Bubonic Plague in Beijing: How Bad Could This Get? ...Did You Say "Antibiotic Resistance?!"

I mentioned in a previous article, and as most of the world has heard by now, the Bubonic Plague has reared its head again in Beijing. First, two patients from Inner Mongolia were diagnosed in Beijing (Yeung), and then a third less than a week later (Yan). Of course, Chinese officials have insisted they have everything under control (Wang X, Li & Ma), and seem rather frantic about repeating this (Wang X), often (Yan), as we would expect them to. After all, we can't admit that anything catastrophic is possible in our Socialist Utopia with Chinese Characteristics, can we?
However, the lack of any explanation or supporting evidence other than "because the authorities said so" is less than reassuring to anyone who is familiar with China's track record of cover-ups (I've never seen a government that never gets caught lying but China's is the only one I've encountered that never gets caught telling the truth). For my part, the first thing that came to my mind upon hearing the insistent, almost furious "how dare you peasants ask questions" tone in the voices of Health Officials was a line from the 1994 Miniseries based off of Stephen King's The Stand: "the so-called 'Super-Flu,' does, not, exist!"

Furthermore, even these assurances from the "authorities" carry within their own lines strong reasons for concern, but I'll get to that later.
In this article, I will focus on three main points. 1) China's response to the disease so far bears eerie similarities to their gross mishandling of the 2003 SARS epidemic (Gittings & Meikle, Garrett), 2) Conditions are ripe in Beijing for this to turn into a pandemic, and 3) China, especially Beijing, is ill-prepared to combat this.

The State's Official Position is There is Nothing to Report... And Never Will Be

In 2003, SARS swept across the world, hitting Asia the hardest. 5,237 people in Mainland China were infected, and 329 of them died (Zhuang (1)). China, however, in their eternal quest to make themselves look better, insisted they had the disease under control and under-reported the number of cases reported (Guardian Staff). In order to hide the severity of the outbreak, 305 suspected cases of the Plague were given the coded diagnosis "Atypical Pneumonia (Gittings & Meikle)." The only reason they finally admitted the outbreak was a full ten times worse than what they reported to the World Health Organization (As of 21 April, 2003, Beijing had reported 37 cases when they had documented 339 (Gittings & Meikle))was because one of their own doctors defied the regime's censorship orders and called them out (1).
Even when the Party-State finally did come clean, they waited a week before allowing World Health Organization officials to visit hospitals in southern China, and officials in Beijing's hospitals declined to comment. In essence, the disease was running out of control in China even as China insisted "we have everything in hand" in their eternal quest to save face, and the disease would have continued to do so if one of the Chinese had not stood up to say "this is bullshit."

So how has Beijing handled the Plague in 2019 so far?

...Well, pretty much the same way.
It is not as though Beijing was blind-sided by this. A quarantine was put in place in Inner Mongolia after a couple died of the Plague in May of this year (Agence France-Press (1)). Also, Beijing authorities took note of last month's Madagascar outbreak (Sui). That same month, the International Association for Medical Assistance to Travelers updated its advisory page to warn that "risk of Plague is present throughout Mongolia."

So why has the regime been so completely caught with their pants around their ankles? To be honest, my inability to come up with an answer to that question frightens me more than any of the answers I considered, but the efforts Beijing has gone to to cover-up news of the disease speaks volumes. Put simply, it is easier to find news of this crisis, which is happening in China, on Western news outlets than news outlets here in Beijing.

A now-deleted WeChat post by a doctor at the hospital, Li Jifeng, claimed that the patients were actually first treated on 3 November - over a week before the public was informed of the presence of highly contagious pneumonic plague in the capital. (Gritten)

Regarding the deleted post by Dr. Li, I was unfortunately not able to find a screenshot to prove it was posted, but according to both the New York Times (Wee) and The Hill (Frazin), it read as follows.

“After so many years of specialist training, I’m familiar with the diagnosis and treatment of most respiratory diseases... But this time, I looked and looked at it. I couldn’t guess what pathogen caused this pneumonia. I only knew it was rare."

While the first two patients (who suffered from "pneumonic plague," the deadliest and most contagious form of the Yersinia pestis bacterium that causes Plague) were being treated at Beijing Chaoyang Hospital (2), authorities had the good sense to quarantine the hospital but did not inform anyone why until some time later (Global Times (1), (Gritten). And, of course, China's internet censorship machine has been ordered to "block and control" any news related to the plague on any and all Chinese-controlled social media (which includes every platform accessible in China without a VPN).
What's interesting is the 12 November article by State-run tabloid Global Times. It lists all the known plague cases in China since 2014.

