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Why did the Plague spare Poland?
The Black Death skipped certain parts of Europe - and that could be a lesson for today's coronavirus epidemic
- Calm down, we're not comparing COVID-19 to the Plague.
- Well, not literally. But this map raises an interesting question: Why were some parts of Europe spared of the Black Death?
- And can that tell us something about where the coronavirus will or won't spread?
The doctor will see you now
Engraving of 'Doctor Schnabel' ('Dr. Beak'), a plague doctor in 17th-century Rome, wearing the typical mask with which caregivers sought to keep the 'bad air' at bay that they held responsible for the spread of the disease.
Image: Paulus Fürst, ca. 1656 - public domain
The Black Death was a ruthless killer – and, if you were lucky, a swift one. Its more fortunate victims "ate lunch with their friends, and dinner with their ancestors in paradise," wrote Giovanni Boccaccio, who lived through the initial wave of the Plague as it struck Italy in the 1340s.
What does that have to do with the coronavirus? Not a whole lot, fortunately. Except that the brief of this little corner of the internet is to look for strange maps, and one map led to another.
The Plague was brought from China to Europe in the 1330s by rodents hitching rides with traders. The infection with the Yersinia pestis bacterium was typically transmitted to humans by fleabites. The Plague's three manifestations were bubonic (causing painful swellings), septicemic (infecting the bloodstream) and pneumonic (choking off breathing, and transmittable via coughing). Left untreated – as was necessarily the case in the Middle Ages – bubonic plague had a mortality rate of about 50%, for the other two, it's virtually 100%.
Bocaccio's Italy was hit hard by the epidemic. Cities like Venice and Pisa lost three-quarters of their population. The disease followed the traditional trading routes north, racing forward each spring as a new generation of fleas was ready to spread the infection.
The Plague afflicted most of Europe in a relatively brief period. It's estimated that it killed as many as 25 million – a third of Europe's population at the time – in just five short years.
Absent explanations and remedies, Europe's populations turned to God for hope, and victimized outsider groups as scapegoats. Some of Western Europe's worst anti-Jewish pogroms before WWII took place during outbreaks of the Plague.
In just a few years, the Plague had moved from its entry points on the Mediterranean as far north as Scandinavia.
Image: Andy85719 - CC BY-SA 3.0
This map shows the progress of the Plague, from its arrival in the Mediterranean:
- First afflicted (in 1347) were Asia Minor, and the islands of Sicily, Sardinia and Corsica, with just small bridgeheads on the European mainland: Marseilles and environs, Calabria (the tip of Italy's shoe), and the southern shore of what is now Turkish Thrace (i.e. European Turkey).
- By the next year (1348), the disease had achieved a firm foothold in Europe, reaching as far as the gates of Toledo and Paris.
- In early 1349, the Plague had overwhelmed London and Frankfurt, and was poised to pounce Vienna and Bucharest. Later that year, it reached as far as Ireland and Norway.
- Its relentless march north continued. In 1350, it hit Lübeck and Copenhagen, reaching high into Norway. In 1351 and thereafter, it swept further north, touching the entire continent.
But as this map indicates, the Plague spared certain areas (marked green on the map) on march of destruction:
- an area in Italy centered on Milan;
- small, contiguous parts of Spain and France, on either side of the Pyrenees;
- an area in the Low Countries around Bruges;
- a large area in Eastern Europe, stretching from Magdeburg to beyond Warsaw, taking in most of present-day Poland, plus some surrounding areas.
Why? First off, the map is slightly misleading. Green does not mean 'safe', just 'less deadly'. Milan, for example, only lost about 15% of its population. Horrific by today's standards, but a mere trifle compared to the almost wholesale extinction of Italy's other cities. In Poland and the other 'green' areas too, people did die of the Plague, albeit in much lower numbers than elsewhere.
Blues vs. Greys
Interconnected equals infected, and vice versa.
One main reason why Poland escaped relatively unscathed, was the decision by Poland's king, Casimir the Great, to close the country's borders – and set up internal quarantines.
This increased Poland's natural isolation, both from the outside world and between the settlements within the country – generally smaller and less connected than elsewhere in Europe. Prague to Krakow took eight days on horseback. People infected took between 24 to 72 hours to get sick. So the issue would 'resolve' itself well before the danger reached the Polish border.
Isolation plus quarantine certainly helped spare Poland from the worst of the epidemic. One more spurious explanation is that Poland had more cats than other parts of Europe, and thus less disease-carrying rats…
Milan's significantly lower mortality rate may also be down to the city's stricter quarantine measures: The houses of infected families were simply bricked up (with the infected left to die inside).
Like Poland, the French-Spanish area, corresponding to the then-kingdom of Navarre, may have benefited from its relative isolation. Why the area around Bruges – then a thriving port with connections to the Mediterranean – might have been spared, is more of a mystery.
So, what's the lesson, if any? Isolation definitely helps against infectious diseases. But that's about the only advantage of being isolated. Take this map of the spread of COVID-19 as of 11 am on 5 March. If you had to divide the world into 'fun' and 'no fun' halves, they would correspond quite well with the blue and grey zones on this map, respectively.
For example, one sure-fire way to limit your exposure to the outside world is to have a bloody civil war – see Yemen, Libya and Syria. Another is to be a destination as out of the way and unconnected as Paraguay, the Central African Republic or Mongolia.
If it's the price of living in an interconnected world, then perhaps there are worse things than having to fight off a slightly deadlier iteration of the flu. Praise globalization and pass the hand sanitizer – with your elbows, please!
