Plague and the medical neglect of the poor

by Jamie Lutton

I am worried about the Black Death outbreak in Madagascar, and am thinking about Trump's FEMA response to the disaster in Puerto Rico - how they are linked 
in a chain of unholy possibilities. 

The government  in Matagasgar -- a military junta has been running the country since 2009 - - has been not able to -- or has ignored the 'black death' or bubonic plague outbreaks that happen every year there.  The average citizen in Madagascar lives on less than $600 dollars a year. Even though this country abounds in natural wealth, like gemstones, this money does not filter down to most of the population. 

Bubonic plague has been carried by rats on that island in rural areas for decades.

After the rice harvest is over in the drier highlands,  there is a die-off of rats who endemically carry the bubonic plague. The disease then is carried by hungry fleas to humans, who catch it, from September to April, directly from the fleas of the dying rats.  Rats are so common in rural areas, they are a food source for the people there. 

But this year is different.  This outbreak has come earlier, and is a different form of the plague. 

There is a pneumonic plague outbreak - and instead of hitting the rural areas, the crowded cities are under siege. As of Oct 19, there were about 74 deaths and over 700 cases of this more serious form of the plague. unlike bubonic plague, which 30 to 60% of the victims recover without treatment, 100% of penumonic plague victims die within three days, sometimes 24 hours. There is no pattern of survival with this version, it is as fatal as rabies is.  

This form of the plague seems to have jumped into the population from an untreated case of the bubonic plague.  Or perhaps more than one.  According to the CDC, 10% of the untreated cases of bubonic plague morphs into penumonic plague, so with hindsight,  with so many cases of every year here, this was bound to happen sooner or later. This version of the disease reaches the victim's lungs and is spread from person to person as an aerosol disease, spread by coughing and breathing. 

The Index case seems to have spread it across the country as he took public transportation, a shared cab that he was in for many hours, as people were dropped off and picked up. .He appeared to think he only had a bad cold or case of malaria, util he suddenly died.   His body was not tested for plague, and was buried without any precautions, or 

with tracing who he had contact with in his trip across the country.  They did not realize they had a plague case until more people had died. 

The pneumonic plague outbreak there could turn into an international crisis, like the Ebola outbreak in 2015 did in Africa, where it  also jumped into cities where it had never been seen before, and into the poor urban population there. As  penumonic plague is spread by breath, coughing or spitting, this is much easier to catch than Ebola is, which is spread mostly by blood contact, as when a body is handled after death or when a caretaker touches the body fluids.   

The authorities in Madagascar  have closed the schools and many businesses in the face of this outbreak, which has terrified the local population. 

You can buy antibiotics over the counter in Madagascar, there is no controlover this.  People are dosing themselves like mad, trying to treat this on their own.

Madagascar's care for their poorer citizens has sharply declined in the past 9 years or so, the infrastructure to support public health nurses and doctors has withered away from neglect and a disinclination to spend any money on the health of the people there. 

This is where it can get dicey if a type of pneumonic plague arises that is resistant to antibiotics, which could happen pretty quickly  since the people are dosing themselves
with all kinds of antibiotics that they can buy over the counter

There is a type of tuberculosis that is resistant to antibiotics as people who had it and were treated with antibiotics did not finish their dose of pills, and a version of this disease evolved that can not be treated easily, as it  is resistant. And this version of tuberculosis is now spreading all over the world. 

Watch the news. If this disease jumps to Africa, out of Madagascar, into their more crowded and poorer nations, this could be a terrible catastrophe. Thousands could die, if this disease is half as contagious as the seasonal flu. 

What with the 1% writing off the poor nations, and poorer parts of nations, we could all be in trouble This is the price of ignoring the poor, and cutting aid to them, as can be seen in Trump's proposed budget. 

The world is a lot smaller now, with passenger jet travel being quite affordable, international tourism and business trips linking all the major cities to each other, so that a sick person could travel thousands of miles in a day with ease. 

Madagascar was devastated by cyclone Enawo  in March this year, with  80 dead, and with 276  thousand losing their homes.  This devastation might have triggered this latest outbreak of the plague, as the tens of thousands struggled to rebuild,  and not able to fight dirt and garbage, with their living conditions degraded. We see this after every natural disaster; it is very had to stay clean and control food waste and human waste, which is where rats thrive. 

Does this not sound like the conditions right now in Puerto Rico, where tens of  thousands are driven to drink unsafe water and catching diseases from that water.? We are already seeing  many deaths of dialysis patents and patents on oxygen because there is no electricity to drive the machines that keep them alive.

All it would take would be to have the rats that are already taking advantage of the garbage and chaos to start spreading this disease, or another disease. Haiti, after their last earthquake, now has endemic cholera on the island, brought there by peacekeeping forces from Asia, cholera that was not endemic before.

The plague can be fought - antibiotics we now have can cure it.  But what about other diseases out there?

Epidemic disease like influenza in the Far East, and this disease arises in areas that are dirty and with a lot of poor people crammed together close fleas on rats (or pigs  and chickens, with the flu) and who have governments who do not fund clinics or nursing care for their poor. 

As anyone knows who owns a cat or a dog even in Seattle, pet fleas are damn hard to control - consider what the challenge is for a poor family in Madagascar without ADVANTAGE flea treatment on hand when they are fighting the fleas from the rats that have just died. . 

The black death  has come back in a pandemic every 700 years. During the Justinian Roman Empire in the 680's, the late 1340's in Western Europe, and now this outbreak. Both those previous times, half the known world died. 

Even though we know much more about epidemic disease than doctors did even 100 years ago, when bubonic plague was first analyzed and described correctly,

Every flu season, a version of the flu goes around the world, killing thousands of people who are very young or old, have weak immune systems, or did not get their flu shots, or have complications from other illness. 

What kind of toll will this disease take? And if not this year, next year, as long as the government in Madagascar refuses to take care of their weakest and poorest residents, by finally suppressing the bubonic plague completely.

What disease could arise in Puerto Rico and sweep the world? And if you think I am being an alarmist, 5% of the world died in the flu epidemic of  1918, which was probably set off by the unsanitary crowded conditions during  World War l. 

And if not this year, what about next?  What will happen in the future in Madagascar, Puerto Rico, or some other neglected and poor corner of the Earth, where the poor have been written off' by the 1% because they are of color, or speak the 'wrong' language?