enter every port town.
Speaker 1: At the edges of these port towns, you would find
Speaker 1: human dwellings encroaching onto natural areas, which allowed for the
Speaker 1: intermingling of domestic and wild rodents, and the rat fleas
Speaker 1: had no preference. They were just happy to have so
Speaker 1: many available hosts. If humans and wild rodents came into
Speaker 1: close contact, as they did following deforestation, or whenever human
Speaker 1: settlements were built in previously natural areas, plague could make
Speaker 1: the jump from rodent to human hosts via the bite
Speaker 1: of an infected flea, and this is what the Third
Speaker 1: pandemic saw, pockets of plague, some larger than others, popping
Speaker 1: up in parts of every continent except for Antarctica, and
Speaker 1: also most of Western.
Speaker 2: Europe actually, which is interesting.
Speaker 1: Funny considering the Black Death was most impacted a lot
Speaker 1: of Western Europe. It was during this pandemic in the
Speaker 1: late nineteenth century that substantial medical research was finally done
Speaker 1: on the plague. Its root of transmission via infected fleas
Speaker 1: was identified, the importance of rat populations was realized, the
Speaker 1: causative agent little Basilli Rcinia pests was described. Even with
Speaker 1: all these pretty monumental advances in the medical underpinnings of plague,
Speaker 1: there was still a long way to go. The earliest
Speaker 1: vaccines and antibiotics used to prevent or treat plague infection
Speaker 1: were developed in the late eighteen hundreds, but these weren't
Speaker 1: all that great. If you received either, your chances of
Speaker 1: dying were reduced by about twenty or thirty percent. Wow,
Speaker 1: it's it, yeah, gosh promising, but not really that reassuring.
Speaker 2: No.
Speaker 1: No, improvements continued to be made, and now there is
Speaker 1: a functional plague vaccine, but it still has its problems,
Speaker 1: mostly with longevity in the protection it offers, and on
Speaker 1: the logistical side it takes multiple courses to immunize. Antibiotics,
Speaker 1: on the other hand, are still effective against plague.
Speaker 2: Than now, goodness for now, for now, but fake goodness,
Speaker 2: thanks for now.
Speaker 1: In the nineteen forties is when streptomycin, which is usually
Speaker 1: used to treat plague now it was discovered. Even with
Speaker 1: all of these ways to combat plague, it persisted. But
Speaker 1: actually that verb tenses is wrong. It continues to persist
Speaker 1: in many regions of the world, including Madagascar. Plague is
Speaker 1: considered to be an endemic disease. And what is an
Speaker 1: endemic disease?
Speaker 2: Erin, an endemic disease is a disease. It is sort
Speaker 2: of constantly occurring at low levels in a population.
Speaker 1: Thank you You're welcome. Although the pandemic was declared to
Speaker 1: be over in nineteen fifty nine, so the third pandemic
Speaker 1: was according to the WHO done thirty nine, that was,
Speaker 1: by no means the last year that plague caused an epidemic.
Speaker 2: Oh, definitely not.
Speaker 1: Let's take a little detour to Vietnam in the nineteen sixties,
Speaker 1: in the midst of the Vietnam War, oh dear, when
Speaker 1: the US military was over there, fighting in a pointless
Speaker 1: war they never should have started, and devastating entire communities.
Speaker 2: Getting political not really, sorry though, well getting factual.
Speaker 1: Side note. Did you know that in Vietnam this war
Speaker 1: is referred to as the American War either resistance war
Speaker 1: against America.
Speaker 2: I did hear that? Yes, I did know that.
Speaker 1: Anyway, One of the tactics employed by the US military
Speaker 1: during this time was using chemical warfare to destroy crops
Speaker 1: and sterilize the land. They did this to try to
Speaker 1: weaken the North Vietnamese army by depriving them of food.
Speaker 1: The problem with that, besides being morally bankrupt and evil,
Speaker 1: is that the army would just come into your food
Speaker 1: from civilians, so it mostly had the effect of starving
Speaker 1: entire communities and villages to death, which honestly was probably
Speaker 1: the intention of the US military all along to weekend
Speaker 1: the army by terrorism.
Speaker 2: Yeah, it sounds like the point.
