Quarantines, inexpensive prophylactic tetracycline treatments, and fast information-sharing by electronic mail were credited with holding the official death toll to 57 and the official number of human plague victims to 693, but the unconfirmed death toll may have been much higher. More than 6,000 people were treated for plague symptoms at government clinics. Post mortems found that 84% of the fatalities were both male and HIV-positive, whereas only 4.7% of those hospitalized were HIV-positive–a strong indication that despite the panic, the strains of plague involved were not usually deadly to people with healthy immune systems who got prompt treatment.
Apparently related outbreaks during early October killed 11 people and afflicted 26 more in southwestern Zimbabwe, which has a large ethnic Indian population. Three cases of bubonic plague detected among Mozambiquan refugees in southern Malawi on October 12 were believed to have been unrelated.
Coming on much like a common cold in most cases, for which reason most Indian officals initially didn’t recognize the disease, plague is caused by the Yersinia pestis bacterium, and may take either of two forms: bubonic and pneumonic. Bubonic plague is carried by infected fleas, who in turn are usually brought into proximity with people by rats and mice, although more than 200 mammal species are known to get the disease. Pneumonic plague is spread by sneezing. Bubonic plague appeared in Maharashtra state, east of Bombay, in early September, but claimed no known fatalities. Pneumonic plague then hit in Surat, which had been free of plague since 1951. Eventually eight Indian states were afflicted.
Rat-catching
Although the cities of Chicago and New York maintain special rat-catching task forces, rat-catching has long since ceased to be a major function–or any function–of most U.S. animal control departments. In the Third World however, including India, the village rat-catcher is as familiar a figure as the dogcatcher is in our Saturday morning cartoons. Rat-catching is the primary duty of animal control departments, followed by killing suspected rabid dogs. Cats generally aren’t part of the Indian animal control beat; feral cats are considered the front line of defense against rats and mice, whom Hindus rarely kill. Indeed, although rats are blamed for eating or spoiling more than 4.5 million tons of food per year in a nation which rarely has any food surplus, rats are worshipped because a rat was the ever-present loyal companion of the elephant god, Ganesh–and the center of rat worship is the Karni Mata temple in Rajastan state, within the afflicted region. Thousands of pilgrims from all parts of India participated in the annual festival of Ganesh, which concluded in Surat on September 18, just a week before the deaths began.
To avoid offending Ganesh and the devout, rat-catchers traditionally transport the animals beyond city or village limits, and let them go, yet another avenue by which plague might have spread.
“This nonsense has to stop,” retired government official Kolomesh Chandra Dev told Dilip Ganguly of Associated Press. “The time has come for people to realize it is either us or the rat.” Dev, of New Delhi, organized a private rat-killing campaign, while the city government struggled to get enough of a 590-vehicle motor pool into adequate repair to catch up on refuse removal, to reduce the food supply for rats. New Delhi rat-catchers set 5,000 traps nightly.
Bombay responded, meanwhile, by adding a night shift to the work schedule of its 4,000 refuse removers; dispatched 2,500 paramedics on a house-to-house search for refugees and other visitors from Surat; and hired extra rat-catchers, with instructions to poison rats rather than just remove them. The preference for poisoning rather than dispatching by quicker, more humane means was apparently because setting out poison technically means the rats kill themselves by eating it, and is therefore less offensive to Hindu religious sensibilities even though it means the rats suffer more. The poison squads claimed to have killed 2,000 rats a day throughout early October.
Plague in the U.S.
While the U.S. has never had a major outbreak of plague, the disease is known here, especially in the west. A national plague tracking system was begun in 1944. During the next decade, cases appeared only in California, Arizona, and New Mexico. Circa 1950, plague spread into the Rocky Mountain region. Of the 362 human cases recorded since national tracking began, 336 occurred in the Rockies–244 of them after 1981. Beginning in 1984, plague between moving north as far as Montana and eastward into Texas, but according to acting plague section director Kenneth Gage of the Centers for Disease Control and Prevention, the disease is likely to stop there because the mid-Plains area marks the eastern edge of the known habitat for the deer mouse, rock squirrel, and prairie dog, who have been the primary mammalian carriers.
Traditionally, most U.S. plague victims contract the disease from wildlife. The first known case in Wyoming, for instance, afflicted a trapper who got it while gutting a rabbit in 1978. The first Wyoming fatality was another trapper who got it while skinning a bobcat in 1992. But, said Gage, seven of the 10 human plague cases in 1993 were infected at home; at least two were infected by cats, rarely carriers abroad, as have been at least 13 other people since 1977.
One victim was a 31-year-old Tucson man, who in 1992 volunteered to rescue a cat from a crawl space beneath friends’ home in rural Colorado. He found the cat docile but desperately ill. Face to face with her while coaxing her out, he apparently contracted pnuemonic plague from a sneeze; mistook the symptoms for stomach flu; waited 48 hours to seek medical help; and died. His case mirrored that of a woman from South Lake Tahoe, California, who died after face-to-face contact with her sick cat in 1980. That region remains a plague risk area, as other infected cats were foundd in nearby Truckee during 1992 and 1993. Sixteen California counties reported plague in animals during 1993. The afflicted locales were scattered throughout the Sierra Nevada foothills, with other cases in San Diego, Riverside, and San Luis Obispo.
According to a veterinary bulletin issued on September 24 by the California Division of Communicable Disease Control, “The incubation period for plague in cats is short, approximately two days. Bubonic plague is the most common form seen in cats, and usually appears as fever, anorexia, lethargy, lympthadenopathy, and/or buboes,” or abcessed lymph nodes. “The submandibular lymph nodes are frequently affected,” the bulletin continued. “In the less common form, pnuemonic plague, respiratory signs may be seen with or without buboes, and include sneezing, coughing, nasal discharge, oral lesions, and/or lower respiratory signs. Exudate from buboes or respiratory secretions and sputum are contagious to humans,” it emphasized.
Veterinarians were advised to hospitalize and isolate any cat with plague symptoms, “until the signs are completely resolved. Protect veterinary clinic personnel from secretions and other body fluids,” the warning added, “by using disposable surgical masks, gowns, and gloves while handling the animal. Thoroughly disinfect or dispose of all contaminated materials. Treat the cat for fleas with an effective insecticide. Also instruct the owner on how to treat the cat’s environment and other contact animals. Owners of cats with suspected plague, the treating veterinarian, and the staff should consult their phsycian immediately, especially if fever or lymphadenopathy develop.”
Concluded the California advisory, “To help prevent plague in cats, advise clients to keep their pets confined away from rodents and teach them how to practice effective, regular flea control.”
The advisory did not recommend any special measures to eliminate the homeless cat population, aware, perhaps, that medieval fear and hatred of cats brought on a purge of the species throughout much of Europe–followed by a population explosion among rats and mice, and the Black Death, a plague epidemic that killed a third of the European population before it subsided.
Forty-four nations undertook special measures to contain the Indian plague outbreak. Nearby nations generally closed their borders to Indian visitors. More distant and more medically advanced nations variously limited air travel from India, screened arriving passengers for symptoms, and discouraged residents from going to India. In-flight fumigations of aircraft, controversial recently after public disclosure of several cases in which passengers had serious reactions to the insecticides, were stepped up. India instituted screening of all departing air passengers.
Japan, plague-free since 1926, helped bring the Indian outbreaks under control by donating 3.3 million antibiotic capsules to India. Informed estimates of the cost of the outbreak to India, where the average daily wage is under a dollar, ranged from $300 million to $10 billion.
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