The US is at a turning point in the fight against CV-19. Deaths are still falling, but new infections are rising again as states re-open economic activity cheered on by the White House.

The big risk for the US is that CV-19 takes hold in the large rural populations, which already suffer from high levels of chronic illness and poor access to healthcare. So far their relative social isolation from the rest of the US has protected them, but if it the disease does take hold, it will be almost impossible to eradicate.

While all of this is going on the BBC are worried about an outbreak of the Black Death in Inner Mongolia.

https://www.bbc.com/news/world-asia-china-53303457

We think of the Black Death as a disease from centuries ago but it still endemic in parts of the USA.

Here are 2 graphs on the prevalence of the Black Death – human plague in the US. This might seem shocking, but the US is the only developed nation with endemic plague, in exactly the kind of chronically ill rural populations I described above.

These 2 graphs are from the US CDC:

This is a slightly longer time series:

The US hasn’t had a plague free year since the 1960s.

If this makes your jaw drop, then you are right. This is real jaw dropping stuff. Crazy. The Black Death is endemic in poor rural America.

I would show the graph for the UK, but we haven’t recorded a single case of the Black Death for hundreds of years.

This illustrates the scale of the problem that the US faces. Endemic Covid in rural populations. Forever.