Speaker 1: The US Department of Defense estimates that about twelve percent
Speaker 1: of the farmable land and forest was sterilized during this
Speaker 1: bombing campaign, although the Vietnamese government puts the amount closer
Speaker 1: to forty five percent. Jesus, what this destruction did was
Speaker 1: to drive the wild rodents out of these deforested, destroyed
Speaker 1: areas into human settlements where there was at least still
Speaker 1: some food.
Speaker 2: Whoa.
Speaker 1: As you might expect, this resulted in a massive outbreak
Speaker 1: of bubonic plague.
Speaker 2: Oh my god, that is not something you learn about
Speaker 2: in like seventh grade history class.
Speaker 1: It's not.
Speaker 2: Holy crap.
Speaker 1: Between nineteen sixty five and nineteen seventy, over twenty five
Speaker 1: thousand plague cases were reported in South Vietnam. That's just
Speaker 1: the reported ones, not actual.
Speaker 2: Wow, the actual.
Speaker 1: Total was probably closer to one hundred thousand to a
Speaker 1: quarter of a million. Not not joking, not exaggerating. That's
Speaker 1: what I found.
Speaker 2: Holy crap.
Speaker 1: In a country where, prior to US invasion there were
Speaker 1: only about fifteen cases a year. Reported.
Speaker 2: Oh my god.
Speaker 1: Most of the cases occurred in small, isolated villages where
Speaker 1: I couldn't find exact figures, but I'm sure the death
Speaker 1: rate was really high.
Speaker 2: Yeah, because if you don't have access to medicine, then
Speaker 2: even if you're getting bubonic plague, that's still a sixty
Speaker 2: percent mortality rate. You know, that's ridiculous.
Speaker 1: Some American soldiers also came down with the plague, but
Speaker 1: they were able to get treatment right away, surprise, surprise,
Speaker 1: and most of them were vaccine it. Anyway, this is
Speaker 1: just one of the many, nasty, shameful chapters of American history.
Speaker 2: That is a whole other podcast. There are multiple, many
Speaker 2: other podcasts about that. Yeah, Okay, back to plague. Back
Speaker 2: to plague.
Speaker 1: A lot of you, particularly those listening in the US,
Speaker 1: may think of plague as a thing of the past,
Speaker 1: a medieval disease that has been gone for centuries. Although
Speaker 1: you'd maybe have to be living under a rock if
Speaker 1: you still think that with this latest outbreak in Madagascar.
Speaker 1: But even with this plague outbreak, you may think that
Speaker 1: you don't have to worry about plague living in the US.
Speaker 2: Wrong. Well, you're probably mostly right to think about that. Wrong,
Speaker 2: We'll get into the details of that more later, but
Speaker 2: in terms of natural infections, yeah, yeah, that's true.
Speaker 1: Did you know though, that there have been over a
Speaker 1: thousand cases of plague in the US since the early
Speaker 1: nineteen hundreds. A thousand, that's it, but.
Speaker 2: Still still still still that's a thousand people.
Speaker 1: In the early nineteen hundreds, plague tended to pop up
Speaker 1: in port towns when plague infected ras disembarked from ships
Speaker 1: and their fleas headed into town for a little barfing.
Speaker 1: Fund outbreaks were reported in San Francisco, Oakland, Hawaii, some
Speaker 1: Oregon coastal towns, and several of these outbreaks were dominated
Speaker 1: by the pneumonic, more deadly form of the disease. The
Speaker 1: fleas then headed east overland, transmitting plague into the wild
Speaker 1: rodent populations of the Southwest and West. After about the
Speaker 1: nineteen twenties, plague ceased to be a port city disease
Speaker 1: in the US and instead became one of incidental contact
Speaker 1: with dead or infected animals. Every year from the nineteen
Speaker 1: twenties until now, cases of plague were reported YEP. One
Speaker 1: boy from New Mexico died after skinning a dead coyote.
Speaker 1: He came across. Same for another, but this time it
Speaker 1: was a squirrel instead of a coyote. Another with a rabbit, because,
Speaker 1: like we.
Speaker 2: Mentioned before, the dead bodies remain infectious, right because they're
Speaker 2: basically just full of bacteria. So especially some rodent species,
Speaker 2: but especially carnivores, are very hard hit by plague and
Speaker 2: so they have very high back to your loads. So
Speaker 2: basically we're saying, don't play with roadkill, guys, I.
