User:Caitlinnguyen/1924 Los Angeles pneumonic plague outbreak

The 1924 Los Angeles pneumonic plague outbreak was an outbreak of the pneumonic plague in Los Angeles, California that began on September 28, 1924, and was declared fully contained on November 13, 1924. It represented the first time that the plague had emerged in Southern California; plague outbreaks had previously surfaced in San Francisco and Oakland. The suspected reason for this outbreak was a rat epizootic where squirrels that were found to be plague infected likely were secondarily infected by rats. Due to the evidence of infected squirrels near San Luis Obispo County as late as July 1924 and the migration habits of both squirrels and rats, it is thought that squirrels were the original source of the plague outbreak in Los Angeles.

The outbreak killed 30 people and infected several more. Public health officials credited the lessons learned from the San Francisco outbreak with saving lives, and swiftly implemented preventative measures, including hospitalization of the sick and all their contacts, a neighborhood quarantine, and a large-scale rat eradication program. The epicenter of the plague was in the Macy Street District, primarily home to Mexican immigrants. Racism against Mexican Americans tainted the reaction to the plague, an issue not made public until the outbreak concluded. This outbreak was the last instance of aerosol transmission of the plague and the last major plague outbreak in the United States.

October 1924

In the same week, on October 3, 1924, Jesús Lajun's fifteen-year-old daughter Francisca also fell ill with the same symptoms as her father, but also complained of fever, shortness of breath, and headache. Both also had sore throats and back pain. Giles Porter, a physician of the Los Angeles City Health Office, was called to the house and diagnosed Francisca with lobar pneumonia, a form of pneumonia weakening the lobe of a lung due to inflammatory exudate between alveoli. Porter was also the physician who had initially diagnosed Lajun's plague as a venereal disease, or sexually transmitted infection, due to his enlarged lymph node and flu-like symptoms. Following the Lajuns' diagnosis, they were treated by Lucina Samarano, a pregnant nurse. Samarano lived at 742 Clara Street, which would become the eventual epicenter of the outbreak.

However, neither of the Lajuns recovered. 15-year old Francisca died in an ambulance on its way to Los Angeles County General Hospital after her symptoms worsened the next day. An autopsy of Francisca performed by pathologist Webb ruled her cause of death as double pneumonia. Jesús Lajun died on October 11, with his cause of death ruled as bronchopneumonia.

Meanwhile, Lucina Samarano developed similar respiratory symptoms and died days later on October 15. No autopsy was conducted on Samarano however, she had been diagnosed as having acute myocarditis, or inflammation of the heart muscle. Samarano was six months pregnant when she first got sick, and delivered a stillborn baby boy shortly before she died. Her body was returned to her husband Guadalupe Samarano, who later developed infection and died within days.

On October 30, the Los Angeles County Hospital pathologist George Maner finally identified the pneumonic plague as the disease causing the outbreak and notified the Los Angeles City Health Department and state officials. Maner identified it from a blood serum sample from a patient who died after attending Lucena Samarano's funeral. Intrestingly, Maner had never worn gloves during autopsies, but immediately began to once he detected the pathgoen.City health officials quarantined an eight-block area encompassing Clara Street, where the funeral had taken place, as well as a six-block area in Belvedere after Jesús Lajun was identified as the index case, but did not announce the causative disease of the outbreak. Thirteen more cases of an unknown disease were admitted, all of whom developed cyanosis and hemoptysis, or bloody sputum, the former of which is indicative of low oxygen saturation of tissues near the skin surface. Three of the patients died the same day, and in response the pneumonic plague was first suggested as the cause of the outbreak. The following morning, the diagnosis of pneumonic plague was confirmed by pathologists after an autopsy reported gram-negative bipolar staining bacilli resembling the plague. However, the diagnosis was not made public.