According to the statistics from the National Health Commission, there have been occasional cases of plague in China in recent years. In 2014, 2016 and 2017, there were 3, 1 and 1 cases, respectively, of plague infection and death. The cause of infection and transmission route were not disclosed.

There's one small problem: this is not ALL the confirmed cases of Plague in China since 2014. They omitted the couple that died from the Plague earlier this year in May. It's also worth noting that every source I have found reporting on the third case (the one who contracted Bubonic, rather than Pneumonic Plague) have stressed the fact that Beijing authorities have found no connection between the first two cases and the third (Yan, Reuters (1)). I suppose this is meant to ease suspicions of an outbreak, but if anything, it makes the situation more worrisome. If there is no connection, it means the disease is circulating enough that two separate transmissions on two separate occasions have occurred in the same area, which means quarantines are a moot point.

So, in summary, Beijing is more interested in containing news of the disease than containing the disease, just like the 2003 SARS epidemic. And as I will explain in the next section, all the pieces are assembled for a disastrous outbreak that will make SARS look mild.

Beijing is as Vulnerable to a Plague Outbreak as New Orleans is to Hurricanes

In times of plague outbreak, people in all regions are suggested to avoid close contact (within a 2-meter distance) with those who cough, and spend less time in crowded places. Residents in regions with prevalent plague must use insect repellent and stay away from dead animals and rodent habitats. (Wang X)

This is the advice from China's health authorities on how to prevent contracting Plague during an outbreak (such as the one they claim there is almost no risk of). Stay away from crowds, people who cough, and rodents. Regarding avoiding crowds, there is simply no way to be academic about this.

Have you fucking BEEN to Beijing?!

Please, show me any place in this city that is ever not crowded, because I've yet to find it. The subways are infamous for being more crowded during light hours than the New York subway at rush hour, and it's impossible to walk four meters without bumping into someone. Telling someone in Beijing to avoid crowds is like telling someone in the Sahara to stay away from sand. Avoiding people who cough is another fool's errand, as the Chinese are known for not bothering to cover their mouth when they cough, sneeze or spit (Shanghaithere). Perhaps the most noteworthy admonition here, though, is the warning to stay away from rodent dens.
It has been traditionally thought that Yersinia pestis is spread by rodents (though some studies recently have claimed Humans are actually the culprit (Senthilingham)).
If this is true, then Beijing has a problem. Rats have been a prolific pest throughout this region, infesting even upscale restaurant kitchens (Huang). The problem has been so staggering that the government has on several occasions called for a "war on rats (AP Archive, UPI News)," which bears worrisome similarities to Mao's "Four Pests Campaign" that launched the Great Famine, but I digress.
In fact, this infestation is yet another comparison to the 2003 SARS Outbreak. Just as SARS was traced to its source and found to originate from a colony of bats living in China (McKie), Rattus Norvegicus, the common brown rat whose fleas are believed to be the primary carrier of the Plague, originated right here in Northeast China (Wang, D.), and their numbers have been increasing recently. A trend of longer, warmer summers has lengthened the breeding season for rats worldwide (Randall), and in recent years this has been an order of magnitude worse in Inner Mongolia, leading to what authorities have called a "Plague of Rats (Shi)," and oh, they just had to choose that term, didn't they? More rats means more rat fleas, and more rat fleas means more chances to catch the Plague.
It is worthy of note that of the 2019 cases, the May couple and the 55-year-old man diagnosed third in November all caught the bacteria by eating a plague-infected animal. In that case, the solution is simply "don't eat any rats," right?

Well...
...welcome to China.

China likes to try and hide its embarrassing dietary habits, but rats as a culinary staple are not exactly rare (or even new) here, and the eater is not always aware that's what they're eating. There was a global scandal in 2013 involving people who were contaminated with rat poison by eating "lamb skewers," a common Chinese dish, that turned out to be rat, rather than lamb (Boehler). The worldwide negative attention drawn by this prompted a campaign to punish food vendors who were caught peddling rat-meat, culminating (as is always the case with China) in a headline-grabbing bonanza that gave the regime the chance to say "see? Look what a great job we did of solving the problem (Reuters (2))," and then business (as is always the case with China) went back to normal (Global Times (2), Tracey) (3).
But even if one manages to avoid unknowingly (or knowingly) consuming any rodents -which is no small feat in Beijing- the fact remains that China is ill-prepared for an epidemic of this magnitude.

