Why we don’t need to panic about the plague in Inner Mongolia

On Thursday the 11th of June, Donald Trump told a crowd that he prefers to call COVID-19 the “plague from China”. As well as being blatantly xenophobic, this statement strikes fear into the listener because it likens the coronavirus outbreak to one of the most fatal pandemics in human history: the Black Death.

The Black Death was an eruption of the plague throughout Eurasia and Africa, caused by the spread of the bacterium Yersinia pestis through fleas. Infection with the bacterium most commonly caused flu-like symptoms, swollen lymph nodes (called buboes, hence the name bubonic plague), seizures, and gangrene. This cocktail of symptoms, without treatment, killed 30-90% of those infected. Every year between 1346 and 1671, there were deaths in Europe due to the plague – that is over 300 years of continuous outbreaks. Although statistics are notoriously unreliable, owing to the vast expanses of territory and time that the pandemic covered, it is estimated that around a third of the population of Europe died during the Black Death. Arguably, it remains the most significant public health crisis on record. Despite this, the plague feels like a thing of the past, and so the recent outbreak of the plague in Inner Mongolia may come as something of a shock.

The bubonic plague isn’t nearly as rare as we think it is. From 2010 to 2015 there were 3248 cases reported worldwide, including 584 deaths, and a major outbreak in Madagascar in 2017 claimed 221 lives. Peru and the Democratic Republic of the Congo are also susceptible to outbreaks, with 17 cases in Peru in 2010, and 1174 in the DRC in 2006. While that may seem worrying, the plague can be treated – a common enterobacteria antibiotic effectively cures the disease. Indeed, the case fatality rate of the plague is up to 100% without treatment (depending on the variety of plague) but has been reduced to 7.2% globally with the use of antibiotics.

Furthermore, the World Health Organisation (WHO) has detailed plans for outbreaks in the Indian sub-continent, South-America and sub-Saharan Africa. The main concern in plague treatment is rapidly identifying it, and the WHO has supported the development of a rapid development dipstick test so that this can be achieved safely and quickly. Of course, in those areas which are susceptible to plague outbreaks, the disease must be carefully monitored and effectively treated. Vulnerable healthcare systems should continue to be developed and improved. For the most part, however, things seem under control, despite what the last week’s news reports suggest.

In the last week, a case of plague appeared in Bayannur in Inner Mongolia (an autonomous region of China), after a teenage boy came into contact with an infected marmot. The local authorities have restricted access to the affected areas, where people are likely to come into contact with other infected rodents, and quarantined 34 suspected contacts of the boy. They have also issued warnings against hunting animals in the area which could carry the plague.

The Black Death has an incredibly strong cultural resonance, and we are especially culturally aware of pandemics now that we are experiencing one. We remember the Black Death as an unstoppable, devastating force of nature that wiped out a third of Europe’s population. The profoundly entrenched Eurocentrism of British historical understanding means the Black Death is therefore remembered as one of the worst occurrences in human history. To apply that rhetoric to an outbreak of the plague – today, a treatable, well-understood, controlled disease – is to scare the public. The Daily Express reported that China was making a “desperate attempt to contain the Black Death”. The Daily Mail criticised China for “invit[ing] tourists to visit its plague-hit region ‘without worries”. The Black Death is so resonant that its mere mention invokes an archaic sense of fear. For newspapers, plague sells.

More concerning is the focus on this incident of the plague over any other in recent memory. Inner Mongolia is a region of China, the nation in which COVID-19 first appeared. Throughout reporting of this case, the comparison has been emphasised. China is being portrayed variously as a careless, disease-filled country allowing epidemics to spread, or as an anti-Western country inviting tourists to infect themselves before sending them home. It is undeniable that mistakes have been made in the handling of coronavirus, in China as elsewhere. National authorities should be held accountable for their responses to the pandemic, but this needs to happen globally, not just in China. To portray China as a disease hotspot, by sensationalising this outbreak of plague, dangerously deflects blame, preventing appropriate investigations elsewhere. Not only is it xenophobic, but it is also detrimental to change.

Wuhan and Bayannur are 1700 miles away from one another; comparing the outbreaks of coronavirus and plague is like comparing outbreaks in London and Lisbon. It would be irresponsible to say we should ignore the incident of the disease in Inner Mongolia. One thing most will take away from 2020 is that public health concerns should be taken extremely seriously. But the reporting of it has been ridden with xenophobia, making China seem like an alien culture. We need to worry about the plague throughout the world, especially in its hotspots, and fortifying healthcare services the world over so they can cope with any disease, whether plague or coronavirus. Instead of villainising the Chinese response to disease outbreaks, focus on improving. We don’t need to worry about a second Black Death.