Since April of this year, there have been 11 cases of plague in the United States. It’s a frightening disease with a horrific history: It killed tens of millions in Europe between the 14th and 17th centuries. Antibiotics invented in the 20th century have a success rate over 80%. But without intervention, the death rate is between 66% and 93%.
Plague, caused by the bacteria Yersinia pestis, is transmitted through flea bites. Fleas can carry the disease from infected rodents and other animals to humans.
It can develop in three different forms. Bubonic plague, chiefly associated with swollen and black-and-blue lymph nodes near the site of the flea bite, is seen in about 80% of cases in the United States, according to the Centers for Disease Control and Prevention. The other two forms infect the blood (septicemic) and lungs (pneumonic).
While the pain of plague is severe, the treatment is not complex — antibiotics and supportive care.
There have been rare cases where people recover without antibiotics, but “it’s such an uncommon disease, I don’t know if it’s been studied well enough to know if certain people have increased susceptibility,” such as older people or people with chronic diseases, said Dr. Michelle A . Barron, associate professor of infectious diseases at the University of Colorado Medical School.
For those who live through it, plague can be an agonizing journey.
CNN spoke to two survivors, Lucinda Marker and Paul Gaylord.
How did you first learn you had it?
It was November 2002, the weekend of the New York City Marathon. She and her husband, John Tull, were visiting from New Mexico. “We were going to watch the marathon, and it was that morning that we woke up feeling ill,” said Marker.
“We had been there since Friday night. Our initial thought was that we were hungover. We thought we possibly had the flu.”
They quarantined themselves for two days in a hotel room with chills and fever.
“It felt like your skin hurt. I never felt that kind of aches and pain. Total lack of energy. It was a chore just to get to the bathroom,” Marker said. She went out to get some juice and water and could barely carry the bag back up to the room. “It felt like it weighed a ton,” she said.
At one point, Marker recalled her husband saying, “I hope we don’t have the plague.”
They were familiar with the plague, because it lurked in the deserts of northern New Mexico. “We knew plague was in the area that summer,” she said. But they were vigilant in keeping their dogs clean of fleas.
They were never able to pinpoint the source of the fleas that infected them, but they presumed they were bitten while hiking.
By their third day in New York, the pain was getting worse. “I was getting this intense pain in the groin area, and then felt a swelling, and I thought that was a lymph node. John said he had the same thing, and I felt his, and his was much smaller. Mine was getting much larger, and hot, and more and more painful.”
Her mind began to wander to the worst. Marker couldn’t say exactly what it was she felt, but “I was getting these feelings of impending doom. Something was wrong, something was terribly wrong.”
The next morning they called their doctor at home and listed their symptoms. “I don’t remember her saying ‘plague,’ but she said we need to go see a doctor (in New York).” Their hotel suggested Dr. Ronald Primas, a travel medicine specialist.
Primas offered to make a house call, but the couple insisted on coming in.
“They came in looking pretty ill,” Primas said. They were feverish and exhausted. As soon as the doctor saw Marker’s lymph nodes, he knew: “It was a classic ‘bubo.’ I had never seen a bubo, only in textbooks. But I recognized it.”
Primas immediately sent the couple to Beth Israel Hospital, and alerted the CDC and city health officials.
“You have to understand the psyche of the time. Everyone was on high alert, it was a year post 9/11, a year after the anthrax scare,” Primas said. “They were in top security mode. A nurse was screaming, ‘Get her into a room. She’s contagious!’ There was hysteria,” recalled Marker.
It was the summer of 2012. Paul Gaylord lived in rural Oregon at the foot of the Cascade Mountains. Gaylord’s cat Charlie had gone missing for a few days. “He showed up on a Saturday night, and it looked like he had a mouse or something in his mouth.”
Gaylord tried to take the mouse out, and while doing so, scratched his finger on the cat’s tooth.
The next day, Charlie was swollen and lethargic. Gaylord felt the best thing to do was to put him to sleep.
And it hit him the following day, while at work. “I went to work, and I had a fever of 103.” He went to the urgent clinic, where they treated him with antibiotics, but for cat scratch fever.
Gaylord was feeling better, but several days later, it hit again, while he and his wife were driving. “My wife looked at me. I was all gray and sweaty. She took me back to the urgent clinic. The doctor looked at me and he said, “You’re too much.” Gaylord’s case was more than the doctor could handle, so he sent him to the emergency room, where they found the telltale bubo, the swollen lymph nodes. “They told me I had the plague. I thought it was pretty reasonable. I felt pretty sick,” recalled Gaylord.
How were you treated?
Marker and her husband were immediately isolated and treated with antibiotics. “For me, the antibiotics started working right away.” said Marker. But Tull went into a coma within hours of arrival.
“They kept saying your husband is very, very ill, but when I saw him in a coma, I got it,” remembered Marker. “He was given less than a 1% chance of survival.”
While Marker was able to make a recovery within days, her husband’s body fought infection after infection. His toes, fingernails, ears and nose had begun to develop gangrene. His lungs and his entire body went into sepsis.
While the gangrene in Tull’s fingernails, ears and nose began to reverse, it persisted in his feet. It seemed to be a continuing source of infection, and Marker had to make the tough decision to let doctors amputate her husband’s feet.
Tull wouldn’t wake up from his coma till the end of December. “What blew him away was the loss of time. He missed Thanksgiving and Christmas,” said Marker. “The reality of amputation didn’t really sink into him yet, because up until that point he couldn’t see his feet. It wasn’t until the rehab months it all sunk in.”
Gaylord was immediately sent to the intensive care unit, where he was put on a ventilator because his lungs had stopped working. But this hospital felt his case was too much for them to handle and sent him to another hospital about 50 miles from his home.
By that evening he was on full life support, and he fell into a coma for the next 27 days.
His wife, Debbie Gaylord, recalled that he had tubes coming out of everywhere and his entire body was swollen. “It just looked like he was swollen everywhere,” she said.
“When I woke up, I couldn’t lift my arms up. I lost 30 pounds,” Paul said. “I just wanted some water. They wouldn’t let me have some water. That’s all I could think about. At that time I just wanted something to drink.”
It was only after he woke up that his limbs began to develop gangrene. “When I first saw them, it looked like a tight fist of black. It was weird how it just started curling up,” he said.
He stayed at home for a month and a half before his toes and fingers had to be amputated.
What was recovery like?
“The rehab months were unbelievable,” Marker said. “It was like he was a baby, learning how to do everything again. We learned how to lift the wheelchair into the trunk of a car together. We became a team at living life. It really brought us so much closer together. ”
Tull died of cancer last year.
“If I close my eyes, it feels like they are still there,” Gaylord said of his missing toes and fingers.
“After the amputation, I was non-weight-bearing, so I laid in bed for a long time. I had several followup surgeries after the amputations, but now I’m doing good. I can do almost anything.”
“I had physical therapy to help me exercise and learn how to walk again,” said Gaylord. He had to learn new ways to take care of himself. “You do what you have to do,” he said.
He has prosthetics but doesn’t use them because they hurt to use. He still has chronic pain in his hands and feet. But, he said, “It beats the alternative.”