Speaker 1: Know, which is kind of a shame because roadkill can
Speaker 1: be really a useful study thing.
Speaker 2: Sure, yeah, but just wear gloves.
Speaker 1: Wear gloves when you play with roadkill.
Speaker 2: Yeah.
Speaker 1: Several people also got sick when their pets contracted plague
Speaker 1: from infected wild rodents, like the cats that we mentioned
Speaker 1: last episode. So sad sorry for you cat people out there,
Speaker 1: just like.
Speaker 2: Trying to love on your cat and they're sick and
Speaker 2: they're like coughing, and you're like, oh, poor baby, and
Speaker 2: then they cough in your face and then you both
Speaker 2: die of plague. Yeah.
Speaker 1: Since nineteen sixty five, there have been over four hundred
Speaker 1: and sixty cases of plague in the US. Wow, with
Speaker 1: sixteen percent of those infected dying.
Speaker 2: Geez, that's a really high mortality rate.
Speaker 1: Yeah, with the use of antibiotics and everything.
Speaker 2: Yeah, I wonder if that is largely to do with
Speaker 2: people not being able to recognize it or doctors not
Speaker 2: wanting to die I know, something like plague.
Speaker 1: Right, So there's that kind of begs the question why
Speaker 1: is plague still killing people when there's a vaccine, when
Speaker 1: there's antibiotics, And probably that depends on where you are geographically,
Speaker 1: definitely big time. But overall, plague is still a very
Speaker 1: nasty disease. Yeah, And antibiotics, even if administered early, can't
Speaker 1: always save you or even save you from the nasty
Speaker 1: side effects that you will get from from plague infection.
Speaker 2: Plus, even if you can, you know, even if you
Speaker 2: live in a place like the United States where if
Speaker 2: you have health insurance at least, then you in theory
Speaker 2: have access to a physician to get antibiotics. And even
Speaker 2: if you have a physician that diagnoses it early, we
Speaker 2: don't always go to the doctor when we're feeling sick
Speaker 2: until and with something like plague that can come on
Speaker 2: so rapidly, you might not get those antibiotics until too late,
Speaker 2: even if you had access to them.
Speaker 1: Yeah, So and so in some areas, it could be
Speaker 1: that it's underdiagnosed. Definitely, we're not diagnosed early enough. But
Speaker 1: in other areas where plague is endemic, such as Madagascar,
Speaker 1: getting antibiotics to people who need them is often a
Speaker 1: huge logistical struggle and there is a lot of underreporting
Speaker 1: of the disease, which can prolong an epidemic. The story
Speaker 1: of the plague in Madagascar starts in eighteen ninety eight,
Speaker 1: when the disease first appeared after a ship from India
Speaker 1: full of rice rats and plague arrived at the island.
Speaker 1: Since then, there have been plague deaths every year, some
Speaker 1: years worse than others. The plague, usually in bubonic form,
Speaker 1: tends to pop up every year in Madagascar between September
Speaker 1: and April, but this year it was a little early.
Speaker 1: Aerin Can you tell me a little bit about the
Speaker 1: plague situation in Madagascar today?
Speaker 2: I would love to. So we're going to walk through
Speaker 2: this entire outbreak, and then we're going to talk about what,
Speaker 2: honestly a great job who has done in trying to
Speaker 2: contain this pretty.
Speaker 1: Much, so I cannot wait to hear it.
Speaker 2: I'm excited. So, the current plague outbreak in Madagascar begins
Speaker 2: on August twenty.
Speaker 1: Third, twenty seventeen.
Speaker 2: Twenty seventeen. Yeah, August twenty third of this day year,
Speaker 2: when a thirty one year old male reported malaria like symptoms.
Speaker 2: He started to come down with malaria like symptoms so headache, fever,
Speaker 2: malaise on the twenty seventh of August. So four days later,
Speaker 2: he began experiencing respiratory symptoms while in a shared taxi.
Speaker 2: Uh oh. He later died.
Speaker 1: Uh oh.
Speaker 2: His body was prepared for his funeral at a hospital
Speaker 2: without any safety procedures. Thirty one people who came into
Speaker 2: contact with this individual case, either directly or indirectly through
Speaker 2: like shared taxi contacts or contacts with the funeral people
Speaker 2: became ill and four of them died.