Strange Maps #1014
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Join The Daily Show comedian Jordan Klepper and elite improviser Bob Kulhan live at 1 pm ET on Tuesday, July 14!
The team caught a glimpse of a process that takes 18,000,000,000,000,000,000,000 years.
- In Italy, a team of scientists is using a highly sophisticated detector to hunt for dark matter.
- The team observed an ultra-rare particle interaction that reveals the half-life of a xenon-124 atom to be 18 sextillion years.
- The half-life of a process is how long it takes for half of the radioactive nuclei present in a sample to decay.
Gender and sexual minority populations are experiencing rising anxiety and depression rates during the pandemic.
- Anxiety and depression rates are spiking in the LGBTQ+ community, and especially in individuals who hadn't struggled with those issues in the past.
- Overall, depression increased by an average PHQ-9 score of 1.21 and anxiety increased by an average GAD-7 score of 3.11.
- The researchers recommended that health care providers check in with LGBTQ+ patients about stress and screen for mood and anxiety disorders—even among those with no prior history of anxiety or depression.
Study findings<p>For the study, <a href="https://link.springer.com/article/10.1007/s11606-020-05970-4" target="_blank">published in the Journal of General Internal Medicine</a><em>, </em>Flentje and her team evaluated survey responses from nearly 2,300 individuals who identified as being in the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community. Most of the participants were white, while nearly 19 percent identified as a racial or ethnic minority. Multiple genders were represented with cisgender women (27.2 percent) and men (24.6 percent) making up a majority of the participants. Sixty-three percent had been assigned female at birth. For the most part, participants identified their sexual orientations as queer (40.3 percent), gay (36.5 percent), and bisexual (30.3 percent).</p><p>The JGIM study participants were recruited from the 18,000-participant <a href="https://pridestudy.org/" target="_blank">PRIDE Study</a> (Population Research in Identity and Disparities for Equality), which is the first large-scale, long-term national study focusing on American adults who identify as LGBTQ+. It conducts annual questionnaires to understand factors related to health and disease in this population. </p><p>Participants filled out an annual questionnaire (starting in June 2019) and a COVID-19 impact survey this past spring. Flentje noted that on an individual level, some people may not have experienced a big change in anxiety or depression levels, but for others there was. Overall, depression increased by a <a href="https://patient.info/doctor/patient-health-questionnaire-phq-9" target="_blank">PHQ-9 score</a> of 1.21, putting it at 8.31 on average. Anxiety went up by a <a href="https://www.mdcalc.com/gad-7-general-anxiety-disorder-7" target="_blank">GAD-7</a> score of 3.11 to an average of 8.89. Interestingly, the average PHQ-9 scores for those who screened positive for depression at the first 2019 survey decreased by 1.08. Those who screened negative for depression saw their PHQ-9 scores increase by 2.17 on average. As for anxiety, researchers detected no GAD-7 change among the study participants who screened positive for anxiety in the first survey, but did see an overall increase of 3.93 among those who had initially been evaluated as negative for the disorder. </p>
Risks among gender and sexual minorities<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="fc3fd1ae68b77bbbf58a6995638d6d65"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/EnUqDjCqg0A?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>The LGBTQ+ community is a vulnerable population to mental health concerns because of their fear of stigmatization and previous discriminatory experiences.</p> <p>Previous research by the Human Rights Campaign has found "that LGBTQ Americans are more likely than the <a href="https://medicalxpress.com/tags/general+population/" target="_blank">general population</a> to live in poverty and lack access to adequate medical care, paid <a href="https://medicalxpress.com/tags/medical+leave/" target="_blank">medical leave</a>, and basic necessities during the pandemic," said researcher Tari Hanneman, director of the health and aging program at the campaign.</p> <p>"Therefore, it is not surprising to see this increase in anxiety and depression among this population," Hanneman said in the release. "This study highlights the need for <a href="https://medicalxpress.com/tags/health+care+professionals/" target="_blank">health care professionals</a> to support, affirm and provide <a href="https://medicalxpress.com/tags/critical+care/" target="_blank">critical care</a> for the LGBTQ community to manage and maintain their mental health, as well as their physical health, during this pandemic."</p>
What should health care providers do?<p>The authors of the study recommend that health care providers check in with LGBTQ+ patients about stress and screen for mood and anxiety disorders in members of that community—even among those with no prior history of anxiety or depression.</p><p>As cases of COVID-19 continue to mount, the sustained social distancing, potential isolation, economic precariousness, and personal illness, grief, and loss are bound to have increased and varied impacts on mental health. Effective treatments may include individual therapy and medications as well as more large-scale coronavirus support programs like peer-led groups and mindfulness practices. </p><p>"It will be important to find out what happens over time and to identify who is most at risk, so we can be sure to roll out public health interventions to support the mental health of our communities in the best and most effective ways," said Flentje.</p>
What we know about black holes is both fascinating and scary.
- When it comes to black holes, science simultaneously knows so much and so little, which is why they are so fascinating. Focusing on what we do know, this group of astronomers, educators, and physicists share some of the most incredible facts about the powerful and mysterious objects.
- A black hole is so massive that light (and anything else it swallows) can't escape, says Bill Nye. You can't see a black hole, theoretical physicists Michio Kaku and Christophe Galfard explain, because it is too dark. What you can see, however, is the distortion of light around it caused by its extreme gravity.
- Explaining one unsettling concept from astrophysics called spaghettification, astronomer Michelle Thaller says that "If you got close to a black hole there would be tides over your body that small that would rip you apart into basically a strand of spaghetti that would fall down the black hole."