Russia has quarantined and tested nearly 200 people following the mysterious death of a scientist at a Siberian anti-plague institute, triggering panic reporting that the Black Death has reappeared in Russia. The EU says it is “monitoring the situation very closely” and there have been calls to close the borders in case the illness spreads.
And the danger is real as the bubonic plague spores are still active in many of the former Soviet republics and there is usually an infection reported every year. Mongolia is particularly prone to outbreaks as locals hunt marmots, which are considered a delicacy, and have taken over from rats as the main carrier of the infection in modern times.
However, there is a great deal of confusion over what happened. Moscow has insisted that the victim, a labour worker at a medical institution, died from an unidentified form of pneumonia and there is no cause for alarm. But no one really trusts Moscow, especially when it comes to natural disasters. The Soviet government didn’t report the meltdown at Chernobyl for over 36 hours and hid the scale of the disaster from the public in 1986 and not much has changed since then.
Alarm bells began to ring after Darya Shipilova, a 28-year-old employee of the Irkutsk Anti-Plague Research Institute of Siberia and the Far East, was admitted to hospital in Shelekhov, near Irkutsk, with severe pneumonia in a just over a week ago and died days later.
Early reports claimed Shipilova had accidentally broken a test tube containing live plague bacteria while collecting samples. Russia keeps a number of deadly pathogens like Anthrax in storage in its medical institutes for research purposes, although it has signed off on the Chemical Weapons Convention (CWC) in 1993 and ratified it in 1997 that preclude their use by the military and has committed to destroy what remaining stockpiles of biohazardous agents it still had soon after.
Local media described the suspected infection as pneumonic plague, the most dangerous form of the disease because it attacks the lungs and, unlike the more familiar bubonic form, can spread directly between people through respiratory particles.
The reports triggered a rapid response. At least 197 people who had been in contact with Shipilova were placed under medical observation, including 189 who were hospitalised. Of those, 114 were reportedly held in one regional hospital, 63 in another and 12 at the anti-plague institute.
“All identified contact persons have been placed under medical observation. As of today, the contacts show no signs of illness, and their laboratory test results are negative,” Irkutsk Governor Igor Kobzev said. Typically, the illness has a 4-7 days incubation period before the first symptoms is detectable. It is extremely lethal if not immediately treated with antibiotics, killing 98% of its victims between 18-24 hours. However, it is not particularly infectious, spreading mainly through large respiratory droplets during close contact, with a low R0 rate of only 1.2-1.3 (one infected person typically infects one more person on average.)
The Shelekhov district hospital imposed quarantine restrictions, public events were postponed and Russia’s chief state sanitary doctor Anna Popova travelled to the region to oversee the response.
The nearby Irkutsk Aluminium Smelter, operated by Rusal (HKEX: 486; MOEX: RUAL), introduced mandatory masks for its 2,154 employees.
“We have introduced a mask protocol at the facility as a precaution. God protects the cautious, so follow safety measures. If symptoms appear, seek medical help immediately,” plant director Artyom Fominykh said.
But the official story then changed.
Russia’s consumer health watchdog Rospotrebnadzor said Shipilova did not die of plague and diagnosed her instead with “pneumonia of unknown aetiology”. Tests found no microorganisms associated with the dangerous pathogens she handled at work, according to the agency, while an investigation found no evidence that a laboratory accident had occurred.
Officials said subsequent testing of Shipilova’s contacts had found two cases of Covid-19 and two rhinovirus infections, but no plague.
Gennady Onishchenko, an epidemiologist and former head of Rospotrebnadzor, said the illness was “likely not plague”, while stressing that Russia had established treatment and prevention procedures should plague be confirmed.
Occasional outbreaks
Nevertheless, the scale of the precautions — quarantines, medical surveillance, masks and the personal intervention of Popova — has attracted attention as the former Soviet Union space does see occasional outbreaks of the bubonic plague, which killed a between a third and half of Europe’s population when it first appeared in the 14th century.
WHO has identified active natural plague foci across Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan, covering about 1.8mn square kilometres, with sporadic cases historically registered almost every year in the region.
The European Commission said it was monitoring the situation “very closely” and was in contact with the European Centre for Disease Prevention and Control.
“We are aware of the reports concerning the laboratory incident in Russia, seemingly involving a pathogen causing plague,” a Commission spokesperson said.
“Public health is always a priority for us, so we are in touch with our experts from the European Centre for Disease Prevention and Control,” the spokesperson added but saying it was not in contact with Russian officials since Russia's full-scale invasion of Ukraine.