On October 31, the United States Public Health Service and California State Board of Health learned of the diagnosis indirectly from telegrams sent from the assistant superintendent of the hospital. The telegram was sent to federal and state authorities and medical supply dealers to explore where vaccines or serums to the plague could be found. However, the antiserum requested was produced solely by the H.K. Mulford Company laboratories in Philadelphia, a 3,141-mile journey which would require automobile transport to Mineola, New York then a flight by mail plane to Los Angeles with a stopover in San Francisco. With cooperation from the United States Post Office Department and its respective air mail officials, it was prepared within an hour, according to the company. In a promotional literature release by Mulford Laboratories, a producer of the serum, stated that the serum was delivered within 36 hours, would stop the "Swath of Death", and "save the lives of thousands".

On November 5, the plague antiserum requested by the Los Angeles County Hospital finally arrived, though it was only used on three patients, was successfully used on only two patients, Raul Samarano and Mary Costello, and remained largely unused for the rest of the outbreak. However, there were doubts on the effectiveness of the serum against pneumonic plague from reports. There was mention of the use mercurochrome as a therapeutic agent that aided in the subsequent recovery of two plague patients. Before the antiserum was used on Mary Costello, she endured intravenous injections of mercurochrome because it was believed that the compound was a way of sterilizing the body's infected blood and other maladies. By this time, everyone else who lived at 742 Clara Street died. Despite a piling death toll, the hospital continued falsifying or contorting information regarding the outbreak. A six-block quarantine was also imposed in Belvedere Gardens in response to two suspected plague deaths.

Transmission
The pneumonic plague is the only form of the plague capable of person-to-person transmission, which occurs during droplet-respiration, or breathing, as opposed to other forms of the plague. Symptoms being one to four days after exposure and is extremely fatal without treatment intervention. The 1924 Los Angeles pneumonic plague outbreak was the last instance of aerosol transmission of the plague in the United States. A person is infected when they breathe in particles of Yersinia pestis, a bacterium transmitted by rat fleas, in the air. Alternatively, if the bubonic plague (another form of the plague) goes untreated, the bacteria can spread to the lungs through the bloodstream and cause a secondary case of the pneumonic plague. Pneumonic plague is the most virulent form of plague while the bubonic plague is the most common form. The incubation period can be as short as 24 hours.

Plague can also be transmitted from human corpses or animal carcasses. Pneumonic plague specifically can be transmitted by thorough handling of a corpse or carcass through the inhalation of respiratory drops. Bubonic plague can be transmitted by blood-to-blood contact with bodily fluids.

There is a large concern that Y. pestis will be weaponized as a bioterrorism agent. Because it is highly infective and can be stored in large quantities, there is a concern that it could be dispersed in a form that is resistant to desiccation or foreign environmental conditions. This is concerning because an aerosol attack would be able to cause cases of pneumonic plague. Currently, Y, pestis is categorized as a 1 of 6 Category A biological agent that poses a threat to national security.

Diagnosis

Currently, the pneumonic plague is diagnosed after evaluation by a healthcare worker and a laboratory test of the patient's blood, lymph node aspirate, or sputum confirms infection. A rapid diagnostic tests called F1RDT can be used and performed at the patient's bedside, which detects the F1 capsular antigen of Yersinia pestis. Specifically, the sample can be taken from pus from buboes (swellings) or from the mucus from the respiratory track (sputum). Results are given within 15 minutes based on a scale of the intensity of the infection. Diagnostic tests are commonly paired with culturing, serology, and polymerase chain reactions. Improving diagnostic testing for plague is important due to the high mortality rate associated with delayed diagnosis and treatment.

Treatment

The plague can be treated with a therapeutic antiserum, a treatment first initiated in 1896 by Alexandre Yersin, a bacteriologist, physician, and co-discoverer of Yersinia pestis as the causative bacterium of the plague. The antiserum was first tested on 23 Chinese patients in 1896 in Hong Kong, which resulted in a mortality rate of 9%. The efficacy of antiserum is disputed but it is generally accepted to be successful in mitigating negative effects of the plague: the mortality rates for antiserum-treated patients was 35%, as opposed to 82% for untreated patients. The antiserum was replaced by sulphonamides in the 1930s and then by streptomycin beginning in 1947.

