It turns out that epidemics and pandemics all end the same way. People get tired of worrying about being sick and say “Life or death, I don’t want the rest of my life to be spent in hiding.”  It helps to not be part of the “if you get it, you’re dead” category of citizens, although many people who were not supposed to be at risk die anyway and no one is entirely sure why.

Bubonic or Pneumonic plague has no effective vaccine. You can’t get a “shot” that will prevent you from getting it and while heavy doses of antibiotics help, mostly, it kills you. Its favorite targets are young, healthy people, not very young or very old folks. Why don’t we see Bubonic Plague these days?

We do. Since it showed up in Europe in 1347 and decimated its population, it has made its way around the world, killing millions, including in the United States where the last cases were in 1900 and again in 2015 when the U.S. had 1,036 cases. In 2015, 16 people in the Western United States developed Plague, including 2 cases in Yosemite National Park.

It has not disappeared. It is lying low and could come back. Let’s hope not!

How did it end? The most popular theory of how the Plague ended is through the implementation of quarantines. The uninfected would typically remain in their homes and only leave when it was necessary, while those who could afford to do so would leave the more densely populated areas and live in greater isolation.  Also, the plague stopped being dependent on fleas and became Pneumonic, which meant that coughed up droplets or sneezes could spread the disease from person to person, no rats or fleas required.

Museum of London, Plague 1665-1666

While it seems like the Black Death was the only instance of the bubonic plague epidemic, there were many other bouts with it through the centuries, including a pandemic that started in Asia in the 19th century. The World Health Organization didn’t consider this pandemic officially over until 1959 when the annual deaths finally dropped to fewer than 200.

In 1920 Galveston, that “oozy prairie,” as early settlers described it, was only 20 years removed from the devastating 1900 hurricane. Then came Plague. A 17-year-old feed store worker was the first to contract and die from the disease. The first case was diagnosed in early June 1920. Over the following months, eighteen people were diagnosed. Seven survived.

There was initial mishandling with Plague. In two cases the doctors note in their report that the patient isolation “was not accomplished as rapidly as desired,” both because families were slow to call in a doctor and because the doctor didn’t consider bubonic plague to be an actual possibility.

Vaccines have not been found useful for Plague. Vaccines work best for diseases that are stable and don’t mutate such as smallpox and polio. The Coronaviruses are rapid mutators, so whether or not they can find an effective vaccine is a big question.

The plague bacteria, Yersinia pestis, had lain dormant in China’s Gobi Desert for centuries. But in the 1300s, it emerged with a vengeance, fanning out via trade routes from Asia to Europe and killing millions of people along the way. The plague was transmitted by fleas harbored by rats, which flourished in the overcrowded, filthy cities of the Middle Ages. By the end of the 1500s, between a third and half of Europe’s population had died from the Black Death.

Even during the 1900s, the plague still killed millions of people, but since then, the advent of better hygiene in cities and swift treatment with antibiotics has reduced this killer.

This article from The Washington Post by Mary E. Fissell, Professor of History of Medicine at the Johns Hopkins University School of Medicine explains what we are seeing today with histories of previous pandemics and epidemics. It is shockingly similar to past events. Here are quotes. If you can read the entire article, please do.

“Just as today, a global economy was a key driver of the English epidemic. Bubonic plague, which is bacterial rather than viral, is typically spread to humans by fleas who have fed on the blood of infected rats. Earlier plague epidemics — such as the Black Death of the 1300s, which may have wiped out half the population of Europe — came to Europe via merchants traveling back from Asia along the Silk Road. In the same way, contemporary observers reported that the 1665 epidemic may have been brought to London by Dutch trading ships; the epidemic had already spread there a year earlier. In the months before it reached England, authorities had tried, obviously without success, to quarantine ships from the Netherlands and other plague-affected places.

Another conspicuous resemblance is socioeconomic. In the United States, we’ve seen that covid-19 is disproportionately affecting poor people, as well as blacks and Latinos. Overall, these groups tend to have poorer health and less access to health care, and they are more likely to live in crowded, unhealthy conditions and to work in jobs that require them to come into close contact with others who may be infected.

In New York for example, the death rate among blacks is twice as high as it is for whites; for Latinos, it is 60 percent higher. In Louisiana, blacks make up a third of the population but so far account for almost 60 percent of covid-19 deaths. About 5,000 meatpacking workers, and perhaps many more, have tested positive for the virus to date, largely because of a lack of safety measures and the industry’s cramped and grueling working conditions.

The situation 350 years ago in London was similar. During the epidemic, the London city government counted the dead, tracking how many people died of plague in each parish. This work was performed by “searchers of the dead,” who were often older poor women. These parish lists, known as Bills of Mortality, were printed up and sold weekly, a kind of early version of Zip-code-by-Zip-code health reports from state health departments.

Examining these lists, both 17th-century readers and historians have found that, no surprise, the poorest neighborhoods tended to have the highest death rates from the plague. The reasons for this are probably similar to the causes of today’s disparities — the poor were already less healthy, lived in dense, unsanitary neighborhoods and did the city’s dirty work.

They could not leave. Even without our current scientific knowledge, people knew the disease moved from place to place. And once it reached English shores, people practiced social distancing as best they could, by getting away from the worst disease hot spots. Just as we are seeing today, those who could afford it left the cities for the countryside, where there was less disease; the classic medical advice of the time was “leave quickly, go far away and come back slowly.”

…  Today, as we face another disease, one that we still don’t understand very well, 17th-century England reminds us that despite the enormous leaps we’ve made in science and technology, humans themselves remain in many ways the same: imperfect, not always rational and still deeply vulnerable to novel nasty microbes.”

Thus we can see that human reaction to pandemic outbreaks hasn’t changed. We blame others for it. We persecute others for it. We run away if we can. The better-off survive while the poorest pay the full price.

People believe rumors. Others spread them. In the end, life goes on, but not as it was before the plague came. This “return to normal” is not a return to the world before the plague. It’s a social return only and it doesn’t mean people stop dying. Viruses don’t care how you feel about them.

Economies do not recover in a month or two. Not ever in the history of the world has that happened. Nations fall, governments collapse, economies are decimated. Plagues change everything, not just human lives.

Is this one over? Probably not. Wait. watch and we shall see.