Buboes and Bureaucracy

As with many news stories emanating out of Russia, the sensational death of a lab scientist (potentially) from Y.Pestis is surrounded by denials and misinformation. Verifiable information is non-existent or opaque at best, and a lot of what is being published is speculation due to lack of information.

That said… perhaps there is some value to a  discerning eye looking at the situation, contextualizing it, and maybe adding some insight.

In terms of definites… a 28-year-old lab worker/researcher is reported to have died around October 2 after coming down with a pneumonia like illness. Since then, news has been filled with conflicting information and speculation whether she died from pneumonic plague. This been confirmed and denied multiple times, if it is genuine that information has not left state hands.

There are many questions raised by this incident. It is reported the worker told hospital staff she ‘dropped a test tube’ in the lab. If she was walking around with a dish of plague, which seems unlikely, then the transmission vector seems iffy. A bacterium in medium dropped on the floor would not have the aerosolization needed to infect a standing person, especially one wearing PPE. Even in a powdered form, they wouldn’t be wandering around with, work on it would be done in a glove box. If all of these unlikely events happened, then it would seem to be a breach of proper lab procedures for this kind of pathogen.

Is it possible that the staff had been incorrectly provided for in terms of training, and vaccination? The efficacy of plague vaccines has been shown to be difficult to prove[1]^,[2], but if the staff were vaccinated, this should have mitigated some of the issue. Had she lied about her vaccinations, was she an anti-vaxxer, was the vaccine itself attenuated through dilution? Did the worker understand the seriousness of what had happened and declare the ‘accident?’ Does this kind of thing happen so often that it isn’t logged – just swept under the carpet? If they were following procedures the proper response would have included isolating her and giving a post-exposure prophylaxis course of antibiotics, and not letting her travel on her business trip!

Wild plague, even the pneumonic form, does not spread easily from person to person, yet it is being reported that Russia has reacted very aggressively and quarantined five local hospitals, with a reported 200 people under medical observation. Does this mean that the institute was working with a manipulated strain of the bacteria? Given the history of Russian BW programmes, and the fact that anti-plague institutes[3], like Irkutsk, supplied virulent pathogen cultures to the offensive biological weapons network, it is not entirely unfeasible… then what were they doing to it?

Just two months ago over 300 hundred Chinese personnel, including staff from the Chinese PLA Center for Disease Control and Prevention, joined Russian specialists to run an exercise focussed on an imported plague outbreak, and in attendance was the director of the Irkutsk institute[4]^,[5]. It would be a safe assumption that everything would have been at a high state of readiness after this kind of drill… or did it mean that all the PPE had been used up and not replaced?

Considering that we have just been through a pandemic that killed seven million people worldwide, you would have thought that the processes of getting the sequence of this agent, sharing it, and assessing countermeasures against it would have been far better. Russia is such a pariah state that no-one is expecting them to play with the international community, and this is a bad example for other states that might have their own emerging infectious disease. We’ve seen what happens with the ‘Let’s pretend it’s not a problem’ playbook, but nothing seems to have changed.

There are so many questions raised by this incident, and Russia’s (over?) reaction to it, but one thing we can rely on is that Russia has competence keeping both pathogens and news contained. The Aralsk 7 smallpox incident in 1971 and Sverdlovsk anthrax leak in 1979 both show the Soviet response to this, and you can imagine that the Russian playbook is not much different. This story will continue to evolve, and the WHO are pressing Russian authorities for more information, whether they, or us, get the full picture is unlikely.