This Podcast Will Kill You - Ep 6 Plague Part 2: TGFA

Episode Date: December 5, 2017

We're back with another episode all about plague-TGFA: Thank Goodness For Antibiotics! Today we'll focus on the status of plague in the modern world: where it is, where it isn't, and what we can do about it. And as always, we'll let you know whether or not to put on your scaredy pants. See omnystudio.com/listener for privacy information.

This is exactly right. There are already enough things charging your card every month. Dinner should not be one of them, which is exactly why Blue Apron is now subscription-free. You heard that right, Blue Apron no longer requires a subscription. You can order meals when you want them and skip when you don't without adding another recurring charge. Blue Apron meals are designed by chefs and arrive with pre-portioned ingredients, so there's no meal planning and no extra grocery trip. Order now at Blue Apron.com. Get 50% off your first two orders plus free shipping with code this podcast 50.

Terms and conditions apply. Visit blue apron.com slash terms for more information. On eBay, every find has a story. Like if you're looking for a vintage ban tea. Not just a tea. The ban tea. You wore it everywhere. Until your BFF stole it.

Now you're on eBay. And there it is. Same tea from the same tour. The things you love have a way of finding their way back to you, especially on eBay. Where else can you find that mint trading card you searched everywhere for? Or your first car, the one you wished you never sold. It has to be eBay. Shop eBay for millions of fines, each with a story. eBay, things people love. Indeed, sponsor jobs gets you quality candidates when you need them most. Spend less time searching and more time actually interviewing

candidates who check all your boxes. Less stress, less time, more results. When you need the right person to cut through the chaos, this is a job for Indeed sponsored jobs. And listeners of this show will get a $75-sponsored job credit to help get your job the premium status it deserves at Indeed.com slash podcast. Terms and conditions apply. Need to hire?

This is a job for Indeed Sponsored Jobs. June 20th. With the help of Father Vagano, I try to persuade some of the time. English sailors, whose duty it is to bury the dead from the city and other hospitals, to let me take the buboes from the dead before they are buried. A few dollars conveniently distributed and the promise of a good tip, for every case, have a striking effect. The bodies before they are carried to the cemetery are deposed for one or two hours in a cellar. They are already in their coffins in a bed of lime. The coffin is opened. I move the lime to clear the thigh region. The

Bubo is exposed. Within less than a minute, I cut it away and run to my laboratory. I see a real mass of bacilli, all identical. From the bubo, I inoculate agor tubes, mice, and guinea pigs. My bacillus is most probably that of plague, but I am not certain. June 21st. I go on cutting and examining bubos. I always find the same bacillus, extremely abundant. My animals inoculated yesterday are dead and show the typical plague bubos. I love that. I was really nervous. I was really It was so perfectly, like I can imagine the exact scientist who was like, Burr-Ber-Bu-B-B-B-B-B-B-you-you- Well, the exact scientist was Alexander Yerson in the year 1894, which is when he discovered, yep, that's right, Yersinia Pestis, the causative agent of plague.

Yersen. Yerson. I never knew where it got its name. Now I know. A Swiss scientist. And also, even though he probably was the first. to actually describe and identify the bacterium, he did not get credit for a while because he did not publish in English, which is very interesting. Oh, interesting. So what in Switzerland, what,

what language did he publish in German or French? Probably German. Cool. Interesting. Yeah. How fun. Hi and welcome to episode six. Yes. Of this podcast will kill you. My name is Aaron Welsh. And I'm Aaron Alman Updike. And this is Plague part two. Yeah. Before we start off, we want to tell you guys about a few other podcasts that are awesome and you guys should totally check out. Yeah, as if, you know, you have all the time in the world to listen to all the podcasts. Let's tell you about some of our favorites. Yeah. Yeah. So our friend Matt Candace, who's also a student with us, produces a podcast called In Defensive Plants and it's an awesome, awesome botany podcast. It's like top rated on iTunes. He interviews really awesome people and

it's just a really great podcast in general, you know, dot, dot, dot, look out for a crossover episode in the future. We also made a Twitter friend, which to me is the most exciting thing in the world. I don't know if that's nerdy, but when we got our first Twitter friend, I was like, I wanted to die of excitement. Yeah. As someone who doesn't really do Twitter at all, I was in the dark about this, but Erin was really excited. I was, I almost like I squealed so hard. But anyways, we made friends because I found this podcast called The FEMS of STEM, which is this amazing podcast all about the history of women in science, technology, engineering, and math, which is STEM. And each episode focuses on a different woman and all of her amazing accomplishments in the field. It's super interesting.