Speaker 1: How many people became ill?
Speaker 2: Thirty one people from that one person initially.
Speaker 1: And he died how soon after showing symptoms within a
Speaker 1: few days. Okay, that's okay.
Speaker 2: The outbreak was officially detected on September eleventh, after a
Speaker 2: forty seven year old female was admitted to the hospital
Speaker 2: with respiratory failure because of pneumonic plague. So that was
Speaker 2: when they first realized that this was an outbreak. By
Speaker 2: the twenty eighth of September, So this is just one
Speaker 2: month after that initial man. There had already been fifty
Speaker 2: one cases of pneumonic plague, the bad one the bad one,
Speaker 2: and twelve deaths reported. There had been an additional fifty
Speaker 2: three cases of the bubonic plague and seven deaths elsewhere
Speaker 2: in the country.
Speaker 1: Interesting, mm hmmm. I have questions about the origin.
Speaker 2: Yeah, I do too. And so there wasn't at least
Speaker 2: what I found a ton of detail on, like the
Speaker 2: specifics of how many index cases there might have been.
Speaker 2: They had the details of this specific story.
Speaker 1: And so this guy who was the index case right,
Speaker 1: had mneumonic plague, yes, and so those people.
Speaker 2: Where he had bubonic plague, that became mnemonic.
Speaker 1: For surekay okay, And so those people that got bubonic plague,
Speaker 1: that indicates that there was a bubonic plague outbreak exactly,
Speaker 1: not related to him, necessarily.
Speaker 2: Necessarily exactly, yeah, okay, because bubonic plague is not transmitted
Speaker 2: person to person, that's transmitted by the bites of the fleet.
Speaker 1: Gotcha.
Speaker 2: By October second, just a few days later, that number
Speaker 2: fifty one cases of mnemonic had jumped to seventy three.
Speaker 2: By November second, and part of the massive increase in
Speaker 2: this numbers has to do with better reporting. But by
Speaker 2: November second, that number had jumped to one thousand, eight
Speaker 2: hundred and one cases of mnemonic plague.
Speaker 1: WHOA, it's a lot of day in cases.
Speaker 2: By the fifteenth of November, which is the most recent
Speaker 2: data that I found, the total count stands at two thousand,
Speaker 2: one hundred and nineteen over twoy one hundred total cases.
Speaker 2: That is, that is considering both what they call confirmed
Speaker 2: so laboratory confirmed cases, probable cases and suspected cases, and
Speaker 2: one hundred and seventy one deaths, which is an eight
Speaker 2: percent case fatality rate.
Speaker 1: Wow.
Speaker 2: Yeah, But what's interesting is that's quite low because the
Speaker 2: vast majority of these cases were clinically classified as mnemonic
Speaker 2: plague and not bubonic plague. So for neumonic plague, that's
Speaker 2: actually a fairly unusually low fatality rate.
Speaker 1: Which indicates potentially that there was a rapid response.
Speaker 2: It could indicate that it could indicate that for some reason,
Speaker 2: this was just like an unusually not virulent strain. But
Speaker 2: who has done an amazing job at responding to this outbreak.
Speaker 2: So let's talk about what happens in the case of
Speaker 2: an outbreak because I think it's thrilling. It's what I
Speaker 2: wanted to do for my job for a long time. Wanted, wanted,
Speaker 2: want to CDC Diami. Just kidding docs, Yeah, not kidding.
Speaker 2: But so what happens when you have a suspected outbreak
Speaker 2: is a whole mass of people from the who from
Speaker 2: the CDC, from doctors without borders, Minisson san frontier, right.
Speaker 2: They're all sent to the place with the main goal
Speaker 2: of finding the index case, the initial person or persons
Speaker 2: who could have sort of started this outbreak. And in
Speaker 2: order to do that, you have to do what we've
Speaker 2: referred to before as boots on the ground epidemiology. You
Speaker 2: have to go there and interview people who were either
Speaker 2: friends of the patient, family of the patient, healthcare workers,
Speaker 2: everyone who ever came into contact with that patient, and
Speaker 2: then trace their contacts back and back and back. And additionally,
Speaker 2: you have to do surveillance of all of those contacts
Speaker 2: to see who might develop symptoms in the future.
