The Russia plague incident sounds scarier than it is. Here’s why.

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Last week, a 28-year-old laboratory worker—who, notably, worked at an anti-plague research institute—died under mysterious circumstances in a remote Siberian city. Cue widespread speculation. Early reports suggested that she fell ill after breaking a test tube. A government official in a nearby region released a statement saying that the woman had died of the plague; he has since updated the statement to add the word possibly. An independent regional news outlet has reported that nearly 200 people are now in quarantine. Russian authorities have denied that she died of the plague and attribute her death to “pneumonia of unknown etiology.” So, it’s all very murky and uncertain … but long story short: It is possible that plague is at play.

Yes, plague is a real, actual disease, and one that isn’t confined to history books. It’s caused by a bacteria called Yersinia pestis that infects fleas and the small mammals that host fleas, and there are actually three types of plague depending on which part of the body becomes infected. (The type suspected in this case is pneumonic plague, which could account for the victim’s “pneumonia of unknown etiology,” but you can get pneumonia a whole bunch of ways.) And while plague can be very deadly, it’s much less common than it was in the past, and it’s treatable. There are roughly 1,000 to 2,000 annual cases worldwide, with only a few in the U.S.; last year, a young man died of pneumonic plague in Arizona. Compared with other illnesses, the plague isn’t much of a problem these days: Each year the regular old flu kills many thousands of people in the United States alone.

Yet, even as a journalist who covers public health, every time I hear about a case of “the plague,” I get a little shiver down the spine. There are so many scary diseases out there that I had to wonder: Is there something about plague that is particularly unsettling? For a disease that doesn’t kill very many people in modern times, it certainly has terrible branding.

Some of the word’s fear factor can be attributed, certainly, to Americans’ keen awareness of the “Black Death,” taught at length in middle and high school history classes; as you may recall, the bubonic plague killed at least a third of Europe’s population—some 25 million people—in the 1300s. (The bubonic plague infects the lymph nodes). Or you might have seared in your mind the image of the beaked masks that plague doctors wore in the 1600s, which, given the lack of treatments at the time, became closely associated with death.

But plague has, for a very long time, been shorthand for various kinds of bad news. The Bible tells of 10 plagues that preceded the Hebrews’ exodus into the wilderness, each one devastating in its own right: one turned water to blood, the story goes; others brought locusts, frogs, hail, boils, and darkness; the last one brought about the death of every firstborn child. Plagues were associated with the wrath of God, punishment, and retribution. That supernatural connotation would continue into the 14th century, when we were still a long way from understanding bacteria and viruses: “During the time of the Black Death, it must have been truly terrifying to witness otherwise healthy individuals cut down rapidly by a seemingly invisible demon,” notes a historical report in the American Journal of Medicine. Eventually, plague had become so iconic that it was—and continues to be—used interchangeably to refer to any infectious disease that 1) spreads rapidly, and 2) has a high mortality rate. In modern lingo, plague is shorthand for something really awful: “I caught the plague last weekend!,” “I avoided him like the plague,” etc.

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Now, the term plague is linked to the sudden and uncertain death of a healthy young woman—and this time it easily calls to mind our own recent, collective plague-like experience. The COVID-19 pandemic may not have caused 25 million deaths in Europe, as the Black Death did, but it did cause 7 million deaths worldwide. We wore KN95 masks—a modern version of the plague doctor beaks—and hid in our houses, and saw our hospitals overflow, and couldn’t be with our loved ones when they died. Scientifically, COVID-19 was a virus, not plague. But colloquially, it was a plague.

That this might be a case of plague is actually relatively good news compared with some of the alternatives (like, say, a novel virus that can spread via asymptomatic carriers), at least from a public health perspective. Epidemiologists aren’t worried about the Russia incident turning into another COVID-19, for many reasons. First, though plague is usually fatal without treatment, we have very effective antibiotics, which can also be taken prophylactically by people who came in contact with someone infected. Plague is also not that contagious, and even the most contagious type, pneumonic plague, requires close contact; it’s very unlikely that you would catch it by just being in the same room with someone—whereas a single person with measles can infect people for two hours after they’ve left the room. And plague symptoms emerge really quickly, sometimes within a day, which means less opportunity for an infected person to spread the disease without knowing. That’s very different from our recent experience with hantavirus, which can take 42 days for symptoms to show, necessitating long periods of quarantine for people who were exposed.

As for concerns about why there might be plague in a test tube in Siberia: the lack of transparency from Russia is worrying for biosecurity experts. Pneumonic plague has been identified by the Centers for Disease Control and Prevention as having the potential to be used as a bioweapon, and Russia has a history of studying bioweapons. If this plague had been altered in a lab to be resistant to antibiotics, for example, that would be concerning (though we have multiple different antibiotic treatments for this exact reason). Scary stuff, yes, and also completely hypothetical. The question here isn’t “am I going to get the plague?” It’s more like “what is Russia up to?” Just because biosecurity experts are concerned about what could be happening doesn’t mean that you need to be. “It is their job to worry,” epidemiologists note in the Substack Your Local Epidemiologist. “This worry shouldn’t transfer to the general public right now, mainly because there is nothing for you to do and your risk is so low.” As they put it, the risk of plague coming to the U.S. is “essentially nil.”