It's hosted by a badass lady named Michelle. It's great. You should definitely check it out. There's also another super cool podcast we want to tell you about. And it's created and produced by our friend Shane Campbell-Staten. and his and his friend Aryan Darby. It's called The Biology of Superheroes, and in it they talk about some of your favorite comic book heroes and the biological principles underlying their superpowers.

It's going to be amazing. The first episode is being released on December 1st. So it'll already be out by the time this episode is out. Oh, cool. Great. I was going to say, the first episode just dropped. And it's all about Peter Parker and his spidey physiology. Oh, my God.

I can't wait to listen. It's going to be really good. I'm thrilled about it. It's going to be super high quality. Yeah. Mage. Mage. What are we chatting about today, Aaron?

Well, this week, just like last week, we're doing something a little bit unusual. So the topic of plague is so huge that we needed to split it up into two weeks. So this is part two. So if you missed part one, pause here. Go and download episode five and then meet us back here in like an hour. Yeah, that episode five will give you the biological background and historical context that you may need for this next episode. Yeah. So this episode, we're going to be talking all about the plague in modern times and ending with the discussion of the recent outbreak in Madagascar and what that means for the rest of the world.

Cool. I guess we should start, though, with our quarantinis. It's quarantini time. What do we have on the menu for this episode, Aaron? Another boobo babya. Oh, okay. Is this one the pneumonic variety? Yes, absolutely.

Okay, okay. Yeah. So this one's made with vodka. Okay, so it's just another, it's an extra dry martini with vodka and... And this time we used an olive just to mix it up. There we go. Maybe olives are more mnemonic. I don't know.

Well, how about we start with an overview of the bioly just as a refresher. That's a great idea. So just to review, plague is a disease that is caused by a bacteria known, as we mentioned, as Yersinia pestis. It is spread in several different ways, and the root of transmission determines the type of disease that you get. So the most famous form is bubonic plague, and that disease is acquired when it is transmitted by the bite of an infected flea. Pneumonic Plague, on the other hand, is when a bubonic plague spreads to infect your lungs and then can be transmitted via respiratory droplets, aka coughing. And then the third type of plague is known as septicemic plague, and that means that the bacterium has infected your bloodstream and proliferated

in your blood. And there are different mortality rates associated with each of these forms, right? Absolutely. So bubonic plague is the least fatal of the three. It has mortality rates of 30 to 60% if untreated, and then pneumonic plague is the most virulent, and it has up to 100% mortality rate if left untreated. The good news is all three of these types of disease are treatable with antibiotics, as long as you get to them fast enough. Super. Super dupes. Okay. I think that's a good, I think that's a good little... Biology in a nutshell. Now let's pick up where we left off last week, which is more or less at the beginning of what historians called the third pandemic. So we talked about last week the first pandemic, which was the plague of Justinian, the second

pandemic, which was the black death and then the local epidemics that followed that in the centuries after. The third pandemic began in 1855 in China and spread to India and some other places as well. Over the course of that one year, more than 12 million people died. And in those two countries alone. Wow. Yeah. 12 million? 12 million.

Although the death toll of the third pandemic could not hold a candle to that of the Black Death. Right. Nothing can. No. The Black Death. It's the mother of all plagues. Yeah, definitely.

One of the significant outcomes of it was that by the early 1900s, plague was endemic in wild rodent populations all around the world. Wow. And by this time, both the Black Rat and its flee had a global distribution. This was thanks to the widespread rapid global travel that was now possible. Infected rats brought infected fleas onto boats, which would enter every port town. At the edges of these port towns, you would find human dwellings encroaching onto natural areas, which allowed for the intermingling of domestic and wild rodents.

And the rat fleas had no preference. They were just happy to have so many available hosts. If humans and wild rodents came into close contact, as they did following, deforestation or whenever human settlements were built in previously natural areas, plague could make the jump from rodent to human host via the bite of an infected flea. And this is what the third pandemic saw. Pockets of plague, some larger than others, popping up in parts of every continent except for Antarctica and also most of Western Europe, actually, which is funny considering the Black Death

was most impacted a lot of Western Europe. It was during this pandemic in the late 19th century that substantial medical research was finally done on the plague. Its root of transmission via infected fleas was identified. The importance of rat populations was realized. The causative agent, little basilie, ursinia pestis, was described. Even with all these pretty monumental advances in the medical underpinnings of plague, there was still a long way to go. The earliest vaccines and antibiotics used to prevent or treat plague infection, were developed in the late 1800s, but these weren't all that great.

If you received either, your chances of dying were reduced by about 20 or 30%. Wow. That's it. That's it? Yeah. Gosh. Promising, but not really that reassuring. No.