Smog? Check. Antibiotics? ...Eh, Excuse Me a Minute

The one thing every article about the Plague-cases seems to emphasize is that Yersinia pestis is easily treated by common antibiotics. Well, that's a relief. I'm certainly glad China isn't the epicenter of a sudden rash of antibiotic resistance, right?
...Well, it is.
Swedish scientists have found that Antibiotic Resistance in bacteria is on the rise, more so in China than in anywhere else (Zhuang, (2)), findings which were later corroborated by Chinese scientists (Qu, Huang & Lv; Liu, Yuan, Yun, Feng & Jian) (4). One of the main reasons cited for this is the misuse of antibiotics in China (Yang, Cai & Zhou).
Of course, antibiotic resistance may be a moot point, given the tendency of Chinese hospitals to run out of medicine anyway (Patriam (1)).
But doctors are well-educated, highly-trained and specialized professionals with extensively vetted credentials. Certainly they could not so clumsily mis-administer antibiotics on such a large scale, right? Well, China's medical profession has come under fire not only for its low standards of training, but for the alarming frequency of doctors with fake credentials (Patriam (2)).
And finally, there is the fact that China's quarantine procedures in the event of an outbreak leave much to be desired themselves. In Hangzhou (an urban center outside Shanghai) there is a residential center called 'Zai Shui Yi Fang.' During the 2003 SARS Outbreak it was used as a quarantine center. The problem is infected people were brought here for quarantine while the building was still occupied, and the 70 households living there were simply told "you can't leave. We've brought SARS cases to your home and as a result, we may have infected you. Sorry. Make the best of it," and were given no help from the government that brought this upon them. In order to avoid death by starvation and thirst, the households had to form what Tang Jun describes as "mutual aid groups" to provide each other with the food and water they were not allowed to leave and buy (Tang, Zhang, Wang & Feng, 84). If anything, this likely increased the likelihood of members of these households becoming infected, but if this happened then the book, which was written, edited and published by the Party, conveniently overlooked that in its efforts to portray the residents' actions as one of China's "achievements."
Given that Beijing has already handled the 2019 Plague in much the same way as SARS, it's not hard to imagine this happening again.
And of course, the Party will bend over backwards to cover it up, just like they did in 2003.

Cover, Simmer, and Serve When Ready

In summary, let's examine this tidbit from Dr. Li Dongzeng (no relation as far as the author is aware to Dr. Li Jifeng, mentioned earlier), one of the doctors responsible for treating the first two cases diagnosed.

"Although the disease results in high fatality, plague is not likely to cause mass outbreaks in an organized modern society." (Wang X)

Well, we're not exactly dealing with an organized modern society, now are we? Xi Jinping himself openly admits more than 10 times in Governance of China Vol. I that China is still a developing country. It's infamously crowded, with deplorable hygiene (especially in the capital city), and an explosive rodent population that has a sad history of ending up on dinner plates. Add in a medical industry that can be generously described as "third-world," and it's a recipe for China's next "contribution" to the world to be an epidemic of antibiotic-resistant Bubonic Plague.

Thanks, China.

I have commented before on my lack of faith in Chinese superstitions, but given that they have already been proven right about disaster striking in years ending with 9, I cannot help but take note of one Weibo post.

"Bird flu in the year of the rooster... swine fever in the year of the pig... Next year is the year of the rat...the plague is coming." -Agence France-Press (2)

In previous articles I have asserted that the West has nothing to fear, because China is not nearly as advanced as they claim to be. Well... now the entire world has reason to be afraid.

...Because China is not nearly as advanced as they claim to be.

Footnotes

(1) The author inserts a personal note: According to the 9 Apr, 2003 article by The Guardian staff, the doctor who called out the regime for their lies was surnamed Jiang, and worked at the 301st hospital (which, I assume, means the 301st PLA Hospital since that's the only 301st I can find in Beijing), where he had formerly been the Chief Surgeon.The doctor who made such an absolute mess of my leg surgery earlier this year at the 306th PLA Hospital was surnamed Jiang, and I know he was formerly a high-ranking member of the 301st. I cannot be sure, but I speculate it was the same doctor.

(2) The author inserts a second personal note here: this entry causes me to shudder a bit as I read it, because this hospital stands directly over Dongdaqiao Subway Station, where I get off of the subway twice a week on my way to a Krav-Maga class.

(3) The date of this MSNBC article by Brian Tracey is, for some reason, not displayed on the website. However, the exchange rate it lists when describing the price of rat meat is "6 yuan [79 cents] for a kilogram [2.2 pounds]." This puts the value of the RMB at the time of release at roughly 7.5, which means the article was somewhere in 2016, according to exchangerates.org

(4) The author once again can personally attest to this, as the aforementioned leg surgery was made necessary because of a diagnosis of Methicillin-Resistant Staphylococcus Aureus (MRSA), or "antibiotic-resistant staph infection" in Laymen's terms.

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