First Death of Plague in Russia in 50 Years

On October 2, a 28-year-old laboratory assistant at an anti-plague research institute in the city of Irkutsk (Siberia), Daria Shipilova, died at a local hospital Shelekhov (a satellite town of Irkutsk). According to one of the explanations, she died after breaking a test tube containing the plague pathogen, and may have infected about 200 more people.

The Russian authorities deny this version and insist that there was no pathogen leak; they claim Shipilova died of pneumonia. The silence of the officials caused concern not only amongst the residents of Irkutsk, but also globally. The World Health Organisation (WHO) has been concerned about the possible spread of the plague. The organisation stated that it was “monitoring the situation.” On October 10, the WHO reported that “a key uncertainty remains the absence of a confirmed diagnosis in the deceased laboratory worker.”

As early as October 5, the possibility of a plague outbreak was discussed at the White House, according to The Washington Post. The US authorities are attempting to obtain more information about the incident, and Trump has already offered Russia assistance. It is likely that the US authorities believe Moscow is concealing the scale of the incident. Speaking to Fox News, former CIA officer Dan Hoffman even compared the incident to the Chernobyl disaster. IStories look into the scale of the situation.

What happened in Irkutsk?

On September 25, Daria Shipilova, an employee of the Irkutsk Anti-Plague Institute, reportedly broke a test tube containing the pathogen responsible for pneumonic plague, according to Pavel Stepanov, a local blogger. Stepanov claims that the young woman “concealed this fact” and did not self isolate in order to avoid spreading the disease. “The number of people she had been in contact with ran into the hundreds, and you can imagine what a risk that poses,” said Stepanov.

Shortly afterwards, Shipilova started feeling unwell and was admitted to a hospital in Shelekhov. On the night of October 2, Shipilova died, and the hospital was placed under quarantine. The news quickly spread through local chat groups, and rumours of plague outbreak began to circulate. The authorities made no comment on the situation whatsoever. Against this backdrop, two further theories emerged: according to the first, the woman had been bitten by a rat; according to the second, she had contracted pneumonic plague while on a trip to Thailand. 

Stepanov’s version, however, became the prevailing one, albeit unofficial, and soon after journalists managed to identify the infected woman.

Does the plague still exist?

Humanity has never managed to completely eradicate the plague (unlike smallpox). The causative agent of the infection — Yersinia pestis — still exists in the wild and is carried by ground squirrels, rodents and many other animals. The infection is transmitted among animals via fleas.

The disease can only spread effectively amongst animals in certain regions of the world where certain species of small mammals and flea vectors are present. In these areas, the plague exists as natural foci.

According to Rospotrebnadzor, Russia’s public health and consumer protection agency, the natural foci of plague are present in at least 13 regions of the country — Kalmykia, Dagestan, Ingushetia, Karachay-Cherkessia, Chechnya, Tuva, Altai, Kabardino-Balkaria, the Astrakhan, Volgograd and Rostov oblasts, and the Stavropolsky and Zabaykalsky Krai. The bacterium particularly thrives in border areas near Kazakhstan, Mongolia, China, Azerbaijan and Georgia.

There are three main forms of the plague infection: bubonic, pneumonic and septicaemic. The infection is the same, but the symptoms and fatality rates are different. Bubonic plague, which was rampant in the Middle Ages, is now considered the mildest form. While the bubonic form is caused by an infected flea’s bite, or contacting the tissues of infected animals, pneumonic plague is caused by inhaling bacteria-laden droplets (tiny particles of moisture expelled by infected animals or people). Septicaemic plague, the rarest and most dangerous form, is caused by the bacteria entering the bloodstream directly.

Could there be a new epidemic?

Cases of plague infection in Russia are extremely rare. The latest officially recorded death from the plague occurred in 1979 in Kalmykia. Over the following 35 years, the disease would be scarcely mentioned. Between 2014 and 2016, Rospotrebnadzor recorded three non-fatal plague cases in Altai, where the cause was unlawful hunting of plague-infected grey ground squirrels. The most recent case was widely covered by the media: a ten-year-old boy visited his grandparents and contracted the plague whilst butchering a ground squirrel. He later recovered.

It is likely that all those three patients contracted the bubonic form, whilst the incident in Irkutsk — if it actually had to do with plague — involved the pneumonic form, which is more dangerous and can be transmitted between people via airborne droplets.

In reality, it is very difficult to contract plague this way. Transmission of the infection requires prolonged contact with the infected person. In modern Russia, there has never been a single recorded human-to-human transmission case. In the US, the latest recorded instance was in 1924.

Experts believe that a single case of pneumonic plague in Irkutsk is unlikely to trigger a full-blown epidemic. According to Irina Yakutenko, a molecular biologist, we are not at risk of a new ‘Black Death,’ even if the disease were to accidentally spread into a large town or city. The necessary transmission chain — “rats to fleas to humans” — is missing for it to spread further. Furthermore, doctors are able to trace contact chains and diagnose and treat the disease quickly.

“In Russia, the United States and in Europe there is no risk of a plague epidemic because the conditions to foster this risk are absent. As for the pneumonic form, the transmission chains are short because victims die before they have a chance to infect large numbers of people. For a bubonic plague epidemic, which would claim millions of people’s lives in the past, a sustained combination of poor sanitation, rats, fleas and people living together in close proximity is required,” Yakutenko told the BBC Russian Service.

Do anti-plague institutes pose a danger?