Improvements continued to be made, and now there is a functional plague vaccine, but it still has its problems, mostly with longevity and the protection it offers and on the logistical side. It takes multiple courses to immunize. antibiotics on the other hand are still effective against plague for now for now for now but thank goodness for now but thank goodness for now in the 1940s is when streptomycin which is usually used to treat plague now is was discovered even with all of these ways to combat plague it persisted but actually that verb tense is wrong it continues to persist in many regions of the world including madagascar plague is considered to be an endemic

disease. And what is an endemic disease, Aaron? An endemic disease is a disease that is sort of constantly occurring at low levels in a population. Thank you. You're welcome. Although the pandemic was declared to be over in 1959, so the third pandemic was, according to the WHO, done, in 1939. That's it, no more. That was by no means the last year that plague caused an epidemic. Oh, definitely not. Let's take a little detour to Vietnam in the 1960s. In the midst of the Vietnam War, when the U.S. military was over there, fighting in a pointless war,

they never should have started, and devastating entire communities. Getting political. Not really. Sorry. I mean, really, though? Well, getting factual. Side note,

did you know that in Vietnam this war is referred to as the American War, or the resistance war against America? I did hear that, yes. I did know that. Anyway, one of the tactics employed by the U.S. military during this time was using chemical warfare to destroy crops and sterilize the land. They did this to try to weaken the North Vietnamese Army by depriving them of food.

The problem with that, besides being morally bankrupt and evil, is that the army would just commandeer food from civilians. So it mostly had the effect of starving entire communities and villages to death, which honestly was probably the intention of the U.S. military all along to weaken the army by terrorism. Yeah, sounds like the point. The U.S. Department of Defense estimates that about 12% of the farmable land and forest was sterilized during this bombing campaign. Oh, my God. Although the Vietnamese government puts the amount closer to 45%. Jesus.

What this destruction did was to drive the wild rodents out of these deforested, destroyed areas into human settlements, where there was at least still some food. as you might expect this resulted in a massive outbreak of bubonic plague oh my god that is not something you learn about in like seventh grade history class it's not holy crap between 1965 and 1970 over 25,000 plague cases were reported in south vietnam that's just the reported ones not actual wow the actual total was probably closer to 100,000 to a quarter of a million Not joking, not exaggerating. That's what I found. Holy crap. In a country where prior to U.S. invasion, there were only about 15 cases a year reported. Oh, my God. Most of the cases occurred in small isolated villages where I couldn't find exact figures, but I'm sure the death rate was really high. Yeah, because if you don't have access to medicine, then even if you're getting bubonic play,

that's still a 60% mortality rate. Yeah. That's ridiculous. Some American soldiers also came down with the plague, but they were able to get treatment right away. Surprise, surprise. And most of them were vaccinated anyway. This is just one of the many nasty, shameful chapters of American history.

That is a whole other podcast. There are multiple many other podcasts about that. Yeah. Okay. Back to plague. Back to plague. A lot of you, particularly those listening in the U.S., may think of plague as a thing of the past, a medieval disease.

that has been gone for centuries. Although you'd maybe have to be living under a rock, if you still think that, with this latest outbreak in Madagascar. But even with this plague outbreak, you may think that you don't have to worry about plague living in the U.S. Wrong. Well, you're probably mostly right to think about that. Wrong.

We'll get into the details of that more later. But in terms of natural infections, yeah. Yeah. That's true. Did you know, though, that there have been over 1,000 cases of plague in the U.S. the early 1900s. A thousand, that's it. But still, still, still, that's a thousand people. Dinner shows up every night, whether you're prepared for it or not. And with Blue Apron, you won't need to panic order takeout again. Blue Apron meals are designed by chefs and arrive

with pre-portioned ingredients so there's no meal planning and no extra grocery trip. There, assemble and bake meals take about five minutes of hands-on prep. Just spread the pre-chopped ingredients on a sheet pan, put it in the oven, and that's it. And if there's truly no time to cook dish by Blue Apron meals are fully prepared. Just heat them in the oven or microwave, and dinner is ready. And here's the exciting news. Blue Apron no longer requires a subscription. You can order meals when you want them and skip when you don't,

without adding another recurring charge. Order now at blueapron.com. Get 50% off your first two orders plus free shipping with code this podcast 50. Terms and conditions apply. Visit blueapron.com slash terms for more information. Anyone who works long hours knows the routine. Wash, sanitize, repeat. By the end of the day, your hands feel like they've been through something.

