A person in Arizona has died from the plague, local health officials reported on Friday.

This marks the first such death in this region in 18 years. But it’s a stark reminder that this historic disease, though rare nowadays, is not just a disease of the past.

So what actually is “plague”? And is it any cause for concern in Australia?

There are 3 types of ‘plague’

The word “plague” is often used to refer to any major disease epidemic or pandemic, or even to other undesirable events, such as a mouse plague. Naturally, the word can evoke fear.

But scientifically speaking, plague is a disease caused by the bacterium Yersinia pestis.

Plague has three main forms: bubonic, septicemic and pneumonic.

Bubonic is the most common and is named after “buboes”, which are the painful, swollen lymph nodes the infection causes. Other symptoms include fever, headache, chills and weakness.

Bubonic plague is typically spread by fleas living on animals such as rats, prairie dogs and marmots. If an infected flea moves from their animal host to bite a human, this can cause an infection.

People can also become infected through handling an animal infected with the disease.

Septicemic plague occurs if bubonic plague is left untreated, or it can occur directly if the disease enters the bloodstream. Septicemic plague causes bleeding into the organs. The name comes from septicemia, which refers to a serious blood infection.

The recent death in the United States was due to a case of pneumonic plague, which is the most severe form. Bubonic plague can in some cases spread to the lungs, where it becomes pneumonic plague. However, pneumonic plague can also spread from person to person via tiny respiratory droplets, in a similar way to COVID. Symptoms are similar to the other forms but also include severe pneumonia.

Some 30–60% of people who contract bubonic plague will die, while the fatality rate can be up to 100% for pneumonic plague if left untreated.

Plague: a potted history

This disease is one of the most important in history. The Plague of Justinian (541–750CE) killed tens of millions of people in the western Mediterranean, heavily impacting the expansion of the Byzantine Empire.

The medieval Black Death (1346–53) was also seismic, killing tens of millions of people and up to half of Europe’s population.

Spread by the growing trade networks of the British empire, the third and most recent plague pandemic spanned the years 1855 until roughly 1960, peaking in the early 1900s. It was responsible for 12 million deaths, primarily in India, and even reached Australia.

It’s believed the bubonic plague was largely behind these pandemics.

Plague in the modern day

First introduced into the US during the third pandemic, plague infects an average of seven people a year in the west of the country, due to being endemic in groundhog and prairie dog populations there. The last major outbreak was 100 years ago.

Deaths are very rare, with 14 deaths in the past 25 years in the US.

Globally, there have been a few thousand cases of plague over the past decade.

The countries with the most cases currently include the Democratic Republic of the Congo, Madagascar and Peru, with cases also occurring in India, central Asia and the US. Cases usually occur in rural and agricultural areas.

Plague can be treated

Plague can easily be treated with common antibiotics, typically a course of 10–14 days, which can include both oral and intravenous antibiotics. But it must be treated quickly.

The recent death is concerning, as it involves the airborne pneumonic form of the disease, the only form that spreads easily from person to person. But there’s no evidence of further spread of the disease within the US at this stage.

As Y. pestis is not found in Australian animals, there is little risk here. Plague has not been reported in Australia in more than a century.

But plague, like many diseases, is influenced by environmental conditions. The risk of climate change causing an expansion in the habitat of animal hosts means public health experts around the world should continue to monitor it closely.

The plague, though often perceived as a disease of history, is still with us and can pose a major health threat if not treated early.

Thomas Jeffries, Senior Lecturer in Microbiology, Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The assertion from Queensland’s chief health officer John Gerrard that it’s time to stop using the term “long COVID” has made waves in Australian and international media over recent days.

Gerrard’s comments were related to new research from his team finding long-term symptoms of COVID are similar to the ongoing symptoms following other viral infections.

But there are limitations in this research, and problems with Gerrard’s argument we should drop the term “long COVID”. Here’s why.

A bit about the research

The study involved texting a survey to 5,112 Queensland adults who had experienced respiratory symptoms and had sought a PCR test in 2022. Respondents were contacted 12 months after the PCR test. Some had tested positive to COVID, while others had tested positive to influenza or had not tested positive to either disease.

