Most people assume that the fourteenth-century Black Death that quickly ravaged the western world was a bacterial bubonic plague epidemic caused by flea bites and spread by rats. But the Black Death killed a high proportion of Scandinavians where it was too cold for fleas to survive. Biology of Plagues. Evidence from Historical Populations published by Cambridge University Press, analyzed 2,500 years of plagues and concluded that the Black Death was caused by a viral hemorrhagic fever pandemic similar to Ebola. If this is correct, the future medical and economic impacts from Ebola have been vastly underestimated.  

Authors Dr. Susan Scott, a demographer, and Dr. Christopher J. Duncan, a zoologist at the University of Liverpool point out that the Bible used the term “plague” to describe a catchall of afflictions resulting from divine displeasure. The researchers analyzed the “Four Ages of Plague”, including the “Plague of Athens” from 430 to 427 BC that killed about a third of the city; the “Plague of Justinian” from 542 to 592 AD and killed 10,000 a day in Constantinople; the Black Plague from 1337 to 1340 AD that killed a third of Eurasia; and a series of plague outbreaks in Europe from 1350 to 1670 that killed about half a number of city populations.

Historical records of the Athenian plague paint a very similar picture to the Black Death and the accelerating Ebola pandemic. Like Ebola, the plague is believed to have originated in Africa and then travelled northward. 

Athenians suffered a sudden onset of severe headache, inflamed eyes, and bleeding in their mouths and throats. The next symptoms were coughing, sneezing, and chest pains; followed by stomach cramps, intensive vomiting and diarrhea, and unquenchable thirst. With flushed skin burning from fever and open sores, 50-90% died in the second week of symptoms. Desperate to cool off, contagious victims may have transmitted the disease to other humans by jumping into public cisterns and watering troughs.

Bubonic plague was first recorded in China about 37 AD and still is a worldwide public health problem with thousands of cases each year. The most recent outbreak was in the Chinese city of Yumen on July 22, 2014, where a man died after handling a dead marmot. The Chinese military responded by quarantining 30,000 local residents.

The first symptom of bubonic plague is a mild and non-alarming fever. But bubonic swellings follow within a few days. Sufferers either go into a deep coma or become violently delirious, paranoid, and suicidal. Most victims die within a few days. Recovery is almost certain for those whose “buboes”, sores lymph glands, fill with pus. But before antibiotics, the appearance of black blisters was considered a sign of imminent death.

Bubonic plague is very seldom spread from person to person. The disease needs a rodent population, usually rats, to carry fleas to spread the infection to humans. Once the local rats die out from the infection, human infections tend to tail off. 

For the 2011 book, The Black Death in London, archaeologist Barney Sloane, who worked on medieval sites for the Museum of London and is now attached to English Heritage, documents the 1348-49 epidemic that killed two thirds of the city could not have been bubonic plague, because “The evidence just isn't there to support it.” 

“We ought to be finding great heaps of dead rats in all the waterfront sites but they just aren't there. And all the evidence I've looked at suggests the plague spread too fast for the traditional explanation of transmission by rats and fleas. It has to be person to person – there just isn't time for the rats to be spreading it.” 

The World Bank just estimated the cost of Ebola in West Africa is $32 billion over the next two years as it spreads from Guinea, Liberia, and Sierra Leone to its larger neighbors. This estimate assumes that the Ebola hemorrhagic fever can only be transmitted by direct human to human contact with bodily fluids. 

But The United States Center for Disease Control (CDC) in June 30, 1995 published guidelines (44(25);475-479) for managing patients with suspected viral hemorrhagic fever, including “Lassa, Marburg, Ebola, and Congo-Crimean hemorrhagic fever” to prevent hospital acquired “nosocomial transmission”.  According to the CDC:

“Epidemiologic studies of VHF in humans indicate that infection is not readily transmitted from person to person by the airborne route.” Although airborne transmission “is considered a possibility only in rare instances from persons with advanced stages of disease (e.g., one patient with Lassa fever who had extensive pulmonary involvement may have transmitted infection by the airborne route). In contrast, investigation of VHF in nonhuman primates (i.e., monkeys) has suggested possible airborne spread among these species.”

On October 2, 2014, the CDC published "Ebola Virus Disease -- Transmission" stating “Ebola is not spread through the air or by water”. The CDC states “Only mammals have shown the ability to become infected with and spread Ebola virus.” They suggest “humans, bats, monkeys, and apes” as transmitters. But this mammal-to-mammal theory should concern Americans, since 18.6 billion rats are the most populous mammal and six cities with the largest rat populations on earth are in the U.S; including: 1) New York; 2) Boston; 3) Baltimore; 4) Chicago; 5) New Orleans; and 6) Atlanta.

Senator and medical doctor Rand Paul warns that U.S. officials are underestimating the danger posed by Ebola, because, “This could get beyond our control.”  The World Health Organization agrees “There is no evidence that the EVD [Ebola] epidemic in West Africa is being brought under control.” The WHO’s current “Ebola count” is 8,033 cases and 3,865 deaths from Guinea, Nigeria, Senegal, Sierra Leone, Liberia, Congo, Spain and United States. Australia, Germany, and Turkey just reported new cases and some authoritarian nations may be suppressing disclosure of Ebola cases.      

A pandemic is “an epidemic (a sudden outbreak) that becomes very widespread and affects a whole region, a continent, or the world due to a susceptible population.” True pandemics cause a high degree of mortality”, like the Black Death and Ebola outbreak.

The logical conclusion to be drawn from President Obama not closing U.S. airports to travelers from Ebola-ravaged countries is that with the death of first U.S. Ebola patient and numerous cities reporting potential cases, the U.S. risks becoming an “Ebola-ravaged” nation.

Chriss Street suggests that if you are interested in the economics of healthcare,  please click on  "Covered California Admits to 'Narrow Networks' of Doctors and Hospitals"