Plague Again

A wet spring breeds disease

It was as if a killer from the Middle Ages had returned to strike anew. This summer the once dreaded scourge of bubonic plague is on the loose in the Southwest U.S. Since April, hospitals in five states have admitted 35 patients complaining of fever, chills, headache and swellings in the armpits, groin or neck. Six deaths have been reported so far; the most recent was a 13-year-old New Mexico boy who died last week less than twelve hours after the disease was diagnosed.

This year's outbreak is the most severe in the U.S. since 1925, when 34 of 38 victims died. But it is comparable in name only to the Black Death that ravaged Europe in the 1300s. Spread by ship-borne rats and nurtured in urban filth and squalor, the plague killed an estimated 20 million people, roughly one-third of the Continent's population, in a terrifying 2 1/2-year rampage. The disease has largely disappeared today because of improved sanitation, measures to control the rodents that carry it, and the use of antibiotics to combat the plague bacillus. At the last count in 1980 there were 505 cases worldwide.

The vast majority of plague cases can now be cured, if diagnosed quickly enough. Left untreated, however, the illness is fatal in more than half the cases, developing into either the highly contagious pneumonic plague or septicemia (blood poisoning), which caused all six of this year's plague deaths.

In the U.S., plague makes its infrequent appearances in the far West and Southwest because it flourishes among rodents of the high desert plains. The human risk is limited primarily to people trekking into the wilds who are bitten by fleas that have been infected by the rodents. The Navajo Indians of the region seem particularly susceptible, owing to their outdoor lifestyle, their sheepherding and their free-running dogs, all of which increase the risk of infection. They account for half of the cases in Arizona and New Mexico, where the disease has been concentrated this year. Nonetheless, the incidence is comparatively low even among these Navajos.

Why this year's rash of cases? One likely culprit is the weather, says Dr. Jack Poland of the Centers for Disease Control's regional office in Fort Collins, Colo. Because of a particularly cool and wet spring, plague-carrying squirrels, prairie dogs and other rodents proliferated. So did the fleas that spread the disease to wild animals and eventually to humans.

Although treatable, plague poses a number of problems for doctors. One is the difficulty of diagnosing a disease whose symptoms initially resemble those of flu, especially if the telltale swelling or buboes (hence the name bubonic plague) have not appeared. Intestinal flu was in fact the initial diagnosis in the case of the New Mexico boy, who died shortly after the buboes appeared and doctors realized the true nature of his condition. Says State Epidemiologist Jonathan Mann: "The doctors really got right on it, but by the time the boy was back in the hospital he already had a heavy load of bacteria in his blood. He just had an incredibly rapid course." The opposite, relatively speaking, was true of an elderly Navajo man in Arizona who had what looked to doctors like ordinary heatstroke. Four days after being sent home from the hospital, he was dead; in this and two other instances, the plague was discovered only posthumously.

The recent upsurge in cases as well as the deaths from plague have understandably worried tourists traveling to Arizona and New Mexico. Answering phone calls from vacationers, state officials point out that the number of cases does not constitute an epidemic and that the risk to humans is low. Precautionary measures are being urged, however, for both tourists and residents, including the Navajos: avoid contact with sick animals, make residences rodent-proof, dispose of trash, use insect repellent as well as flea powder on pets. Such measures should ensure safety for the more than 100,000 tourists expected in Arizona in the next month. As for local residents, they seem unconcerned, treating the disease as just another bug going around. Their attitude is expressed in a bumper sticker popular in the region: LAND OF THE FLEA, HOME OF THE PLAGUE. This file is automatically generated by a robot program, so viewer discretion is required.