To what extent did outbreaks of bubonic plague disrupt daily economic activity? We estimate the impact of epidemics on regional markets over four centuries – from the Black Death in the 14th century, until the medieval form of the plague became extinct in the 17th century. Despite the extreme mortality risk of bubonic plague, we find that outbreaks only had a modest impact on trade costs and market integration, as measured by local variations in wheat prices. The results provide quantitative evidence on how the lives versus livelihoods tradeoff was managed through history and the extent to which people learned to live with plague. They suggest that economic activity in low income societies is very resilient to epidemics.