Paper: Pneumonic plague as bioweapon, signs

https://www.nejm.org/doi/full/10.1056/NEJMra1409755

In this article, we review the clinical management of deliberate infection with several pathogens of greatest bioweapons concern. On the basis of historical incidents coupled with information on ease of dissemination, contagiousness, mortality rates, public health impact, ability to engender panic, and the need for special preparedness,1-3 the Centers for Disease Control and Prevention (CDC) stratifies pathogens and toxins into three risk categories — A, B, and C — with category A meriting the highest level of concern and preparedness.4,5 In this review, we consider diseases that are caused by category A agents for which there are high-quality clinical data in the unclassified literature (see the Supplementary Appendix, available with the full text of this article at NEJM.org). The category A viral hemorrhagic fever viruses are beyond the scope of this review.

Pneumonic Plague

Pneumonic plague is caused by infection with the fleaborne bacterium Yersinia pestis. This organism, found worldwide and responsible for the “Black Death,” can cause several forms of illness: bubonic (the most common) (Figure 1D), septicemic, and pneumonic plague.41 Because of the focus of this review, only pneumonic plague is discussed.

How fucking fascinating.

CARDINAL FEATURES OF PNEUMONIC PLAGUE

In a deliberate attack, primary pneumonic plague — rather than secondary spread from bubonic or septicemic forms — would occur 1 to 3 days after inhalation of the released bacterium or after droplet transmission from another infected person. The initial presentation of pneumonic plague is nonspecific and is difficult to differentiate from an ordinary pneumonia in its early stages. Hemoptysis, a unique feature, might be present, and rapid progression to respiratory failure and death would occur with greater frequency than in ordinary pneumonias.41

I imagine this would make the death count impossible to distinguish from regular pneumonia.

Remember: “Hemoptysis, a unique feature, might be present…”

About that….

https://tribune.com.pk/story/2146154/1-coronavirus-scare-looms-karachi/

“Maintaining that the 2019-nCoV may cause mild to severe respiratory disease, initially clinically presented as fever, dry cough, myalgia (muscle pain), fatigue and gradually progressing to a more severe productive cough that produces phlegm, episodic headaches, hemoptysis (coughing up blood) and occasional diarrhoea.”

http://www.china.org.cn/china/Off_the_Wire/2020-01/26/content_75650590.htm

“About 55 percent of the patients developed dyspnoea. Less common symptoms were sputum production, headache, hemoptysis and diarrhea.”

https://www.msn.com/en-us/health/medical/is-it-a-cold-the-flu-or-coronavirus-how-to-tell-the-difference/ar-BBZzIsH

“Common coronavirus symptoms can include: — Fever — Dry cough — Shortness of breath — Aching muscles — Fatigue

Less typical coronavirus symptoms: — Phlegm buildup — Headache — Hemoptysis — Diarrhea ”

What PP is versus what we’re told CV is by the MSM.

“Hemoptysis, a unique feature…”

Why has nobody else done it this way? aka the empirical one

look at signs, look at symptoms

unique feature…

u n i q u e   f e a t u r e

I can’t be the only smartass.

But if I must.

DIAGNOSIS OF PNEUMONIC PLAGUE

Because the clinical features of pneumonic plague are nonspecific, diagnosis is largely based on the results of culture. Sputum, blood, or lymph-node aspirates could yield positive culture results. Chest radiography would reveal a severe pneumonic process. Serologic testing can also be useful but would not play much of a role during acute illness.41 Rapid antigen tests are available in regions in which plague is endemic, but none are FDA-approved.

Oh no!

So we’d see tests be useless early on…

and… a shortage of testing kits…

especially for America… who I imagine would call some state of emergency.

TREATMENT AND PREVENTION OF PNEUMONIC PLAGUE

The treatment of pneumonic plague involves a 10-day course of an aminoglycoside antibiotic agent, such as streptomycin or gentamicin. Doxycycline is considered a second-line treatment.41 However, a randomized, controlled trial of potential treatments for bubonic plague revealed equivalency between gentamicin and oral doxycycline; it is unclear whether these results can be extrapolated to pneumonic plague.42 There has been increased interest in the use of fluoroquinolones as primary treatment in mass-casualty settings.42 A 7-day course of doxycycline or ciprofloxacin would be used as postexposure prophylaxis.41 No vaccine against plague is available. Because pneumonic plague can be transmitted from person to person through respiratory droplets, droplet precautions must be implemented for all patients.41

Why do the Chicoms want disease-ridden people in hospitals that can supposedly do nothing for them?

https://www.medscape.com/viewarticle/500621_2

..supplemented with 10% fetal calf serum and penicillin/streptomycin. To make the quail QT6/ACE2 cell line, the gene encoding the receptor for SARS-CoV, human angiotensin-converting enzyme 2…

Rest behind a paywall. Great. It’s a 2005 paper about treating coronavirus.

https://www.nejm.org/doi/full/10.1056/NEJM199709043371004

Yersinia pestis is the causative agent of plague, a zoonotic disease transmitted to humans through flea bites and typically characterized by the appearance of a tender and swollen lymph node, the bubo. Human-to-human transmission can occur, through either the bite of fleas (bubonic plague) or respiratory droplets, causing an overwhelming infection called pneumonic plague.

