Latest / Culture Positive: An Infection Prevention Podcast / It's a Bird! No, it's the Plague
Transcript
- Ally: So a fun fact about me is that I have an irrational fear of birds. I really don't like any of them, and I'm convinced they are always on the attack. I respect their space, and I pray the birds respect mine. I have tried to place where my fear of birds came from, and here is the most rational explanation. Thank you for listening to Culture Positive. If you have any questions or ideas for an episode, please send me an email at culturepositivepod at gmail.com. References for the episode can be found in the show notes. Infection prevention is about more than policies and protocols. It's about people. Until next time, stay curious. Welcome to Culture Positive, an infection prevention podcast where healthcare, public health, and real life meet. I'm Allie, and by day I work in infection prevention at an academic hospital, bringing my background in epidemiology and public health into everyday practice. Each episode will dive into healthcare stories. Public health conversation, workplace reality, historical context, and the human side of this work. This is a space for curiosity, honesty, and hopefully some inspiration. I'm glad you're here. Picture me another lifetime. London, March of 1665. I woke up to having a high fever and crippling headache. I also have painfully swollen lymph nodes, and I'm unable to eat or drink. My family has called the doctor, and the last thing I remember is a bird mask staring at me. Stay compassionate and keep building a culture that's truly positive. It seems reasonable for me to have a fear of birds, right? I mean, creepiest PPE I have ever seen. And what was this used for? Well, the bubonic plague, of course. The Great Plague of London that lasted from 1665 to 1666 killed almost a quarter of London's population in about a year and a half. This was not the first time the bubonic plague rendered its ugly head. Have you ever heard of the Black Death? Let's get into it. Thinking about this through a historical epidemiological lens, let's talk about how the Black Death even started. Black Death is a zoonotic disease, meaning it can spread between animals and humans. Some other famous zoonotic diseases in recent years would be COVID-19 and the hantivirus, which we previously went over. Remembering Back to how quickly COVID-19 spread globally might give a better perspective on how the Black Death moved throughout Europe and Asia. We actually have a time frame of when the plague arrived in Europe. October 1347. Via what? We're bringing up ships again via merchant ships. And what would a devastating disease be without rodents and fleas? This is how the Black Death spread. Fleas fed off the rodents who were a natural carrier for the disease. Fleas and rodents were known to be on merchant ships, and when the rats would die, fleas were still hungry, The fleas transmitted the bacteria through their bites and infected humans. Unfortunately, the Black Death could also be transmitted person to person while also being zoonotic. Okay, back to the ships. There were twelve ships from the Black Sea that were docked in present day Sicily, port of Messina, and spread. Rapidly throughout Europe via the various trading ports. When I first started researching the Black Death, I thought maybe the disease got its name due to being associated with trading ships being docked in the Black Sea. This is not the case, but I will share later on in the episode how this outbreak got the name Black Death. Anyway, with the nature of how trading goods occurred in medieval times, the illness eventually made its way to Spain, France, Austria, Hungary, Switzerland, Germany, England, Scotland, Scandinavia, and Baltic countries. Okay. I'm gonna make us go back to history class for a quick second. Do you remember learning about the Silk Road? This was a network of trade routes that included major trading ports where goods, money, ideas, and unfortunately illness were shared. Merchants carried silk, jade, tea, and spices from China to Europe. And in exchange, horses. Textiles and manufactured goods were traveled back east. The plague originated in Central Asia and made its way all along the Silk Road to Europe. While the Silk Road was extremely beneficial in terms of trade and commerce, it unfortunately also brought sickness and death. When the Black Death reached Europe, It is believed that 30 to 60 percent of the continent's population died, which could be as high as 50 million people. It is probably no surprise that cities with compact living situations and not having the best hygiene practices at the time led to high volumes of mortality. I can speak to, as I mentioned earlier, my time in London in 1665, that poor hygiene practices could include human waste being discarded into open streets. and public water. You rarely took a full body bath. And you also would have straw covered floors that, wouldn't you know it would attract the fleas and the rodents. It's never good if you have any areas that are attracting fleas and rodents. Just like COVID-19, the spread of the bubonic plague turned into a pandemic, worldwide spread. Also, with COVID in the back of your mind, does the word quarantine ring at any bells? The concept of a quarantine can actually be linked to the Black Death. There was a port city known as Rogusa, modern day Croatia, was a big trading port between Europe and Asia. Very similar to the port in modern day Sicily we spoke about during the starting