The World Health Organization reported Thursday there are 1,801 suspected cases of plague in Madagascar. As of Saturday morning, seventy percent of this season’s diagnoses have been classified as pneumonic plague, which is spread through respiratory means (coughing and sneezing).
There is increased concern the epidemic could spread outside of Madagascar, across the water to the African continent.
If the WHO’s estimate is correct, suspected cases will have jumped by some 500 cases in a single week. Understand that plague is a pervasive infection in Madagascar, where bubonic plague is reported in most years. There is actually a season for plague, usually September through April.
According to reports, in early September, “The Ministry of Health of Madagascar notified WHO of an outbreak of plague.” The first case was identified on August 17 and the person died two days later.
By August 30, 14 cases—including 10 deaths— had been reported.
Four weeks later, by September 30, the number of “probable and confirmed” cases of pneumonic plague had jumped to 73, including 17 deaths. The WHO also reported 58 cases of the less deadly bubonic plague, including seven deaths.
The most worrying aspect of this year’s outbreak is its occurrence in more densely populated coastal cities. One reason for this, authorities have suggested, may be nearby forest fires have pushed rats out of the brush into more populated centers. The rats are infested with fleas that carry the disease.
According to the WHO, “the more dangerous pneumonic form [of plague] invades the lungs and can kill a person within 24 hours if not treated.” The infected fleas bite humans who, once bitten, usually develop a bubonic form of plague that can be treated with antibiotics.
The death toll jumped within days to 20, with another 84 cases confirmed.
There are real fears this outbreak could worsen because the plague season has only just begun. In a typical year, 400 total cases are reported. But this season started early, and at the end of September, the number of cases was already high.
Back on September 29, a World Health Organization spokesman said in a statement, “The overall risk of further spread at the national level is high.” Four weeks later, by October 25, the caseload moved higher to 1,192, according to the United Nations Office for the Coordination of Humanitarian Affairs and Madagascar’s National Bureau of Risk Management and Disaster. Officials reported 780 cases have been cured.
Recently, an unprecedented 40% spike in diagnoses was reported. In just five days, from October 27 to November 1, cases skyrocketed to 1,801, increasing by 500 cases in just one week.
The death toll rose to 127.
Local authorities have told citizens to avoid gathering in large groups to minimize risk of airborne infection. Unfortunately, November 1 was the annual celebration to honor the dead. All Saints Day, or the Day of the Dead, is a public holiday that sees families gather at local cemeteries to dig up corpses of loved ones and dance about holding them on their shoulders.
Few people questioned the celebration despite being informed of the health risk posed by the plague. The national Famadihana or ‘turning’ ceremonies went ahead as usual.
As of November 2, the death toll has reached 133, and the number of reported case sits at 1,836.
Perhaps health workers will be able to manage the epidemic, containing it to the Island nation. Professor Johnjoe McFadden, a molecular genetics expert at University of Surrey calls the situation, “a crisis…we don’t know how bad it’s going to get.”
With the epidemic breakout already classified as “unusual,” both in regard to the number of infections and its occurrence in atypical geographic locations, it makes you wonder why no travel restrictions have been made across the Indian Ocean. The nearby countries of Mozambique and Tanzania, along with South Africa, Kenya, and Ethiopia, are only hours away—and through those portals, the whole world.