In the 1924 Los Angeles outbreak, the serum was only successfully used on two patients, Mary Costello and Raul Samarano, remaining largely unused. At the time, it was only produced by H.K. Mulford Company laboratories in Philadelphia, Pennsylvania, but was quickly flown the 3,141-mile route via car to Mineola, New York then flown on air mail to Los Angeles via San Francisco.

A vaccine to the plague was first developed in 1897 by Waldemar Haffkine who demonstrated that a heat-killed culture of Y. pestis protected rabbits from infection and was later tested in humans in India. This resulted in an observation of both reduced incidence and mortality in individuals who were immunized. In 1931, Georges Girard and Jean Robic developed a live attenuated vaccine from a strain from Madagascar called EV. However, by the end of the 20th century, vaccines were rarely used outside of Russia due to the prominent side affects and reactions. There is currently not a safe or effective vaccine against the plague for human use despite considerable progress made in the development of one.

Media coverage
Los Angeles media coverage of the plague was considered vague compared to that of media outside of the city, often attributing the outbreak to pneumonia, as seen in a subheading in the Los Angeles Examiner reading "Officials Believe Virulent Pneumonia Outbreak Controlled" and a headline in the Los Angeles Times reading "Seven are Dead from Pneumonia," both of which published on November 3. From November 1 to November 5, despite thee fact that the plague was confirmed by name, it was referred to as a "strange malady," "pneumonia," "virulent pneumonia," or "malignant pneumonia" by city health officials. The plague was not referred to by name until November 6 by Los Angeles newspapers, by which time the plague was practically over. The justification for the evasion was that pneumonic plague was a technical term that meant "malignant pneumonia". The news blackout was mostly confined to Los Angeles since most Californian newspapers referred to the outbreak correctly. For example, the State Board of Health in Oakland dedicated time to discuss the epidemic on its weekly radio show.

Many Los Angeles newspapers also incorrectly depicted Belvedere Gardens and the Macy Street District, both heavily populated by Mexican immigrants, as separate from the City of Los Angeles. Any news reports that did refer to the outbreak by name often portrayed Mexican Americans and their respective neighborhoods as 'menaces.'

By comparison, The New York Times and The Washington Post both referred to the plague by name, even comparing it to the Black Death of the 14th century. Several newspapers outside of Los Angeles covered the deployment of the plague antiserum in early November in detail, including the Chicago Tribune; The Evening World; Herald & Review; The Indianapolis Times; Moon-Journal of Battle Creek, Michigan; New York World; The Philadelphia Bulletin; The Philadelphia Inquirer; The Philadelphia North American; Public Ledger; San Francisco Daily News; and the San Francisco Evening Bulletin.

Racism

Plague discrimination was something that became heavily prevalent as the plague went on. Links of sociability, ethnicity, neighborhoods, and kin all linked to plague discrimination against Mexicans. Certain illustrations that accompanied public health documents described environments with the "typical interior of a Mexican home" as ones that were vulnerable to the plague. Images of homes of people with Mexican ethnicity were linked to cases of plague from these images, curating a perceivable connection between ethnicity and plague transmission for mainstream society.

Discrimination was seen from the leading healthcare workers in California. A comment made by Doctor Walter Dickie who stated that a connection between the two initial cases of plague and the second group was that it was explained by "the tendency of the Mexicans to withhold information, especially when they are not fully aware of just why such information is desired".

After the plague, health officials recognized the need for programs encouraging safe hygiene practices among the Mexican population. Health officials blamed the plague outbreak on Mexicans' supposed ignorance of proper hygiene, despite actually being the fault of notoriously inferior living conditions and poverty in the Macy Street District. Some health officials even blamed the outbreak itself entirely on Mexican Americans, which Feldinger argues reinforced the pro-segregation views widely held at the time. The response also failed to provide vital access to clean water and sanitary disposal.