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Should you worry about #SquirrelPlague?

Should you worry about #SquirrelPlague?

Reading Time: 2 minutes

I’m not sure if you’ve seen the news yet of the squirrel found in a Los Angeles park which tested positive for bubonic plague?


Avid readers may have been my recent Black Death post, but there’s nothing like a topical blog post, so I thought I’d come back to it in light of today’s news.

In schools across the (Eng)land, children are taught that between 1665 and 1666 anywhere between 15-50% of the UK population was wiped out by bubonic plague. However, this was just part of an extended period of intermittent plague epidemics which began in 1347, killing between 75-200 million people. Pretty significant!

So given the identification of Yersinia pestis in LA, should we be worried?

The simple answer is no (not least because in its Bubonic phase it is not highly contagious) . Sporadic cases of plague occur from time to time in both wild and domesticated animals. On occasion it is also found in humans, with 999 probable or confirmed cases between 1990 and 2010. The fact that Plague has been identified isn’t, in itself, a cause for concern. Early treatment with antibiotics, which weren’t available in the 1600’s, is very effective.

For outbreaks of novel disease, public health agencies take a number of proactive measures, such as the closure of the park and contact tracing of people potentially exposed, to try and reduce the spread of disease. From media reports, it looks as though all the measures that I would expect to be implemented at this early stage have been.

Plague is often high on the list of organisms that could be used by terrorists. This is nothing new, in fact, there is evidence that early Mongol armies casually tossed plague infected corpses over fortress walls in an effort to defeat their enemies in the 1346 Siege of Caffa. And there is certainly a general level of anxiety around the term, having even been incorporated into daily language “to avoid something like the plague” (although this probably owes to earlier use of the term plague in the medical profession in a more generic sense).

Plague has a complex biology; requiring the involvement of fleas and rodents and consequently on climatic conditions, as well as a relationship with social factors such as sanitation, healthcare and environment. Theoretically, the pneumonic plague form of infection has a potential for person-to-person transmission, however a relatively short infective period and poor adaptation to transmission by respiratory routes mean that it is still not highly communicable.

In 1994 in Surat in India, 52 people died from pneumonic plague. However, things quickly got out of hand, partly as a result of misinformation in the media. Therefore, whilst its right that health authorities in the states are talking this outbreak seriously, and it will be interesting to see how the media handle the story when eastern news agencies wake up. But, there really is little cause for alarm.

As my colleague John Twigg at UCL states, the most dangerous aspect today, would be unrestrained use of the word plague.


Image source: (I don’t think this is the squirrel in question!)

Plague and Progress

Plague and Progress

Reading Time: 4 minutes

Following incidents responders undertake debriefs to identify lessons for the responder community; I’ve participated in and facilitated many such events. However, investigation of past disasters can also reveal information on how they were caused, contributing factors and identify options for prevention or mitigation – essentialy progress is (at least partly) driven by past experience.

black death

Cries of “make way for the Plague Doctor” were heard from the back of the auditorium as Dr Carole Reeves (UCL), in long coat, beaked mask and hat, made her way to the lectern. It’s safe to say that not all lectures start as dramatically as the one I attended today, entitled Plague Bones: how London’s Black Death became a tropical disease.

The Museum of London (arguably one of my favourites) has amassed quite the collection of bones, sourced from plague pits or during the construction of the London Underground, which are made available to researchers to help analysis of past events, including the Black Death.

As a term, “Black Death” didn’t arrive until relatively recently in the 19th Century, with “plague” or “pestilence” the terms in 14th Century vogue. As an emerging (or re emerging) infectious disease there was little or no inherent population immunity. It was therefore devastating.

At the time, Plague (Yersinia pestis) was seen as a sign of a displeased deity (interestingly, Islamic doctrine at the time was that Plague was the will of God and was to be endured). However, through providing ministry to the dying, the clergy had a higher degree of exposure and was one of the hardest hit populations, with 1 in 3 perishing.

Plague doctors, their leather beaks stuffed with herbs and spices to ward off evil airs, were in short supply in the Middle Ages. However, other professions rolled up their sleeves to provide diagnosis and treatment, notably barbers (have you noticed the red and white striped pole outside some barbers – this has it’s roots as an advertisement of the practice of bloodletting). Treatments of the day included purging, cupping, cauterisation and lancing. Some more outrageous suggestions were also suggested including placing a frog on the buboes, rubbing oneself with a chickens bottom, drinking snail tea or chopping up a puppy and applying it, still warm, to the victims chest.

On the authority of the Pope, top Parisian doctors concluded the conjunction of Saturn, Jupiter and Mars in the sign of Aquarius in 1345 was the cause of the pestilence – causing the earth to “exhale poisonous vapors”. Offering some prescription, the same report advised:

No poultry should be eaten, no waterfowl, no pig, no old beef, altogether no fat meat. . . . It is injurious to sleep during the daytime. . . . Fish should not be eaten, too much exercise may be injurious . . . and nothing should be cooked in rainwater. Olive oil with food is deadly. . . . Bathing is dangerous.

With such helpful medical advice, it’s no wonder that people turned to religion and ritual; there was a strong reliance on charms and lighting of fires of juniper and rosemary to ward of the mal arias (or bad air, from which we get “malaria”).

The significant numbers of fatalities put extreme pressure on burial space, and in London, saw the construction of large emergency cemeteries, the final resting place of some 20,000 victims, some in coffins, but many in burial pits 6 deep.

Infections don’t emerge (or re-emerge) in a vacuum, their mutation is linked to climatic and, ecosystem factors, levels of health and immunity and coexisting infections. It’s thought that a contributory factor to the Black Death could have included a series of famines including The Great Famine 1315-1317, movement of military and opening of trade routes between Europe and Asia, and coexisting infections of tuberculosis, lice and intestinal parasites.

The modern plague doctor has a much more sophisticated range of tools at his disposal:

  • Border Biosecurity – ships suspected of coming from infected areas were turned away. Today, much effort goes into maintaining bio-secure borders – partly the reason that there are restrictions on what you can take on holiday with you
  • Containment – some settlements isolated themselves from the disease through isolation for 40 days (hence the term quarantine). Whilst this was only minimally effective at the time, containment was one of the response strategies during the 2009 Swine Flu Pandemic
  • Surveillance – absent in the Middle Ages, we now have vastly improved international schemes to monitor the epidemiology of human, animal, insect and plant diseases which mean that decisions can be taken much further in advance
  • Medical Treatments – a significant step on from the ‘frogs and dogs’ approach, with a continually developing understanding of the body, pharmacology and disease we now have access to a much better range of effective treatments
  • Protection – with advances in materials and understanding, we’re now able to protect ourselves against infections through hand and respiratory hygiene and barriers such as gloves and masks rather than beaked leather masks stuffed with herbs and spices.
  • General Health – again rooted in understanding of disease, the notion of germs and the rise of cleanliness, we now have access to clean water, flushing toilets and it’s difficult to imagine a situation where public health authorities recommend exercise being injurious!

plague doc modern doctor

Much of this has progress has been the result of learning stemming from past incidents. Whether the Black Death hundreds of years ago, or recent outbreaks of SARS, lessons from the past must continue to shape our preparedness for the future.


Image Credits: Corbis, Paul Fürst, Brian Thomas Humek,