That's why O'Keefe's working hands hand cream is such a relief. It's a concentrated hand cream that is specifically designed to relieve extremely dry, cracked hands caused by constant hand washing and harsh conditions. Working hands creates a protective layer on the skin that locks in moisture. It's non-greasy, unscented, and absorbs quickly. A little goes a long way. moisturization that lasts up to 48 hours. It's made for people whose hands take a beating at work, from health care and food service to salon, lab, and caregiving environments. It's been relied on

for decades by people who wash their hands constantly or work in harsh conditions because it actually works. O'Keefs is my hand cream of choice in these dry Colorado winters when it feels like my skin is always on the verge of cracking. It keeps them soft and smooth, no matter how harsh it is outside. We're offering our listeners 15% off their first order of O'Keefs. Just visit o'Keef's company.com slash this podcast and code this podcast at checkout. A timeless wardrobe starts with pieces that are built well from the beginning. From the fabrics to the fit, everything needs to last beyond one season. And that's how Quince approaches design. Quince has all the staples covered, from 100% organic cotton sweaters to premium denim made with

stretch for all-day comfort and luxe cotton cashmere blends perfect for the changing seasons. The quality shows in every detail, the stitching, the fit, the fabrics. Every piece is thoughtfully designed to be your new wardrobe essential, and each piece is made with premium materials in ethical trusted factories and priced far below what other luxury brands charge. I recently got a pair of Quince's Bella stretch wide-leg jeans, and they are now in constant rotation. They are so comfortable, the fit is amazing. and they come in a bunch of different washes, so I'm about to go order some more.

Refresh your wardrobe with Quince. Go to quince.com slash this podcast to get free shipping on your order and 365-day returns, now available in Canada too. That's Q-U-I-N-C-E.com slash this podcast to get free shipping and 365-day returns. Quince.com slash this podcast. In the early 1900s, plague tended to pop up in port towns when plague-infected wrath disembarked from ships and their fleas headed into town for a little barfing fun. Outbreaks were reported in San Francisco, Oakland, Hawaii, some Oregon coastal towns, and several of these outbreaks were dominated by the pneumonic, more deadly form of the disease. The fleas then headed east overland, transmitting plague into the wild rodent populations of the

southwest and west. After about the 1920s, plague ceased to be a port city disease in the U.S. and instead became one of incidental contact with dead or infected animals. Every year from the 1920s until now, cases of plague were reported. One boy from New Mexico died after skinning a dead coyote he came across. Same for another, but this time it was a squirrel instead of a coyote, another with a rabbit. Because like we mentioned before, the dead bodies remain infectious, right? Because they're basically just full of bacteria.

So especially some rodent species, but especially carnivores, are very hard hit by plague. And so they have very high bacterial loads. So basically we're saying don't play with roadkill, guys. I know, which is kind of a shame because roadkill can be really a useful study thing. Sure, yeah, but just wear gloves. Wear gloves when you play with roadkill. Yeah. Several people also got sick when their pets contracted plague from infected wild rodents,

like the cats that we mentioned last episode. I'm so sad. Sorry for you cat people out there. Just like trying to love on your cat and they're sick and they're like coughing and you're like, oh, poor baby. And then they cough in your face and then you both die of plague. Yeah. Since 1965, there have been over 460 cases of plague in the U.S. with 16% of those infected dying. Geez, that's a really high mortality rate. Yeah, with the like use of antibiotics and everything. Yeah. I wonder if that is largely to do with people not being able to recognize it or doctors not wanting to diagnose something like plague. Right. So that kind of begs the question, why is plague still killing people when there's a vaccine, when there's antibiotics? And probably that depends on where you are geographically. Definitely. Big time. But overall, plague is still a very nasty disease. Yeah. And antibiotics, even if administered early, can't always save you or even safe.

you from the nasty side effects that you will get from from plague infection plus even if you can you know even if you live in a place like the united states where if you have health insurance at least then you in theory have access to a physician to get antibiotics and even if you have a physician that diagnoses it early we don't always go to the doctor when we're feeling sick until and with something like plague that can come on so rapidly you might not get those antibiotics until too late even if you had access to them. Yeah. So.

And so in some areas, it could be that it's underdiagnosed. Definitely. We're not diagnosed early enough. But in other areas where plague is endemic, such as Madagascar, getting antibiotics to people who need them is often a huge logistical struggle. Yeah. And there is a lot of underreporting of the disease, which can prolong an epidemic. Mm-hmm.

The story of the plague in Madagascar starts in 1898, when the disease first appeared after a ship from India full of rice, rats, and plague arrived at the island. Since then, there have been plague deaths every year, some years worse than others. The plague, usually in bubonic form, tends to pop up every year in Madagascar between September and April, but this year it was a little early. Erin, can you tell me a little bit about the plague situation in Madagascar today? I would love to. So we're going to walk through this entire outbreak, and then we're going to talk about what honestly a great job WHO has done in trying to contain this pretty much. So I cannot wait to hear it.

