Should we be worried about plague?

This morning, I woke up startled and very happy to be in my own bed.

You see, I had been reading about the death of a laboratory worker at a plague research institute in Russia. One article became another, and before I knew it, I was deep in a rabbit hole of bubonic plague, pneumonic plague and everything surrounding the incident.

I have also been battling a terrible flu these past few days, which has rendered me practically useless at many things. So I fell asleep with a hot water bottle beside me and, apparently, enough material for my brain to produce its own medical thriller.

In the dream, I had cared for a patient who developed a nosebleed during ward rounds the week before. That part actually happened. The day began as mine normally does. I was getting ready in the bathroom, when I found myself coughing up blood, with tiny specks coming from my nose too. Naturally, I called the CDC directly. Not the UK’s UKHSA. The CDC. I suppose they feature more prominently in the news and films, so my sleeping brain knew exactly whom to call.

Somehow, I convinced them that I had a newly discovered, mutated form of plague. I was not patient zero, I explained. The patient with the nosebleed had sadly died—in the dream—and I had apparently worked out the rest.

I put myself into quarantine, locked the bathroom door and the main door and told my family to stay away from me. Within barely 3 hours, the CDC came! It was very much an E.T. situation: protective suits, lots of personnel and the full emergency response. I was airlifted right away!

Then I woke up, half expecting to be somewhere in the air, on my way to a quarantine facility. Fortunately and thankfully, I was in my own bed.

Whew.

Once I had established that my bedroom was still my bedroom, I thought it was worth separating what my brain had invented from what we actually know.

What happened in Russia?

A laboratory employee at the Irkutsk Anti-Plague Research Institute in Siberia died after developing pneumonia of an initially unexplained cause. Reports suggesting pneumonic plague prompted concern, and authorities introduced precautions, including monitoring contacts and quarantining the hospital where she had been treated. The reports did not establish a confirmed plague diagnosis.

In updates on 6 October 2026, Russian authorities reported that testing had not detected plague in her contacts or identified plague bacteria in her samples. The cause of her illness remained unresolved in the reporting available at the time of writing. Stories about a broken laboratory test tube should therefore be treated as unverified, rather than an established explanation.

A woman has died, and that deserves care and a proper investigation. It also deserves accuracy. An unexplained death at a plague institute is not, by itself, proof of a plague outbreak.

A reason to breathe: plague can be treated

The word plague carries a great deal of history. It is difficult to hear it without imagining the Black Death. But we have something those communities did not: effective antibiotics.

Plague is still a serious infection, and treatment needs to begin quickly, especially when the lungs are involved. It is not something to dismiss, but neither is it automatically untreatable. WHO’s assessment, reported on 6 October, was that the risk outside Russia was very low. That assessment could change if new evidence emerges, but the available information did not justify assuming a wider outbreak.

What is plague, and are there different types?

Plague is caused by a bacterium called Yersinia pestis. The main forms are named according to where the infection affects the body:

• Bubonic plague affects the lymph nodes, causing painful swellings called buboes.
• Pneumonic plague affects the lungs and can spread between people through infectious respiratory particles.
• Septicaemic plague affects the bloodstream and can cause severe illness.

These are different forms of the same bacterial infection, rather than three separate “plague viruses.” Infection commonly involves infected fleas or animals; pneumonic plague can also spread through close contact with an infected person.

What should we look out for?

Symptoms can include sudden fever, chills and marked weakness. Bubonic plague can cause painful swollen lymph nodes. Pneumonic plague can cause a rapidly worsening cough, breathing difficulty and sometimes blood in the sputum. Symptoms alone do not tell us that someone has plague. Doctors also consider possible exposure, travel history and laboratory results.

And a nosebleed on its own does not establish plague, whatever my dream’s diagnostic confidence suggested.

One practical point is worth taking seriously: coughing up blood should be checked, regardless of whether plague is remotely likely. In the UK, even a few small streaks warrant an urgent GP appointment or advice from NHS 111. More than a few spots, or blood accompanied by breathing difficulty or chest pain, requires emergency help.

What happens if doctors suspect plague?

Medical teams assess the person’s symptoms and exposure history, take samples and arrange urgent treatment. When suspicion is strong, antibiotics may need to start before confirmation. People with suspected pneumonic plague are isolated, and close contacts may need monitoring and preventive antibiotics. Those precautions help protect people while the facts are being established. They do not, on their own, confirm an outbreak.

For the rest of us, the useful response is to follow reliable updates and seek medical advice for concerning symptoms, mentioning any relevant travel or exposure. There is no need to diagnose ourselves from a headline or take antibiotics “just in case.”

As for me, I am grateful that the airlift existed only in my sleep. Tonight, I may choose something gentler to read.