Our history books missed out that part.

Suddenly those masks don’t look so stupid.

The last plague pandemic began in Hong Kong in 1894 and spread throughout the world, establishing many endemic foci. Antibiotics and enforcement of public health measures significantly decreased the morbidity and mortality associated with the disease but did not allow its eradication. In fact, plague is now considered a reemerging disease1 ….

We report high-level resistance to multiple antibiotics, including all the drugs recommended for plague prophylaxis and therapy, in a clinical isolate of Y. pestis. The resistance genes were carried by a plasmid that could conjugate to other Y. pestis isolates. This report should serve as a warning of the risk of the spread of resistance in Y. pestis, a species previously considered universally susceptible to antibiotics.

…Strain 17/95 was resistant not only to all the antibiotics recommended for therapy (chloramphenicol, streptomycin, and tetracycline) and prophylaxis (sulfonamides and tetracycline) of plague4 but also to drugs that may represent alternatives to classic therapy, such as ampicillin, kanamycin, spectinomycin, and minocycline. The isolate remained susceptible to cephalosporins, other aminoglycosides, quinolones, and trimethoprim, and treatment with trimethoprim, despite its lack of synergism with sulfonamides, most likely led to the patient’s recovery….

https://www.nejm.org/doi/full/10.1056/NEJMoa2001316

The initial cases of novel coronavirus (2019-nCoV)–infected pneumonia (NCIP) occurred in Wuhan, Hubei Province, China, in December 2019 and January 2020. We analyzed data on the first 425 confirmed cases in Wuhan to determine the epidemiologic characteristics of NCIP.

LOL: https://www.theguardian.com/world/2019/nov/13/two-people-diagnosed-with-pneumonic-plague-in-china

identified by local hospitals using a surveillance mechanism for “pneumonia of unknown etiology” that was established in the wake of the 2003 severe acute respiratory syndrome (SARS) outbreak with the aim of allowing timely identification of novel pathogens such as 2019-nCoV.4 In recent days, infections have been identified in other Chinese cities and in more than a dozen countries around the world.5 Here, we provide an analysis of data on the first 425 laboratory-confirmed cases in Wuhan to describe the epidemiologic characteristics and transmission dynamics of NCIP.

Suspicious.

Furthermore, children might be less likely to become infected or, if infected, may show milder symptoms, and either of these situations would account for underrepresentation in the confirmed case count. Serosurveys after the first wave of the epidemic would clarify this question.

re Pneumonic plague above: “Serologic testing can also be useful but would not play much of a role during acute illness.”

If it looks like a duck, walks like a duck and quacks like a duck – sure, it could be a chicken in a duck suit for kinky reasons but I’m inclined on probability to call it a fucking duck.

delays to hospitalization were much longer, with 89% of patients not being hospitalized until at least day 5 of illness (Figure 2). This indicates the difficulty in identifying and isolating cases at an earlier stage of disease. 

re pneumonic plague, above: “The initial presentation of pneumonic plague is nonspecific and is difficult to differentiate from an ordinary pneumonia in its early stages.”

It’s the same hymn sheet. I can’t be the only one seeing this.

Our preliminary estimate of the incubation period distribution provides important evidence to support a 14-day medical observation period or quarantine for exposed persons.

re pneumonic plague, above: “In a deliberate attack, primary pneumonic plague — rather than secondary spread from bubonic or septicemic forms — would occur 1 to 3 days after inhalation of the released bacterium or after droplet transmission from another infected person.”
“The treatment of pneumonic plague involves a 10-day course of an aminoglycoside antibiotic agent, such as streptomycin or gentamicin. ”
“Because pneumonic plague can be transmitted from person to person through respiratory droplets, droplet precautions must be implemented for all patients.41

That takes about…. 14 days.