There are at least five anti-plague institutes in Russia — in Saratov, Volgograd, Rostov, Irkutsk and Stavropol. The Stavropol Research Institute also has two branches in Sochi and Budennovsk.

According to Stepanov, the Irkutsk Anti-Plague Institute has “deteriorated” in recent years. “Many people have left, and the expertise has weakened. It is possible that this is precisely what led to the tragedy,” he said. There is no confirmation on this information in open sources.

Experts, however, note that incidents in laboratories do indeed occur, even despite strict safety protocols. This also happens in developed countries and in laboratories with the highest biosafety levels, according to Irina Yakutenko.

Precautionary measures are to be set out in the institute’s internal documents. Furthermore, more general recommendations are available on the World Health Organisation (WHO) website.

Stepanov claims that the laboratory assistant breached numerous instructions. According to him, Daria did not inform the research institute’s officials about the incident, most importantly. It is not known whether she had been vaccinated and briefed on what to do in an emergency, and whether she wore a protective suit.

Daria’s colleagues were sceptical about this explanation. In an interview with a local outlet, Lyudi Baikala, they described her as a highly responsible worker.

“Daria was extremely anxious about infecting anyone if the worst were to happen. This was evident from how often she sanitised her hands, even outside of work,” one of her colleagues said.

Furthermore, the institute’s staff do not believe it was possible to simply break a test tube in the laboratory.

“That sort of thing doesn’t happen here. But even if she had broken one — the booth and the clothing are isolated. Nothing would have happened at all,” said a source speaking to Lyudi Baikala.

In global medical history, there had been another well-known case where a researcher studying the plague died from the disease. In 2009, Malcolm Casadaban, a biologist from the University of Chicago, died from the septicaemic form of the plague. The exact route of infection was never established. However, Casadaban’s colleagues said that was not consistently wearing protective gloves, and experts suggest that the bacteria entered his bloodstream through a small wound or mucosa.

How to manage plague outbreaks?

In the event of a plague outbreak, the WHO issues the following recommendations to the authorities: find and stop the source of infection; protect health workers by instructing them and providing them with protective equipment and antibiotics; isolate patients with pneumonic plague and ensure the correct treatment; identify and monitor close contacts of pneumonic plague patients and do the testing; responsibly disinfect the spaces and ensure safe burial practices.

The plague is treated with antibiotics, primarily fluoroquinolones and aminoglycosides. According to Yakutenko, if diagnosed early, a course of antibiotics (10–14 days) will be sufficient to save the patient’s life. With timely treatment, the plague mortality rate is 5–10%, while in the Middle Ages the fatality rate reached 90–100 per cent.

One should not self-medicate. In the case of the pneumonic form, it is not only the medication that is important, but isolation as well. Therefore, if suspicious symptoms arise, one must first and foremost consult a doctor.

Furthermore, the necessary medication may not be freely available. On October 3, Lyudi Baikala reported that plague antibiotics are hardly distributed to Irkutsk pharmacies, and where they are available, they are sold strictly on prescription in small quantities — there are at maximum five packs in stock. This is because the Irkutsk Oblast is not among the regions known to have natural foci of the plague.

What measures have the authorities already taken?

According to Lyudi Baikala’s report, on the evening of October 1, Irkutsk authorities held a meeting attended by the heads of law enforcement and administrative agencies. FSB officers were assigned to escort ambulances transporting people who had been in contact with Daria on their way to undergo examinations. On the first day alone, 90 people were placed in quarantine at a COVID-19 centre. On October 2, according to the Izvestia newspaper, there were 200 people.

The regional governor, Igor Kobzev, reported that Russia’s Chief State Sanitary Doctor, Anna Popova, was also present. According to Kobzev, everyone who had been in contact with the infected woman was under medical supervision, and so far no signs of the disease have been observed in them. However, he did not specify the cause of Daria Shipilova’s death.

It has been indirectly confirmed that the cause of death was the plague by Alexei Tsydenov, the head of the neighbouring Russian region, Buryatia. He stated that the deceased laboratory technician had not visited the Buryatia republic and that the source of the infection lay outside the region. Following this, Baikalsk (a town 145 km away from Irkutsk) authorities urged residents to refrain from travelling to Shelekhov (the town where Daria died) and its neighbouring settlements. Later, they deleted the post.

The Irkutsk Oblast authorities have not acknowledged the outbreak of plague yet. However, quarantine measures were introduced in the region: three city clinical hospitals (Nos. 1, 3 and 10), the Ivano-Matreninskaya Children’s Hospital and the city maternity hospital were placed under quarantine. On October 3, the Irkutsk Aluminium Plant in Shelekhov introduced a mask mandate for the first time since the pandemic began.

The press office of Rospotrebnadzor finally commented on the situation on October 4. The agency announced that the sanitary and epidemiological situation was stable and cited the cause of Daria Shipilova’s death as “pneumonia of unknown aetiology.” No “microorganisms linked to her professional activities” were detected in samples of her biomaterial, the agency stated.

Are such measures enough?

As the authorities are providing little information about the measures taken and deny that Daria was infected with the plague, it is difficult to assess whether their actions have been adequate.

“We do not know what happened there. If we are talking about the pneumonic form of the plague, then yes, preventive quarantine is a good measure to prevent transmission chains, even the short ones. <...> When all contacts are preventatively isolated and monitored, it is possible to cut the chains of transmission at the very start and avoid further deaths,” Yakutenko told the BBC Russian Service.