“We are much better prepared for any pandemics” following the coronavirus crisis, the spokesperson said, during which significant antibiotic stocks were built up.
Washington is also monitoring events. US officials have urged Moscow to provide “accurate” information “quickly and openly”, while Brussels has called for “timely and transparent reporting”.
But for the moment there is no confirmed plague outbreak. No secondary plague cases have been reported and Russia says laboratory analysis does not support the theory that Shipilova contracted Yersinia pestis.
The Black Death never disappeared
Plague is caused by Yersinia pestis, a bacterium that survives naturally in populations of wild rodents and the fleas that live on them.
The disease still exists across parts of Asia, Africa and the Americas. Most recent cases reported to the WHO have been in the Democratic Republic of Congo and Madagascar, but natural plague reservoirs also persist across parts of Central Asia and Siberia.
Modern medicine has also radically changed the danger posed by the disease. When it first appeared, arriving on rats travelling with merchants along the Silk Road from Central Asia and merchant ships trading with Asia, it cut through Europe’s unprotected populations like a hot knife through butter. But since then the plague can be treated effectively with antibiotics if diagnosed quickly.
WHO says untreated bubonic plague has a fatality rate of roughly 30-60%, while untreated pneumonic and septicaemic plague are effectively invariably fatal. Pneumonic plague can kill within 18-24 hours of the onset of symptoms if treatment is not started, but recovery rates are high when antibiotics are administered early.
Over the years, Russia itself has recorded sporadic human infections. The last confirmed Russian case was in 2016, when a 10-year-old boy in the Altai Republic contracted bubonic plague after helping his grandfather skin a marmot. The boy reportedly cut himself while handling the animal. Seventeen contacts, including six children, were quarantined, and the boy survived after treatment.
Russian scientific literature records human cases in the same high-altitude Altai plague focus in 2014, 2015 and 2016, all associated with handling grey marmot carcasses.
But it is Mongolia which is most prone to infections and death. Marmots — large ground-dwelling rodents similar to ferrets — are a principal natural host for plague in Mongolia.
Mongolia's National Centre for Zoonotic Diseases says natural plague foci have been identified across 28.3% of the country's territory, covering 132 soums in 18 provinces. More than half of the roughly 3,000 plague strains isolated in Mongolia since 1928 have come from Mongolian marmots, while another 27% were isolated from ectoparasites including marmot fleas.
That creates a particular problem because hunting and eating marmots remains a tradition in parts of the country despite restrictions and the locals are so keen on the meat that they routinely ignore government warnings and continue to trap the rodents.
Research into Mongolian plague cases found 73 reported human infections between 1998 and 2020, of which 59% were associated with close contact with infected marmots and 7% with eating raw marmot organs.
In July 2020, two brothers aged 27 and 16 in western Mongolia's Khovd province contracted bubonic plague after hunting and eating marmot. Authorities quarantined their contacts and restricted travel while the pair were treated, who survived.
Later that month, a 15-year-old boy died in Govi-Altai province after contracting plague following the hunting and consumption of a marmot. Fifteen people who had been in contact with him were isolated and given antibiotic treatment.
A year earlier, two people died again after consuming raw marmot organs in Mongolia.
Marmot hunting has been banned, but enforcement is difficult and the animals remain a prized food in some rural communities. Parts of the animal are also traditionally believed to possess health-giving properties.
In Mongolia the disease is often referred to colloquially as the “Marmot Plague”, a name that obscures the fact that it is caused by exactly the same bacterium associated with history's most notorious pandemic.
The connection between Central Asia and plague goes much deeper than today's occasional outbreaks.
A landmark genetic study published in Nature in 2022 traced the probable source of the plague strain behind the 14th-century Black Death to the Tian Shan region around modern Kyrgyzstan.
Researchers examined human remains from the Kara-Djigach and Burana cemeteries near Lake Issyk-Kul, the smaller sister lake to Baikal in Siberia, where an unusually large number of tombstones dating from 1338 and 1339 explicitly referred to deaths from “pestilence”.
Ancient DNA recovered from seven individuals revealed Yersinia pestis in three of them. Researchers reconstructed two plague genomes which they identified as ancestors of the enormous diversification of plague strains associated with the Black Death that swept through western Eurasia beginning several years later.
“It is like finding the place where all the strains come together, like with coronavirus where we have Alpha, Delta, Omicron all coming from this strain in Wuhan, [China],” Johannes Krause, a palaeogeneticist at the Max Planck Institute for Evolutionary Anthropology in Leipzig and one of the study's leaders, said at the time. “It was like a big bang of plague,” Krause said.
