Historically, the plague originated from the bacteria, Yersinia pestis. Incidentally infected, this bacterium was responsible for the largest plague epidemics in the world (i.e. Justinian Plague, Black Death, and Bubonic Plague) (Plague History PowerPoint, slides 3-4). Accounting for ~100 million of the Eurasian population (slide 38), the bacterium’s ability to invade and diversify showed the unrestrained capabilities of this disease. Infection was not isolated to one method of transmission and could spread either by blood (septicemic) or air (pneumonic) (slide 12).

Societal factors greatly contributed to the virulence of these plagues. The increase in population created denser environments, multiplying the vulnerability for air borne transmission. Debris infested streets became the ideal breeding compound for rats overrun by fleas, and expansion of trade linking Western Europe and China further enhanced the diffusion of disease. Frightened by mortality, many succumbed to the plague, abandoned any attempts to help those infected, and fixated on self-preservation. In an endeavor for repentance of their sin, the people turned to zealotry, a fanatical and uncompromising pursuit of religious ideals. Fanatics whipped themselves in a brutal imitation of Christ’s suffering and further lead them in to hysteria, persecution, and mass murder (The Plague History Channel Documentary).

As all authoritative (i.e. medics, clerics, nobles, etc.) figures failed to protect the people from pestilence, the masses turned to other methods for salvation. Primarily, they relied on ‘The Flagelance,’ figures who displayed extreme measures of self-harm to ward off the disease and avert God’s wrath. Others, convinced that God was punishing them for their sins, persecuted the Jews and took combative measures. The majority were forced to make false confessions of conspiracies and were either expelled or burned alive (The Plague History Channel Documentary).

Other attempts to control the transference of plague was introduced in 1377. Maritime quarantine was held for 40 days based off Hippocrates theories regarding acute illnesses, mathematical equations, and biblical reasoning (slide 43). Boards of health oversaw isolation of the exposed individuals, managed medical and burial services, and kept record of causes and tolls of death. Based off the intelligence gained by surveillance, confined hospitals were designed and managed to isolate those exposed (slide 44). By the third wave (Modern Plague), Westerners highly criticized poor sanitation conditions and responded draconically. Victims were extremely isolated, clothing and cadavers were burned, houses were fumigated, and slums were razed (slide 60). Immigrants had severe limitations to their personal freedom and were forced to receive experimental and anti-plague vaccines (slide 68)

Today, plague transmission is primarily through the exposure from species to species. Many types of animals such as wood rats, prairie dogs, mice, rabbits can be affected by the plague and serve as long-term hosts for vectors (Plague Today PowerPoint, slide 11). Exposure or contact with contaminated fluid from plague-infected animals primarily result in the bubonic and septicemic plague (slide 17-18). In the U.S., plague mostly occurs as scattered cases in rural areas. Based off reported cases of human plague (1970-2012), majority occur in northern New Mexico, northern Arizona, and southern Colorado, California, southern Oregon, and western Nevada (slides 8-9).

Currently, the highest concentration of plague is in sub-Saharan Africa; predominantly Madagascar (slide 25). The plague re-emerged in Madagascar in the 1990s but reached epidemic levels after 2009, putting the country in a perilous state of public health. Political upheaval coupled with drastic cuts in foreign assistance crippled basic government services (i.e. waste disposal), investments in clean water and infrastructure collapsed, and development of poverty became rampant (slide 29). Cultural factors (i.e. burial practices), lack of health care facilities, co-habitation with animals, and climate effects were other variables that affected the lack of control in Madagascar (slides 30-33).

From our experience, disease is an ongoing threat. Many of the factors that contribute to the escalation of disease is through human behavior and societal issues. We have made vast improvements in our identification and treatment of notable diseases. However, as a society, we must always be vigilant to mitigate behaviors that put us at risk; we never know when the next outbreak will occur. To do so, we must act. For example, we should provide adequate health care, reduce unsanitary behavior, inform the public, etc.

Help Received: PPT History of Plague, PPT Plague Today, The Plague History Channel Documentary, Cadet Jones (structure and organization of information), Dictionary/Thesaurus

In our experience and understanding of previous outbreaks, we have learned that diseases never remain stagnant. Diseases once eradicated return, diseases evolve, and entirely new diseases emerge. We may not be able to stop the ongoing evolution of disease; however, we can further research these epidemics and provide adequate diagnoses and treatments as preventive measures. It is vital to identify pathogens that are at risk for spillover to prevent an outbreak from spiraling out of control. As a society, it is our duty to be vigilant and mitigate behaviors that put us at risk.

Viruses are continually advancing. However, unlike bacteria that can live and reproduce on their own, viruses occupy hosts. They invade species and diversify their range for survival (Spillover video). Their ability to jump species increases the vulnerability of spillover that much more prominent. Hence, the importance of zoonotic diseases. Once infected, casual contact can be the start of an epidemic with an explosive consequence. With the world consisting of millions of species, we are not short handed with the liabilities we face. It has become a growing global threat and accounts for various prominent diseases of the modern age. For example, the Nipah virus that had been widespread in Bangladesh. With a distinguished population of fruit bats, these creatures were culprits in the contamination of tree sap, a delicacy of sort, that quickly spread throughout the country (Spillover video).

Naturally, social and cultural issues also play a role in outbreaks. Primarily from the decisions and behaviors of humans. For instance, there have been debates between pro-vaccination vs. anti-vaccination. Questions on the risks and benefits of vaccination, including whether or not the act of getting vaccinated endangers the lives of others is commonly discussed. There have also been instances where vaccinations have caused allergic reactions and debilitating side effects, negatively affecting people. Thus, opening the floor for continuous debate on risk-benefit analysis (YouTube).

Since the 1900s, we have had a drastic increase in population growth. In dense throngs, pathogens spread easily and quickly develop resistance to drugs (Yong, 2018). Therefore, increases in globalization and densely populated areas pose a tremendous risk. Having the potential to spread explosively, it can quickly escalate from a local epidemic to a world-wide pandemic. For example, in 2003, a Chinese seafood seller hospitalized in Guangzhou passed sars to dozens of doctors and nurses, one of whom traveled to Hong Kong for a wedding. In a single night, he infected at least 16 others, who then carried the virus to Canada, Singapore, and Vietnam. Within six months, sars had reached 29 countries and infected more than 8,000 people (Yong, 2018).

Pathogens do not have boundaries. They do not have borders or political interests. Anything at an international level begins at a local level (Spillover video). With that being said, I find it difficult to believe that we are prepared for a large and sustained outbreak. Though we have been successful in creating new vaccines and have implemented various preventive measures to identify new pathogens, I believe that the world would have a difficult time in effectively containing an outbreak of such parameters. Essentially, we would have to react extremely quickly and activate all precautionary measures such as rapid detection, diagnosis, and treatment at a local level. However, because these outbreaks are typically generated in places where they are not capable of providing effective care, it is difficult to ‘cut it at the root.’ In conclusion, a weak health system anywhere poses a threat everywhere (Spillover video).