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The Black Death

All pandemic infectious diseases are rare and so medical educators must compete for time.

“It first betrayed itself by the emergence of certain tumours in the groin or the armpits, some of which grew as large as a common apple, others as an egg... merely by speech or association with the sick was the disease communicated to the healthy... any that touched the clothes of the sick... seemed to catch the disease... Many died daily or nightly in the public streets. Of many others, who died at home, the departure was hardly observed by their neighbours, until the stench of the bodies carried the news.”

This clinical scenario was written by Giovanni Boccaccio in Decameron (circa 1360). It is hard to better it as a description of the disease. The Black Death was caused by Yersinia pestis and it spread quickly throughout medieval Europe and the world. It was spread by many factors – not least poor hygiene and dreadful living conditions.

However, like all pandemic infections, ignorance also played a role in its rapid spread. Some people said the disease was caused by God’s anger at people’s sins. Others blamed foreigners or minorities. Some despaired and said that nothing could be done to prevent the disease – ignoring the fact that quarantine did work in some cities. These myths and counsels of despair served only to distract from the real cause of the pandemic and so acted as a barrier to its control.

Over six hundred years later, ignorance is still the greatest risk in the spread of pandemic infectious diseases. Simple measures can be taken that would have a great effect if they were universally adopted. The spread of Yersinia pestis can be prevented by early reporting and isolation of affected patients. But if patients or their relatives are scared to present to their doctor then urgent reporting and isolation will be impossible.

This is true of other infectious disease also. For example, patients with Ebola need to be isolated and reported to the relevant authorities. Relatives and healthcare workers who are caring for affected patients need to wear personal protective equipment. They also need to avoid direct contact with the body of someone who has died of the disease. These safe practices need to be followed meticulously but they can be a challenge in certain cultures, where relatives will want to touch their loved ones. In these scenarios, education will help but new cultural practices will need to be developed also. These might include smiling and nodding at people when you meet them as opposed to shaking hands. In Guinea, the highest ranking religious leader said there was nothing in the Koran “that says you must wash, kiss or hold your dead loved ones.” In saying this, he likely convinced many people and saved lives.

All pandemic infectious diseases are rare and so medical educators must compete for time in curricula and continuous professional development programmes to educate healthcare professionals on their diagnosis and management. Pandemic infectious diseases are all different and this makes it even more of a challenge.
However, there are themes that are common to all pandemic infectious diseases. The essentials of recognition, referral and reporting of such diseases are universal themes that apply to all. These three R’s might help with a wide range of diseases – from the ancient threats of Yersinia to the modern but equally deadly menace of Ebola. Education is our greatest weapon against them.


The purpose of this document is to educate and to inform. The content of this document does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care or treatment. The views expressed by contributors are those of the authors. BMJ does not endorse any views or recommendations expressed in this document. Readers should also be aware that professionals in the field may have different opinions. Users of this document hereby agree not to use its content as the basis for their own medical treatment or for the medical treatment of others.

BMJ wins Geneva Centre for Security Policy’s 2018 Prize for Innovation.

Mitali Wroczynski, Head of Strategic Partnerships, Global Health and Global Health Security; Dr Elisa Roma, Programmes and Partnerships Manager; and Amy Hilton, Head of Institutional Marketing at the award ceremony in Geneva.

Mitali says there is a need to look at the critical needs of healthcare systems worldwide beyond the identification and treatment of infectious diseases, and to also be mindful of non-communicable diseases.

It’s important to build resilient healthcare systems so that a workforce is capable of dealing with anything. When there is an outbreak, it’s also about maintaining the healthcare system where the outbreak is happening." 

BMJ Global Health initiatives empower health professionals working in low-middle income communities to improve patient care.

The BMJ

Mitali Wroczynski works closely with ministries of health, agriculture, and defence to influence policy decision-making, and develop new global health partnerships.

She pioneered BMJ’s clinical decision support training initiative that supports healthcare professionals working in low and middle-income countries to improve the detection, diagnosis, and management of infectious diseases and contributes to building health system resilience. Mitali has also played a key role in making risk communication a central issue for managing major infectious disease outbreaks, epidemics or pandemics, as part of the EU-funded programme, TELL ME.  

Contact Mitali to find out how together we can address global health and global health securities priorities: 

Mitali Wroczynski
Head of Strategic Partnerships, Global Health & Global Health Security
Tel: +44 (0) 20 7383 6517
mwroczynski@bmj.com

The BMJ

The Practical Approach to Care Kit (PACK) is a clinical decision support programme guides primary healthcare clinicians through the diagnosis and management process of more than 500 common symptoms and conditions, including:

  • Cardiovascular and respiratory disease
  • Tuberculosis
  • HIV and AIDS and other infectious diseases
  • Skin disorders
  • Women’s health
  • Mental health
  • End-of-life care. 

This four pillar training programme improves primary health care in low and middle income countries. It works most effectively by partnering with governments, universities and NGOs to partner with us. Provide PACK to your clinicians working in remote areas today by contacting Dr. Tracy Eastman.

Dr Tracy Eastman, KTU Director of PACK Global Development and Delivery
Tel: +44 (0) 208 872 6323
Email: teastman@bmj.com