Speaker 1: And so that means going back and checking with them
Speaker 1: every day to say, are you sick exactly, what is
Speaker 1: your temperature like r Are you showing any symptoms? Yes,
Speaker 1: it's a lot of man.
Speaker 2: Hours exactly human hours, let's call it.
Speaker 1: It's a lot of human hours. It really of work.
Speaker 2: And so in the case of this plague outbreak, there
Speaker 2: have been over two thousand cases, but there have been
Speaker 2: over seven thousand contacts of each of these cases identified,
Speaker 2: and of those, ninety five percent of them have completed
Speaker 2: seven day follow ups. So that means they've been contacted
Speaker 2: every day for seven days to because, like we said,
Speaker 2: the incubation period tends to be between one to seven days,
Speaker 2: so you have to follow them up for a whole week.
Speaker 2: You can imagine if this were a disease with a
Speaker 2: longer incubation period, it's just that much more work to
Speaker 2: follow up on these people.
Speaker 1: Yeah, that is a lot of effort to put into
Speaker 1: that mm hm.
Speaker 2: And they also we're all given prophilactic antibiotics. So one
Speaker 2: thing about the plague that's nice is that prophylactic antiboctic
Speaker 2: prophilactic antibiotics can help in reducing the chances that you
Speaker 2: end up showing symptoms of plague. Out of those seven
Speaker 2: thousand contacts, only nine of them actually ended up becoming
Speaker 2: suspected cases, which I think is interesting.
Speaker 1: So imagine that you have plague in just you listener,
Speaker 1: you Aaron? Yeah, And how many people do you come
Speaker 1: in contact with and if you have mnemonic plague over
Speaker 1: the course of twenty four hours of a normal let's
Speaker 1: say work day, how many people Because we you know,
Speaker 1: just sometimes tend to hang in the house on Sundays,
Speaker 1: I think, yeah.
Speaker 2: I actually went to a birthday party today, oh with
Speaker 2: her children? Yeah?
Speaker 1: Oops? Sorry, yikes.
Speaker 2: Yeah, I mean you'd have to follow up with each
Speaker 2: of those people that I interacted with at that birthday party.
Speaker 2: There was probably I don't know fifteen people there and
Speaker 2: then go to each of their families and everyone they contacted.
Speaker 1: I mean, it's insane, especially radio. It's outward endlessly.
Speaker 2: In twenty seventeen when we are so mobile, right Like
Speaker 2: this man, this index case, he shared a taxi with
Speaker 2: multiple people, So you need to find how do you
Speaker 2: even find if you're in an uber today? Can you
Speaker 2: even find if you do uber sharing and you are
Speaker 2: with a random person, like, how do you even find
Speaker 2: those people? It takes a ton of real detective work
Speaker 2: to find all of these people and make sure that
Speaker 2: you're following up in order to sort of put a
Speaker 2: ring around the outbreak and try and contain it, and
Speaker 2: most of the reports that I have seen say pretty specifically, well,
Speaker 2: most of the news articles about the Madagascar outbreak specify
Speaker 2: that it has been limited to Madagascar. However, on October tenth,
Speaker 2: a man was reported to probably have no mumonic plague
Speaker 2: in Seychelles.
Speaker 1: I saw that news article and then that was the
Speaker 1: last I saw of it. So is it possible that
Speaker 1: he was a traveler who came from Madagascar?
Speaker 2: Right? So he did come from Madagascar, however, he Yeah,
Speaker 2: so he did. He had visited Madagascar and he returned
Speaker 2: to Seychelles on the sixth of October. They from that
Speaker 2: one person, they monitored three hundred and twenty contacts of
Speaker 2: this person. Eight of them ended up developing mild symptoms.
Speaker 2: But of those three hundred and twenty contacts, forty one
Speaker 2: of them were passengers on his flight from Madagascar back.
Speaker 1: You imagine being on a flight and getting contacted by
Speaker 1: United Airlines. Knaknack, Hello, it's crazy, were on this flight.
Speaker 1: You may have neumonic plague.
Speaker 2: It's just insane.
Speaker 1: Thank goodness, they're antibiotics.
Speaker 2: That's that should be the name of this episode.
Speaker 1: I hope something a little bit better.