I'm excited. So the current plague outbreak in Madagascar begins on August 23rd. 2017. 2017. Yeah. August 23rd of this dang year. When a 31-year-old male reported malaria-like symptoms, he started to come down with malaria-like symptoms. So headache, fever, malaise.

On the 27th of August, so four days later, he began experiencing respiratory symptoms while in a shared taxi. Uh-oh. He later died. Uh-oh. His body was prepared for his funeral at a hospital without any safety procedures. 31 people who came into contact with this individual case either directly or indirectly through, like shared taxi contacts or contacts with the funeral people became ill and four of them died. How many people became ill?

31 people from that one person initially. And he died how soon after showing symptoms? Within a few days. Okay. That's okay. The outbreak was officially detected on September 11th after a 47-year-old female was admitted to the hospital with respiratory failure because of pneumonic. plague. So that was when they first realized that this was an outbreak. By the 28th of September, so this is just one month after that initial man, there had already been 51 cases of pneumonic plague. The bad one. The bad one. And 12 deaths reported. There had been an additional 53 cases of the

bubonic plague and seven deaths elsewhere in the country. Interesting. I have questions about the origin. Yeah, I do too. And so there wasn't at least what I found a ton of detail on like the specifics of how many index cases there might have been. They had the details of this specific story. And so this guy who was the index case, right, had pneumonic plague. Yes. And so those people that were- Or he had bubonic plague that became pneumonic for sure. Okay. And so those people that got bubonic plague, that indicates that there was a Bubonic plague outbreak that was not related to him necessarily. Necessarily, exactly. Yeah.

Because bubonic plague is not transmitted person to person. That's transmitted by the bites of the fleas. Gotcha. By October 2nd, just a few days later, that number, 51 cases of pneumonic had jumped to 73. By November 2nd, and part of the massive increase in this numbers has to do with better reporting, but by November 2nd, that number had jumped to 1,801 cases. of mnemonic play.

Whoa. It's a lot of dang cases. By the 15th of November, which is the most recent data that I found, the total count stands at 2,119, over 2,100 total cases. That is considering both what they call confirmed, so laboratory confirmed cases, probable cases, and suspected cases. and 171 deaths, which is an 8% case fatality rate. Wow.

Yeah. But what's interesting is that's quite low because the vast majority of these cases were clinically classified as pneumonic plague and not bubonic plague. So for pneumonic plague, that's actually a fairly unusually low fatality rate. Which indicates potentially that there was a rapid response. It could indicate that. It could indicate that for some reason this was just like an unusually not very strain, but WHO has done an amazing job at responding to this outbreak.

So let's talk about what happens in the case of an outbreak because I think it's thrilling. It's what I wanted to do for my job for a long time. Wanted? Wanted. Wanted. Wanted to CDC hire me. Just kidding. Looking for postdocs. Kind of. Yeah, not kidding. But so what happens when you have a suspected outbreak, is a whole mass of people from the WHO, from the CDC, from Doctors Without Borders, Medicine Sons Frontierre, right? They're all sent to the place with the main goal of finding the index case, the initial person or persons who could have sort of started this outbreak. And in order to

do that, you have to do what we've referred to before as boots on the ground epidemiology. You have to go there and interview people who were either friends of the patient, family of the patient, health care workers, everyone who ever came into contact with that patient, and then trace their contacts back and back and back. And additionally, you have to do surveillance of all of those contacts to see who might develop symptoms in the future. And so that means going back and checking with them every day to say, are you sick? Exactly. What is your temperature like? Are you showing any symptoms? Yes.

It's a lot of man hours. Exactly. Human hours. Let's call it. It's a lot of human hours. It really is. Of work. And so in the case of this plague outbreak, there have been over 2,000 cases,

but there have been over 7,000 contacts of each of these cases identified. And of those, 95% of them have completed. seven-day follow-ups. So that means they've been contacted every day for seven days to, because like we said, the incubation period tends to be between one to seven days, so you have to follow them up for a whole week. You can imagine if this were a disease with a longer incubation period, it's just that much more work to follow up on these people. Yeah, that is a lot of effort to put into that. And they also were all given prophylactic antibiotics. So one thing about the plague that's nice is that prophylactic antibiotics can help in reducing the chances that you end up showing

symptoms of plague. Out of those 7,000 contacts, only nine of them actually ended up becoming suspected cases, which I think is interesting. So imagine that you have plague in just you, listener, you, Aaron. Yeah. And how many people do you come in contact with? If you have pneumonic plague, over the course of 24 hours of a normal, let's say, work day. How many people, because we, you know, just sometimes tend to hang in the house on Sundays,

