The effect of the bubonic plague outbreak during the Late Antique Little Ice Age should therefore not be overlooked. Viral infections were already a primary cause of death in a population that seldom lived into their twenties, and a close-knit empire made it easy for microorganisms to spread through crowded cities.
Diseases like leprosy and tuberculosis took full advantage of Rome’s urban areas and extensive highways. When water and food were infected, gastrointestinal illnesses including shigellosis and paratyphoid developed. Then the climate began to shift, and things appeared to get even worse. The Antonine Plague, for example, may have been the first time smallpox decimated a population.