point for the Black Death. Like most large trading ports during this time, there were frequent outbreaks that occurred due to the international travel of the ships and the crew members inside, and also the unknown crew members of rodents and fleas. The city of Ragusa, more specifically the Great Council of Ragusa. Attempted to try and slow down the spread of the plague by issuing a trentina. A trentina required ships coming in from infected or areas of possible activity for the plague to anchor for 30 days before docking in the city. At some point, this got extended to a 40-day period, known as a quarantina, aka quarantine. During this time, they were able to screen individuals for the plague without putting those in their city at harm's risk. Unfortunately, not every city followed the same suit in terms of utilizing the idea of a quarantine. And with how trade occurred during this time, the spread of the plague increased rapidly. The black plague is believed to have presented in three different forms. The most common form was the bubonic plague, which is what I have described previously with the swollen lymph nodes. Pneumonic, which infects the lungs, is far more contagious due to transmission being able to occur person to person. The mortality rate for pneumonic is quite high, with a rate estimated between 90 to 95%. The third and most devastating was septemic plague. Bacteria entered the bloodstream. Those who were infected became septic immediately. This almost always ensured death and could sometimes kill an individual within hours of showing symptoms. Did anyone watch Hamnet? So incredibly sad, but a very good visualization of of how the plague could have presented and the devastation it caused. In case you need a trivia fact about the bubonic plague, the Black Death is not the earliest documentation of the bubonic plague. The earliest historical documentation on an outbreak of the bubonic plague occurred in 541 CE in Constantinople. No surprise here, this was also believed to have occurred due to trading routes. However, These trading routes were from Egypt to Constantinople. Okay, enough with history. Let's talk about the bug that caused so much devastation. What is the organism that causes the bubonic plague? Ursinia pestis, a gram-negative rod-shaped bacteria. As mentioned earlier, this is zoonotic and is spread mostly by fleas on rodents or other animals. Humans can be infected by a flea biting them and can then spread person to person. Exposure to the plague could also occur through infected animal tissues or fluids or bites or scratches. What does this bacteria look like when it enters a human host? It's not pretty. When talking about the most common presentation of the plague, the bacteria enters the bloodstream and eventually makes its way to the lymphatic system. As you may know, the lymphatic system is our immune defense and is essential in fighting off infections and diseases. The lymph nodes themselves play a large role. And the immune response and when they detect something is off, a threat to the body, white blood cells multiply rapidly to try and fight what the body deems as destructive. This is when lymph nodes will become swollen, along with fever, chills, weakness, and fatigue being reported as symptoms. ready to know why ⁓ was called the Black Death? It's because the swollen lymph nodes could darken to a red ⁓ even black color. Imagine how painful that must have been. Can confirm the plague sounds horrible, right? Good thing it's no longer around. Unfortunately, it is still around. Did I get you on that one? There are still reports of both bubonic and pneumonic worldwide. Bubonic is the most common form and can still cause severe disease and even death, with a case to fatality ratio of 30 to 60 percent. Luckily, with advances in healthcare, we now have access to antibiotic treatment. That is effective. Currently, plague epidemics are possible with cases reported in the last several years in Madagascar, Tanzania, Vietnam, China, and the US. Just in 2017, Madagascar experienced an outbreak of the plague from August to November. There were a total of 2,417 cases. That were confirmed and two hundred and nine deaths. The plague is endemic to Madagascar, meaning there is a constant presence in that area of the world. In the US, cases are more likely to occur outwest in rural areas, with a death in Arizona being reported as recently as 2025. Don't fear, we have ways to reduce your risk of getting plague. Something you can do is utilize bug spray, keep your pets safe with flea prevention, and also don't be feeding any wild animals. I also want to highlight that if you seek health care and receive treatment, recovery is in your future with 95% survival rate. Like I said before. We have access to antibiotics. Shout out to science. For our Huddle Corner, a section for some takeaways before signing off, I would like confirmation that it is totally understandable that I am afraid of birds. A bird mask is an absolute no from me. While the Black Death is one of the most devastating and fatal pandemics of the bubonic plague, remember it is not the first occurrence recorded of the bubonic plague. Also, The naming of Black Death did not come from the epicenter of the plague, the ships docked in the Black Sea, but from the painful swollen lymph nodes that were reported to have turned red and black. And finally, even though we still have reported cases every year worldwide, we are lucky enough to live in a time where we have access to treatment.