Speaker 2: What else about that plague well, as of so, we're
Speaker 2: recording this on November nineteenth, twenty seventeen, and as of today,
Speaker 2: it has.
Speaker 1: Been three weeks and one day since a case has
Speaker 1: been confirmed.
Speaker 2: Right, the last confirmed case of bubonic plague happened on
Speaker 2: the twenty fourth of October, and the last confirmed case
Speaker 2: of mnemonic plague was the twenty eighth of October. However,
Speaker 2: like we've said before, plague is endemic to Madagascar, and
Speaker 2: plague season extends until April, so the surveillance efforts are
Speaker 2: not finished and the risk is not entirely done. However,
Speaker 2: it seems like the worst of this outbreak is hopefully over. Hopefully, Yeah, hopefully.
Speaker 2: It's crazy, though, I mean it was a massive outbreak
Speaker 2: because it's over two thousand cases. From twenty ten to
Speaker 2: twenty fifteen, there was only just over three thousand cases
Speaker 2: of plague reported worldwide, wow, and five hundred and eighty
Speaker 2: four deaths.
Speaker 1: So this is a big one.
Speaker 2: Yeah, it's massive. Yeah, it's definitely one of the biggest
Speaker 2: there was. Plague is certainly noted limited to Madagascar. Madagascar
Speaker 2: does tend to be one of the countries that has
Speaker 2: the greatest burden of it. Year after year. But just
Speaker 2: in the two thousands alone, there have been outbreaks in Zambia, India, Malawi, Algeria,
Speaker 2: the Democratic Republic of Congo, China, Peru, and Madagascar. And
Speaker 2: those are just the outbreaks. That's not counting sort of
Speaker 2: individual cases like we see in the West almost every year. Right. Yeah,
Speaker 2: so sheweg is definitely not over.
Speaker 1: Should we talk about how scared we need to be today?
Speaker 2: Oh my god?
Speaker 1: If you listen to last week's episode, you might remember
Speaker 1: that the use of plague and bioterrorism is nothing new, right,
Speaker 1: this fact, it's many centuries old. When the Mongol army
Speaker 1: threw bodies of plague victims over the city wall of Kafa,
Speaker 1: they were hoping to bring down the city with this
Speaker 1: awful disease. While their efforts may have been ineffectual, there
Speaker 1: have been more successful attempts in the last one hundred years.
Speaker 1: There's a true story from the early twentieth century of
Speaker 1: two half brothers in India who were joint heirs to
Speaker 1: an estate. Yeah do you know where this is going?
Speaker 2: But I'm excited about it.
Speaker 1: One day, one brother met the other brother unexpectedly at
Speaker 1: a train station and gave him a hug goodbye. During
Speaker 1: this encounter, the other brother, the one who was hugged,
Speaker 1: felt a pin prick on his arm. Eight days later,
Speaker 1: he was dead.
Speaker 2: No way.
Speaker 1: Turns out I'm not making this up.
Speaker 2: Is this like verified?
Speaker 1: This is from this book Plague and Ancient Disease in
Speaker 1: the twentieth century. So take it up with Charles Greg.
Speaker 2: Charles Greg, you better be.
Speaker 1: Right about this.
Speaker 2: Is this like Wikipedia status nosca?
Speaker 1: He's a he's a researcher or was a researcher at
Speaker 1: Los Alamos. All right, all right, so he guys what
Speaker 1: was talking about?
Speaker 2: Tell me about it?
Speaker 1: Anyway? So the guy who felt the pin prick on
Speaker 1: his arm, yeah, died eight days later. Turns out his
Speaker 1: brother had recently taken out huge life insurance policy on
Speaker 1: him and then teamed up with a microbiologist. I'm not
Speaker 1: making this up to get some plague basilla. While he
Speaker 1: was hugging his brother. The microbiologist injected some of the
Speaker 1: plague bacilla into the guy to kill him.
Speaker 2: Oh my god.
Speaker 1: They were both found guilty of murder.
Speaker 2: Most microbiologists are not like this, And I would have
Speaker 2: got away with it if it weren't for you, pesky microbiologist.
Speaker 2: Oh my god, I can't believe that.
Speaker 1: Is that crazy? That's like, I've got an idea.
Speaker 2: I've got an idea of an elaborate way to kill
Speaker 2: my brother. I know, how did they really figure out
Speaker 2: that it was not just a naturally infected case of plague? Like?