Survey respondents were asked if they had experienced ongoing symptoms or any functional impairment over the previous year.

The study found people with respiratory symptoms can suffer long-term symptoms and impairment, regardless of whether they had COVID, influenza or another respiratory disease. These symptoms are often referred to as “post-viral”, as they linger after a viral infection.

Gerrard’s research will be presented in April at the European Congress of Clinical Microbiology and Infectious Diseases. It hasn’t been published in a peer-reviewed journal.

After the research was publicised last Friday, some experts highlighted flaws in the study design. For example, Steven Faux, a long COVID clinician interviewed on ABC’s television news, said the study excluded people who were hospitalised with COVID (therefore leaving out people who had the most severe symptoms). He also noted differing levels of vaccination against COVID and influenza may have influenced the findings.

In addition, Faux pointed out the survey would have excluded many older people who may not use smartphones.

The authors of the research have acknowledged some of these and other limitations in their study.

Ditching the term ‘long COVID’

Based on the research findings, Gerrard said in a press release:

We believe it is time to stop using terms like ‘long COVID’. They wrongly imply there is something unique and exceptional about longer term symptoms associated with this virus. This terminology can cause unnecessary fear, and in some cases, hypervigilance to longer symptoms that can impede recovery.

But Gerrard and his team’s findings cannot substantiate these assertions. Their survey only documented symptoms and impairment after respiratory infections. It didn’t ask people how fearful they were, or whether a term such as long COVID made them especially vigilant, for example.

In discussing Gerrard’s conclusions about the terminology, Faux noted that even if only 3% of people develop long COVID (the survey found 3% of people had functional limitations after a year), this would equate to some 150,000 Queenslanders with the condition. He said:

To suggest that by not calling it long COVID you would be […] somehow helping those people not to focus on their symptoms is a curious conclusion from that study.

Another clinician and researcher, Philip Britton, criticised Gerrard’s conclusion about the language as “overstated and potentially unhelpful”. He noted the term “long COVID” is recognised by the World Health Organization as a valid description of the condition.

A cruel irony

An ever-growing body of research continues to show how COVID can cause harm to the body across organ systems and cells.

We know from the experiences shared by people with long COVID that the condition can be highly disabling, preventing them from engaging in study or paid work. It can also harm relationships with their friends, family members, and even their partners.

Despite all this, people with long COVID have often felt gaslit and unheard. When seeking treatment from health-care professionals, many people with long COVID report they have been dismissed or turned away.

Last Friday – the day Gerrard’s comments were made public – was actually International Long COVID Awareness Day, organised by activists to draw attention to the condition.

The response from people with long COVID was immediate. They shared their anger on social media about Gerrard’s comments, especially their timing, on a day designed to generate greater recognition for their illness.

Since the start of the COVID pandemic, patient communities have fought for recognition of the long-term symptoms many people faced.

The term “long COVID” was in fact coined by people suffering persistent symptoms after a COVID infection, who were seeking words to describe what they were going through.

The role people with long COVID have played in defining their condition and bringing medical and public attention to it demonstrates the possibilities of patient-led expertise. For decades, people with invisible or “silent” conditions such as ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) have had to fight ignorance from health-care professionals and stigma from others in their lives. They have often been told their disabling symptoms are psychosomatic.

Gerrard’s comments, and the media’s amplification of them, repudiates the term “long COVID” that community members have chosen to give their condition an identity and support each other. This is likely to cause distress and exacerbate feelings of abandonment.

Terminology matters

The words we use to describe illnesses and conditions are incredibly powerful. Naming a new condition is a step towards better recognition of people’s suffering, and hopefully, better diagnosis, health care, treatment and acceptance by others.

The term “long COVID” provides an easily understandable label to convey patients’ experiences to others. It is well known to the public. It has been routinely used in news media reporting and and in many reputable medical journal articles.

Most importantly, scrapping the label would further marginalise a large group of people with a chronic illness who have often been left to struggle behind closed doors.

Deborah Lupton, SHARP Professor, Vitalities Lab, Centre for Social Research in Health and Social Policy Centre, and the ARC Centre of Excellence for Automated Decision-Making and Society, UNSW Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.