I think. Yeah. I actually went to a birthday party today with children. Yeah. Oops. Sorry. Yikes. Yeah. I mean, you'd have to follow up with each of those people that I interacted with at that birthday party. There was probably, I don't know, 15 people there. And then go to each of their families and everyone they contacted. I mean, it's insane, especially. It radiates outward endlessly. In 2017, when we are so mobile, right? Like this man, this index case, he shared a taxi with multiple people. So you need to find, how do you even find, if you're in an Uber today, can you even find if you do Uber sharing and you are with a random person? Like, how do you even find those people? It takes a ton of real detective work to find all of these people and make sure that you're following up in order to

sort of put a ring around the outbreak and try and contain it. And most of the reports that I have seen say pretty specifically, well, most of the news articles about the Madagascar outbreak specified that it has been limited to Madagascar. However, on October 10th, a man was reported to probably have pneumonic plague in Seychelles? I saw that news article and then that was the last I saw of it. So is it possible

that he was a traveler who came from Madagascar? Right. So he did come from Madagascar. However, yeah, so he did, he had visited Madagascar and he returned to Seychelles on the 6th of October. They, from that one person, they monitored 320

contacts of this person. Eight of them ended up developing mild symptoms. But of those 320 contacts, 41 of them were passengers on his flight from Madagascar back. You imagine being on a flight and getting contacted by United Airlines. Knock knock, hello. You were on this flight. You may have pneumonic plague. It's just insane.

Thank goodness they're antibiotics. That should be the name of this episode. I'll quote something a little bit better. Um, what else about that plague? Well, as of, so we're recording this on November 19th, 2017. And as of today, it has been three weeks and one day since a case has been confirmed. Right. The last confirmed case of bubonic plague happened on the 24th of October and the last confirmed case of pneumonic plague was the 28th of October. However, like we've said before,

plague is endemic to Madagascar and plague season extends until April. So the surveillance efforts are not finished and the risk is not entirely done. However, it seems like the worst of this outbreak is hopefully over. Hopefully. Yeah. Hopefully. It's crazy though. I mean, it was a massive outbreak because it's over 2,000 cases from 2010 to 2015. There was only just over 3,000.5. There was only just over 3,000 cases of plague reported worldwide. Wow. And 584 deaths. So this is a big one. Yeah. It's massive. Yeah. It's definitely one of the biggest. There was plague is certainly not limited, limited to Madagascar. Madagascar does tend to be one of the countries that has the greatest burden of it year after year. But just in the 2000s alone, there have been outbreaks in Zambia, India, Malawi, Algeria, the Democratic

Republic of Congo, China, Peru, and Madagascar. And those are just the outbreaks. That's not counting sort of individual cases like we see in the U.S. almost every year. Right, right. Yeah. So plague is definitely not over. Should we talk about how scared we need to be today? Oh my God. If you listen to last week's episode, you might remember that the use of plague and bioterrorism is nothing new. Right. In fact, it's many centuries old. When the The Mongol army threw bodies of plague victims over the city wall of Kaffa. They were hoping to bring down the city with this awful disease. While their efforts may have been ineffectual, there have been more successful attempts in the last 100 years.

There's a true story from the early 20th century of two half-brothers in India who were joint heirs to an estate. Yeah. Do you know where this is going? No, but I'm excited about it. One day, one brother met the other brother unexpectedly at a train station. and gave him a hug goodbye. During this encounter, the other brother, the one who was hugged, felt a pinprick on his arm. Eight days later, he was dead. No way.

Turns out, I'm not making this up. Is this, like, verified? This is from this book, Plague and Ancient Disease in the 20th century. So take it up with Charles Gregg. Charles. You better be right about this, Charles. Is this like Wikipedia status? No, this is like a, he's a researcher or was a researcher at Los Alamos.

All right, all right. So, Mr. Gray. I think he knows what he was talking about. Tell me about it. Anyway, so the guy who felt the pinprick on his arm. Yeah. Died eight days later. Turns out, his brother had recently taken out a huge life insurance policy on him.

Oh, my God. And then teamed up with a microbiologist. I'm not making this up to get some plague bacilli. While he was hugging his brother, the microbiologist injected some of the plague bascili into the guy to kill him. him. Oh my God. They were both found guilty of murder. Most microbiologists are not like this. And I would have got away with it if it weren't for you, pesky microbiologists. Oh my God. I can't believe that. Is that crazy? That's like, I've got an idea. I've got an idea of an elaborate way to kill my brother.