Speaker 1: Did he say they broke under questioning? Did I? I
Speaker 1: don't know. I mean, if I've seen one CSI case,
Speaker 1: I've seen them all. Yeah, Slash House Slash House a
Speaker 1: great crossover episode between the two. Yeah, yeah, you had potential. Guys,
Speaker 1: there's another story of plague as a bioterrorism agent in
Speaker 1: World War Two.
Speaker 2: This is a fun one. Well, it's not.
Speaker 1: Actually, this is a shocking one, I would say.
Speaker 2: I would also say it's a really interesting one. And
Speaker 2: I want to talk about why so go.
Speaker 1: Apparently the Japanese Army had been experimenting on Chinese prisoners
Speaker 1: by making plague bombs, intending to weaponize plague, particularly pneumonic plague,
Speaker 1: and cause epidemics of it. Apparently, around three thousand prisoners died,
Speaker 1: and the Japanese Army escaped prosecution by the Allied forces
Speaker 1: by turning over their research findings to the US. Wow
Speaker 1: that's interesting.
Speaker 2: So I had read a slightly different story.
Speaker 1: There are some yeah.
Speaker 2: Yeah, what what is the more.
Speaker 1: Well, there are also some reports from China that the
Speaker 1: American Air Force deployed some biological warfare agents in North
Speaker 1: Korea during the Korean War in the early nineteen fifties.
Speaker 2: Huh, So I had read that a quote Secret Branch
Speaker 2: of Japanese Army Unit seven point thirty one, it's important
Speaker 2: to have actually dropped infected fleas all over populated areas
Speaker 2: of China. Yes, which what I think is really interesting
Speaker 2: about that is that not that we're trying to tell
Speaker 2: you how to do bioterrorism, but that's not a good
Speaker 2: way to do it.
Speaker 1: Well, clearly they were experimenting.
Speaker 2: Yeah, I mean, I guess, but it's just really interesting
Speaker 2: trial and it. Yeah, but bubonic plague is not as
Speaker 2: infectious and it's not as virulent, and so it's an
Speaker 2: interesting So it's very.
Speaker 1: Possible that that endeavor dropping infected fleas on different towns
Speaker 1: was what led to their attempt to create pneumonic plague bonds.
Speaker 2: Right, Yeah, so that is There are a list of
Speaker 2: a few diseases that the WHO and several other organizations
Speaker 2: have sort of a task force to look out for,
Speaker 2: and plague is one of the ones that is considered
Speaker 2: the most terrifying, the most likely.
Speaker 1: It should be noted also that Russia has been working
Speaker 1: on weaponizing plague for decades now.
Speaker 2: Interesting like confirmed.
Speaker 1: Wow, it's confirmed as smallpox, all right, all right, so
Speaker 1: highly suggested in some of the dossiers that dossiers.
Speaker 2: Yeah, what's interesting about plague in contrast to something like smallpox,
Speaker 2: which we've talked about the bioterism potential of that, is
Speaker 2: that your Sinia pestis is widely available, whereas smallpox is
Speaker 2: only whether it's in many different government's hands or only
Speaker 2: a few government's hands, it still is in the hands
Speaker 2: of governments worldwide, whereas your Sinia pestis is everywhere. You
Speaker 2: can go to Colorado, you can go to California. You
Speaker 2: can get plague bacteria quite easily from a flea, from
Speaker 2: a rat, from whatever. Yes, And because it has the
Speaker 2: capacity to be mass produced and to be aerosolized and
Speaker 2: be transmitted in that way, it is a really terrifying
Speaker 2: prospect in terms of a bioterrorism agent.
Speaker 1: In some ways. Yes, but also okay, so let's just
Speaker 1: say that someone manages to weaponize plague and makes it
Speaker 1: the pneumonic form and then makes it antibiotic resistant.
Speaker 2: Right, scary, that's probably the scariest scenario that have definitely
Speaker 2: and then releases.
Speaker 1: It into a city. Yes, pneumonic plague kills you so
Speaker 1: rapidly that the period of infectivity is relatively low compared
Speaker 1: to other diseases. And so while it is a very
Speaker 1: scary prospect, it's not. Let's say it's not the best
Speaker 1: or most effective bioterrorism agent and that an outbreak could
Speaker 1: likely be content hained pretty rapidly the way that it
Speaker 1: has been in Madagascar.