Our study suffers from the usual limitations of initial investigations of infections with an emerging novel pathogen, particularly during the earliest phase, when little is known about any aspect of the outbreak and there is a lack of diagnostic reagents.

re pneumonic plague: “The initial presentation of pneumonic plague is nonspecific and is difficult to differentiate from an ordinary pneumonia in its early stages.”

re pneumonic plague: “diagnosis is largely based on the results of culture”

Furthermore, the initial focus of case detection was on patients with pneumonia, but we now understand that some patients can present with gastrointestinal symptoms, and an asymptomatic infection in a child has also been reported.17

https://www.cdc.gov/plague/symptoms/index.html

“Pneumonic plague: Patients develop fever, headache, weakness, and a rapidly developing pneumonia with shortness of breath, chest pain, cough, and sometimes bloody or watery mucous. Pneumonic plague may develop from inhaling infectious droplets or may develop from untreated bubonic or septicemic plague after the bacteria spread to the lungs. The pneumonia may cause respiratory failure and shock. Pneumonic plague is the most serious form of the disease and is the only form of plague that can be spread from person to person (by infectious droplets).”

That’s why hide it.

https://www.mayoclinic.org/diseases-conditions/plague/symptoms-causes/syc-20351291

“Pneumonic plague affects the lungs. It’s the least common variety of plague but the most dangerous, because it can be spread from person to person via cough droplets. Signs and symptoms can begin within a few hours after infection, and may include:

  • Cough, with bloody mucus (sputum)
  • Difficulty breathing
  • Nausea and vomiting
  • High fever
  • Headache
  • Weakness
  • Chest pain

Pneumonic plague progresses rapidly and may cause respiratory failure and shock within two days of infection. Pneumonic plague needs to be treated with antibiotics within a day after signs and symptoms first appear, or the infection is likely to be fatal.”

repeating coronavirus paper:

Although delays between the onset of illness and seeking medical attention were generally short, with 27% of patients seeking attention within 2 days after onset.

Complete coincidence.

Back to CV paper generally

Early infections with atypical presentations may have been missed, and it is likely that infections of mild clinical severity have been under-ascertained among the confirmed cases.18 We did not have detailed information on disease severity for inclusion in this analysis.

In conclusion, we found that cases of NCIP have been doubling in size approximately every 7.4 days in Wuhan at this stage. Human-to-human transmission among close contacts has occurred since the middle of December and spread out gradually within a month after that. Urgent next steps include identifying the most effective control measures to reduce transmission in the community. The working case definitions may need to be refined as more is learned about the epidemiologic characteristics and outbreak dynamics. The characteristics of cases should continue to be monitored to identify any changes in epidemiology — for example, increases in infections among persons in younger age groups or health care workers. Future studies could include forecasts of the epidemic dynamics and special studies of person-to-person transmission in households or other locations, and serosurveys to determine the incidence of the subclinical infections would be valuable.14

re Pneumonic plague above: “Serologic testing can also be useful but would not play much of a role during acute illness.”

These initial inferences have been made on a “line list” that includes detailed individual information on each confirmed case, but there may soon be too many cases to sustain this approach to surveillance, and other approaches may be required.19

Study allowed by Chinese Government, who arrested 8 doctors for trying to release some piece of information, can’t imagine what.

If they’d been told to give people antibiotics for a virus though, I imagine they had some pointed questions.

Especially if the Chicoms wanted to buy time to buy up global supply and produce more.

https://en.wikipedia.org/wiki/Pneumonic_plague

“Pneumonic plague is a severe lung infection caused by the bacterium Yersinia pestis. Symptoms include fever, headache, shortness of breath, chest pain, and cough. They typically start about three to seven days after exposure.”

Long lag time.

PP can cause meningitis, which might explain the headache.

from CV article above: “”Common coronavirus symptoms can include: — Fever — Dry cough — Shortness of breath — Aching muscles — Fatigue”

https://www.cdc.gov/coronavirus/about/symptoms.html

“For confirmed 2019-nCoV infections, reported illnesses have ranged from people with little to no symptoms to people being severely ill and dying. Symptoms can include:

  • Fever
  • Cough
  • Shortness of breath”

All three just so happen to be also the symptoms of pneumonic plague.

“CDC believes at this time that symptoms of 2019-nCoV may appear in as few as 2 days or as long as 14 after exposure”

So three, three days on the low end. How familiar.

About dat headache symptom…

http://cdn.intechweb.org/pdfs/23064.pdf

Coronaviruses as Encephalitis

-Inducing Infectious Agents

so why is headache not described as a symptom?

also

“In acute encephalitis, viral replication occurs in the brain tissue itself, possibly causing destructive lesions of the
gray matter, as was described after herpes simplex virus (HSV), rabies, or some arbovirus infections. ”

Yes, herpes can reach the brain. Again, I must remind you. Yes, it can.

This concludes why I’m banned from appearing on tv (pretty much).

1. Be civil. 2. Be logical or fair. 3. Do not bore me.

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