I know. How did they really figure out that it was not just a naturally infected case of plague? Like, did he say? They broke under questioning. Did they? I don't know. I mean, if I've seen one CSI case, I've seen them all. Yeah.

Slash house slash, I don't know. House is a great crossover episode between the two. Yeah. Yeah. You had potential, guys. Anyone who works long hours knows the routine. Wash, sanitize, repeat. By the end of the day, your hands feel like they've been through something.

That's why O'Keefe's working hands hand cream is such a relief. It's a concentrated hand cream that is specifically designed to relieve extremely dry, cracked hands caused by constant hand washing and harsh conditions. Working hands creates a protective layer on the skin that locks in moisture. It's non-greasy, unscented, and absorbs quickly. A little goes a long way. Moisturization that lasts up to 48 hours. It's made for people whose hands take a beast.

eating at work, from health care and food service to salon, lab, and caregiving environments. It's been relied on for decades by people who wash their hands constantly or work in harsh conditions because it actually works. O'Keefs is my hand cream of choice in these dry Colorado winters when it feels like my skin is always on the verge of cracking. It keeps them soft and smooth, no matter how harsh it is outside. We're offering our listeners 15% off their first order of O'Keefe's. Just visit O'Keefe's company. com slash this podcast and code this podcast at checkout. Truck month is going on now at your local RAM dealer.

Hurry in for great deals and exceptional offers on a powerful selection of RAM trucks. And right now purchase and get 0% financing for 60 months on 2026 RAM 1500 Big Horn and Laramie models. Don't miss this great offer. See your local RAM dealer. Not compatible with any other offers. 0% APR financing for 60 months equals 1667 per month per 1,000 financed for well-qualified buyers through Stalantis financial services regardless of down payment. Not all customers will qualify.

Contact dealer for details. Offer ends 3-2. Lego Star Wars just made the jump to hyperspace. Introducing the Lego Smart Brick. New Lego Star Wars sets with smart bricks inspire your child's imagination, taking their play to uncharted regions of the galaxy. With responsive lights,

a color recognition scanner, a synthesizer, and an accelerometer. Your child's play doesn't just come alive. It allows the Lego Star Wars galaxy to play back. May the Force be with you. Shop Lego Star Wars sets now on Lego.com or in Lego retail stores. There's another story of plague as a bioterrorism agent in World War II. This is a fun one.

Well, it's not actually. This is a shocking one, I would say. I would also say it's a really interesting one, and I want to talk about why. So go. Apparently, the Japanese army had been experimenting on Chinese prisoners by making plague bombs, intending to weaponize plague, particularly pneumonic plague, and cause epidemics. of it. Apparently, around 3,000 prisoners died, and the Japanese army escaped prosecution by the Allied forces by turning over their research findings to the U.S. Wow. That's interesting. So I had read a

slightly different story. Mm-hmm. There are some more, yeah. Yeah. What is the more? Well, there are also some reports from China that the American Air Force deployed some biological warfare agents in North Korea during the Korean War in the early 1950s. Huh. So I had read that a, quote, secret branch of Japanese Army Unit 731 is reported to have actually dropped infected fleas all over populated areas of China. Yes. Which what I think is really interesting about that is that not that we're trying to tell you how to do bioterrorism, but that's not a good way to do it. Well, clearly they were experimenting. Yeah. I mean, I guess. But it's just really interesting. Trial error. Trial and error. Yeah. But bubonic plague is not as

infectious and it's not as virulent. And so it's an interesting. So it's very possible that that endeavor dropping infected fleas on different towns was what led to their attempt to create pneumonic plague bombs. Right. Yeah. So that is, there are a list of a few diseases that the WHO and several other organizations have sort of a task force to look out for. And plague is one of the ones that is considered the most terrifying, the most likely. It should be noted also that Russia has been working on weaponizing plague for decades now. Interesting. Like confirmed. Well, it's confirmed as smallpox. All right. So highly suggested in some of the dossiers that dossiers. Yeah. What's interesting about plague, in contrast to something like smallpox, which we've talked about the bioterrorism

potential of that, is that Yersinia pestis is widely available. Whereas smallpox is only, whether it's in many different governments' hands or only a few government's hands, it still is in the hands of governments worldwide. Whereas Yersinia pestis is everywhere. You can go to Colorado, you can go to California, you can get plague bacteria quite easily from a flea, from a rat, and you can go. And from whatever. Yes. And because it has the capacity to be mass produced and to be aerosolized and be transmitted in that way, it is a really terrifying prospect in terms of a bioterrorism agent.