Speaker 2: So what it sounds like you're talking about is the
Speaker 2: r not oh of plague. So are not, dear listeners.
Speaker 2: It's like a capital R with a subscript zero, right,
Speaker 2: and we call that are not? So are not? Is
Speaker 2: the basic reproductive rate of a pathogen. What that means
Speaker 2: is the number of secondary cases that happen from a
Speaker 2: single primary case if everyone in your population is susceptible. Yeah,
Speaker 2: and so in the case of mnemonic plague, You're right,
Speaker 2: the r not is estimated to be only about one
Speaker 2: point three, which means, on average, only one point three
Speaker 2: people it's an average is actually infected from every person
Speaker 2: who has nemonic plague. That's in contrast to something like smallpox,
Speaker 2: which has an r not of guess what, I don't know,
Speaker 2: around six and a half.
Speaker 1: Whoa, yeah, yeah, interesting.
Speaker 2: Yeah, so that's something that because as I was reading this,
Speaker 2: I was like, why am I not more scared of plague?
Speaker 2: Do I need to be? What's the r not? And
Speaker 2: it was actually more difficult than I expected to find
Speaker 2: that number. But yeah, it's quite low compared to other
Speaker 2: potential bioterrorism agents that are maybe more scary, or even
Speaker 2: other infections like measles, which has an ar not of thirteen. Wow,
Speaker 2: it's one of the highest.
Speaker 1: Oh we have to do an episode on that.
Speaker 2: Oh, we definitely will, okay, but also just get vaccinated
Speaker 2: and then we don't have.
Speaker 1: To worry about it. It's a little harder, I think
Speaker 1: in some areas than others. Yeah, yeah, like Orange County.
Speaker 2: God unfortunately, mom kidding, she vaccinated us.
Speaker 1: Overall, it seems like plague is still a scary organism
Speaker 1: and it's still clearly causing a lot of disease and deaths,
Speaker 1: definitely in certain areas of the world, But in terms
Speaker 1: of a bioterrorism agent. It's not the best one, not
Speaker 1: the one we need to worry the most about.
Speaker 2: Right, it's on the list. I think that people who
Speaker 2: are in charge of worrying about those things are worrying
Speaker 2: about it. So like on the day to day, don't
Speaker 2: let it keep you up at night.
Speaker 1: And let's just say also that this bubonic plague mnemonic
Speaker 1: plague is a disease that is once again mostly concentrated
Speaker 1: in countries that are economically poor or economically struggling, and
Speaker 1: with improved sanitation, with improved surveillance of disease and so on,
Speaker 1: that these diseases could be brought to very very low levels.
Speaker 2: Yeah, especially with plague, it's all about surveillance and monitoring
Speaker 2: because if you are able to catch individual cases, you
Speaker 2: can prevent the spread so while and you also can
Speaker 2: prevent initial infection if you don't have houses that are
Speaker 2: infested with fleas. So with improving infrastructure you can help
Speaker 2: prevent things like that.
Speaker 1: Okay, so plague, that was a big one. It was
Speaker 1: to your whole epithet Part two slightly shorter, but not
Speaker 1: any less. Sweet. I guess we want to, Oh, do
Speaker 1: you have any do you have any reading materials to
Speaker 1: cite or do you or do that.
Speaker 2: I actually don't. I got all my information from who.
Speaker 2: Thanks so much for what you do.
Speaker 1: Yeah, once again, I'll just do a shout out for
Speaker 1: Plague and Ancient Disease in the twentieth century by Greg Charles.
Speaker 2: Greg got you, got you girl.
Speaker 1: We want to also thank Bloodmobile for the music yet again.
Speaker 1: Do an extellar job kicking it and please remember to rate,
Speaker 1: review and subscribe, and also feel free to email us
Speaker 1: at this podcast will Kill You at gmail dot com
Speaker 1: if you have any suggestions or questions or corrections or
Speaker 1: corrections any of those things. We are happy to hear
Speaker 1: from you.
Speaker 2: We would love to hear from you, and follow us
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Speaker 2: Thanks for listening.
Speaker 1: Wash your hands yet filthy Animals.