Because if hiding dead bodies isn’t a conspiracy, we don’t know what is.The bubonic plague (and its’ siblings, the septicemic and pneumonic plagues) is alive and well in the Western United States. In fact, in the most plague-stricken region in the United States (Northern New Mexico) several cases pop up every year. Even with modern antibiotics, nearly 1 in 6 plague patients will die – which is still better than no treatment at all, since some forms are 99% fatal if untreated.
Thanks to horizontal gene transfers and other mechanisms, soon antibiotics may not even help: one recently isolated strain of the plague was found to be resistant to eight antibiotics, including all of the three primary treatments for plague. Even more disturbing, a Nevada woman who eventually died was treated for a bacterial infection in early 2017 that was resistant to every antibiotic available in the United States. Yersinia pestis typically hides out in long-term environmental reservoirs, which may provide more opportunities for horizontal gene transfer and makes eradication of the plague almost impossible in the Western U.S. (or other countries). This makes the average 10 to 20 annual cases in the U.S. largely unavoidable. The plague is not native to U.S. soil and its’ presence here was neither inevitable nor even especially difficult to avoid. The plague made landfall in San Francisco’s Chinatown, where deaths started occurring around 1900. Under the direction of the governor of California, Henry Gage, the bodies of plague victims were hidden for at least two years. In fact, over 100 deaths were concealed, and newspapers reported that the plague “Did not, nor ever did exist in California.” The San Francisco Examiner even ran an article: Why San Francisco is Plague-Proof.”
Why hide such a deadly disease from the public? Greed, pure and simple: Gage and his officials feared the loss of revenue during quarantine, and an even more significant loss of revenue if consumers stopped buying California produce, which was by then a burgeoning $25 million dollar industry. Despite the attempts by the governor to silence the medical community and corrupt the media, a handful of champions of public health eventually succeeded in ridding the city of the plague. Two of the city’s most prominent physicians, Wilfred H. Kellogg and Joseph Kinyoun, Chief Bacteriologist and Chief Quarantine Officer, made valiant efforts to protect the public welfare that did not immediately come to fruition. After discovering Yersinia pestis in the blood and lymph smears from infected corpses, these doctors made recommendations to contain the outbreak. The response from California State officials was swift and merciless: the doctors were fired and massive, devastating smear campaigns were launched against them in the local media.
Still, by 1903 the political tide started to turn against the Governor, and after repeated outbreaks in 1906 and 1908, the plague was eradicated from the city of San Francisco. The same newspapers that had denied that the Black Death had ever descended on San Francisco now gleefully declared that it had been eradicated.
Unfortunately, while the cleanup-up was a win for San Francisco, lasting damage had been done to the Western United States. Local populations of mammals, including rats and squirrels had already been infected within the first several years due to the critical delays in treating and containing the outbreak. Over half of all plague related deaths in the United States now take place in a region that had nothing to do with the introduction of the disease. Free-ranging animals have spread the disease, until at last, it found its’ greatest permanent reservoir in the United States: The Gunnison and black-tailed prairie dogs of northern Arizona, New Mexico, southern Colorado and Utah.
These regions overlap with the distribution of plague hotspots in the United States, and not just for humans either: over 90% of the inhabitants of an infected prairie dog town will usually die in a single outbreak. Fleas jump from their dying hosts in favor of dogs (who seem to be plague-resistant) and enter homes where they kill both humans and cats (who seem to be especially vulnerable). Thus, Henry Gage’s legacy repeats itself, claiming more lives every year, and reminding us that the consequences of inaction during a pandemic are severe, while the consequences of actions taken to deliver misinformation during a pandemic are abominable.
 Tansy, T. Plague in San Francisco: Rats, Racism and Reform. 2019 Nature. https://www.nature.com/articles/d41586-019-01239-x.
 Plague Ecology and Transmission. United States Center for Disease Control (CDC) webpage. See infographic, vide supra. https://www.cdc.gov/plague/transmission/index.html.