In some ways, yes. But also, okay, so let's just say that someone manages to weaponize plague and makes it the mnemonic form and then makes it antibiotic resistant. Right. Scary. That's probably the scariest scenario. area that we have. Definitely. And then releases it into a city. Yes. Pneumonic Plague kills you so rapidly that the period of infectivity is relatively low compared to

other diseases. And so while it is a very scary prospect, it's not, let's say it's not the best or most effective bioterrorism agent and that an outbreak could likely be contained pretty rapidly the way that it has been in Madagascar. So what it sounds like you're talking about is the R not of plague. So R not, dear listeners, and this looks like a capital R with a subscript zero. Right. And we call that R not. So R not is the basic reproductive rate of a pathogen. What that means is the number of secondary cases that happen from a single primary case if everyone in your population is susceptible. Yeah? And so in the case of pneumonic plague, you're right. You're the R not is estimated to be only about 1.3, which means on average, only 1.3 people, it's an average,

is actually infected from every person who has pneumonic plague. That's in contrast to something like smallpox, which has an R not of guess what, around six and a half. Whoa. Yeah. Yeah. Interesting. Yeah. So that's something that, because as I was reading this, I was like, why am I not more scared of plague. Do I need to be? What's the R-Nod? And it was actually more difficult than I expected to find that number. But yeah, it's quite low compared to other potential bioterrorism agents that are maybe more scary or even other infections like measles, which has an R-Nod of 13. Wow. It's one of the highest. Oh, we have to do an episode on that. Oh, we definitely will. Okay. But also just get vaccinated and then we don't have to worry about it. It's a little harder, I think, in some areas than others. Yeah.

Yeah. Like Orange County. God. Unfortunately. Mom. I'm kidding. She vaccinated us. Overall, it seems like plague is still a scary organism and it's still clearly causing a lot of disease and deaths. Definitely.

In certain areas of the world. But in terms of a bioterrorism agent, it's not the best one or not the one we need to worry the most about. Right. It's on the list, I think, that people who are in charge of worrying about those things are worrying about it. So, like, on the day-to-day, don't let it keep you up at night. And let's just say also that this bubonic plague, pneumonic plague, is a disease that is once again mostly concentrated in countries that are economically poor or economically struggling. And with improved sanitation, with improved surveillance of disease, and so on. that these diseases could be brought to very, very low levels.

Yeah. Especially with plague, it's all about surveillance and monitoring because if you are able to catch individual cases, you can prevent the spread. So while, and you also can prevent initial infection if you don't have houses that are infested with fleas. So with improving infrastructure, you can help prevent things like that. Okay. So Plague, that was a big one. It was. Two whole episodes.

Part two. Slightly shorter, but not any less sweet. I guess. We want to, oh, do you have any reading materials to site or do you or do that? I actually don't. I got all of my information from WHO. Thanks so much for what you do. Yeah.

Once again, I'll just do a shout out for plague and ancient disease in the 20th Century by Greg. Charles Gregg. Got you. Got you, girl. We want to also thank Bloodmobile for the music, yet again,

doing a stellar job. Kicking it. And please remember to rate, review, and subscribe. And also, feel free to email us at this podcast, We'll Kill You at gmail.com. If you have any suggestions or questions, or corrections,

or corrections, any of those things, we are happy to hear from you. We would love to hear. from you. And follow us on social media. Twitter, Instagram, Facebook. Because we like to hear from you. Thanks for listening. Wash your hands. You have filthy

animals. Running my small business was like playing basketball five on one and I was the one. Now QuickBooks gives me access to a team of AI agents and trusted experts for the assists I need. Nothing but, Nick. Outdo it with Intuit QuickBooks. Feature availability varies by product. Truck Month is going on now at your local RAM dealer.

Great deals and exceptional offers on a powerful selection of ram trucks. And right now purchase and get 0% financing for 60 months on 2026 RAM 1500 Big Horn and Laramie models. Don't miss this great offer. See your local RAM dealer. Not compatible with any other offers. 0% APR financing for 60 months equals 1667 per month per 1,000 financed for well-qualified buyers through Stalantis financial services regardless of down payment. Not all customers will qualify. Contact dealer for details.

Offer ends 3-2. Lego Star Wars just made the jump to hyperspace. Introducing the Lego Smart Brick. New Lego Star Wars sets with smart bricks inspire your child's imagination, taking their play to uncharted regions of the galaxy. With responsive lights, a color recognition scanner,

a synthesizer, and an accelerometer. Your child's play doesn't just come alive. It allows the Lego Star Wars galaxy to play back. May the Force be with you. Shop Lego Star Wars sets now on Lego. or in Lego.com or in Lego retail stores.