On July 5, Chinese authorities in Bayannur, Inner Mongolia reported a suspected case of bubonic plague. The level three warning will remain until the end of this year.

The two patients are a 27-year-old man and his younger brother who is 17. Their hospitalization follows after consuming marmot meat, a large ground squirrel. 146 additional people, who the two brothers have come in contact with recently, have also been isolated and treated.

Bubonic plague, also known as the Black Death, is caused by the bacteria Yersinia pestis, which is spread by the fleas from a small animal. Symptoms appear about one to six days later with flu-like indications including headache and nausea, as well as inflammation of lymph nodes at the neck, underarms, or in the groin.

Infection may also occur after coming in contact with the body fluids of a dead animal killed by the bacteria. The cases of the two brothers came back positive after lab results assessing their blood, sputum, or fluid from their lymph nodes.

History of the Bubonic Plague

The first case of a bubonic plague pandemic was during the rule of Justinian I, a Byzantine emperor from the 6th century, where they called the illness Plague of Justinian. Around 25 million died as it spread from the Eastern Roman Empire (Byzantine) to Constantinople, the Mediterranean Sea, and east towards Asia Minor. The illness recurred for the next two centuries killing about 50 million people.

The Black Death came back in 1347, killing about 30% of Europe, which spread from Mongolia via the Silk Road. Mongol soldiers used to catapult infected corpses against their Italian merchant enemies after closing the trade route, being the first to use biological warfare. In an old historic account, one Italian wrote, 'Those burying, carrying, seeing or touching the infected often died suddenly themselves.'

Today, there is a vaccine and antibiotics for the infection. However, lack of treatment would result in the bacteria spreading to other parts of the body and a 30% to 90% chance of mortality.

The bacteria multiplies with the gut of xenopsylla cheopis, or the oriental rat flea. While remaining harmless to the flea, the bacteria rapidly spread once in contact with the human lymphatic vessels.

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'Risk of a Human Plague Epidemic'

In severe cases, the bubonic plague may progress into the septicemic plague as the bacteria enter the bloodstream. Bleeding occurs under the skin, usually at the nose, mouth, and bottom.

Buboes, or the painfully swollen and bleeding parts of the body, look like severe bruising. The inflammatory swelling may occasionally cause lymph nodes to break open.

A third possibility of the bacteria progressing is its movement into the lungs, which is quite rare. Pneumonic plague is highly contagious since it is airborne, or spread in the air if an infected person coughs.

The local health authorities in Inner Mongolia announced, 'At present, there is a risk of a human plague epidemic spreading in this city. The public should improve its self-protection awareness and ability, and report abnormal health conditions promptly.'

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