Missing details keep U.S. plague response on hold

Two big unknowns stand in the way of determining how serious the plague threat in Russia is and whether travel advisories, restrictions at U.S. ports of entry or other precautions are warranted. We still don't know which pathogen killed a Russian researcher, or how well contained it is.Why it matters: Though public health experts say there's no cause for Americans to panic, the episode serves as a wake-up call emphasizing the nature of global biological threats and the need for pandemic preparedness.State of play: A worker at the Anti-Plague Research Institute of Siberia and the Far East recently died after contracting pneumonia. There are conflicting accounts of how she got sick and whether she was infected with pneumonic plague, which is almost always deadly without prompt treatment with antibiotics. Secretary of State Marco Rubio said Monday that the administration is closely monitoring the situation, adding, "I don't think it's cause for alarm, but it is cause for focus and a cause to just keep an eye on. And we're doing that."If a response is required, "the playbook for these instances is very well defined," David Mansdoerfer, a former health official in the first Trump administration, told Axios."Traditionally, the precautionary measures the government would take would be via a travel advisory from [the State Department]," he said, adding the U.S. already has its most serious travel warning in place for Russia due to the war with Ukraine. It would also contact U.S. citizens in the affected area with guidance, and the Centers for Disease Control and Prevention would follow up with a travel health notice, Mansdoerfer said."The government would then focus on [Customs and Border Protection] ill traveler rules" that can include stopping high-risk individuals from boarding flights or flagging health officials if they land at a port of entry. At that point, "it becomes a CDC protocol-driven process," he added.The intrigue: If the Russian worker did die from pneumonic plague, experts say there's a possibility that it was a genetically altered version that behaves differently than the treatable strain. That's just speculation at this point. But the prevalence of "gain-of-function" research that enhances pathogens to study them and Russia's known development of biological weapons make it impossible to rule out.U.S. preparedness efforts will focus first on getting as much detailed information as possible because officials first need to understand what is going on to prepare for it, said Tom Inglesby, director of the Johns Hopkins Center for Health Security."It's really critical to get the diagnosis right. There are conflicting stories around it," Inglesby said, noting that while there are substantial supplies of antibiotics in government stockpiles and pharmacies, there's still the possibility the strain is resistant to them.Another key unknown is if pneumonia believed to be linked to plague has spread in the community. So far, reports suggest it's li