CORONAVIRUS CONTACT TRACING AND LOCKDOWN: Learning from Smallpox

Coronavirus. Quarantine. Social distance. Contact tracing. Lockdown. New terms and questions dominate our consciousness. Vaccine—where’s the vaccine? With no vaccine and no proven treatment for COVID-19, we isolate, wear masks and wash our hands to stay safe in the midst of the pandemic.

Since all viruses share certain characteristics, it seems like an appropriate time to share my experience with a previous pandemic, contact tracing, quarantine.

It’s my up-close view of another virus—variola major—that causes smallpox. In West Africa and Bangladesh, my husband helped send the disease into history. Today (May 9) marks the 40th Anniversary of that eradication—a ten-year campaign, followed by over two years of surveillance to make sure no smallpox was left anywhere on the planet.

This post might help inform your current COVID-19 response. 

Virus Talk

I gained a layperson’s knowledge of viruses when I more or less married public health.

My late husband, Carl Bloeser, was a communicable disease fighter. All the time.

When not out in the field fighting a particular disease, he thought about it. He studied it. He talked about it. He strategized the next attack on it. 

Viruses and other microbes were the breakfast, lunch and dinner table-topic in my home.

And because of our family’s mission, I saw hideously scarred victims up close. 

I witnessed a mother’s tearful joy and gratitude the moment she knew that, because of the vaccine, her child would never suffer the horrors she had suffered. 

vaccinating
From Nigerian vaccination poster, 1969

For all of these reasons, I have something to share that relates to the virus we’re dealing with now. Yet, as most of us can attest to from watching daily Coronavirus (COVID-19) briefings on television, even the scientists have many unanswered questions about this novel virus.

Smallpox Virus Warrior

In the most successful battle between human and microbe, Carl and the others would go down in history. He was one of the eradicators of smallpox, 

      with CDC and USAID in West Africa as an operations officer in the smallpox eradication-measles control program.

      with WHO in Bangladesh when the smallpox campaign was on the home stretch toward the finish line of global eradication.

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Smallpox containment hospital Carl set up in Bangladesh, 1975

Much of what Carl did over four decades ago resembles what we’re going through today. 

In the African Sahel

I’ll share a glimpse of Carl’s work in this brief excerpt from my forthcoming first-person history:

“As we pressed north in the African Sahel, my husband leaned forward, searching the horizon. At the last mud-walled village he’d learned that a group of nomads was camped nearer Nigeria’s border with Niger, and he had to find them before they moved on. With no new cases of smallpox reported for several weeks, this was a high-risk period when people might let down their guard. Carl and his teams had to step up their surveillance, search for any case lurking undetected. 

If new victims were found, the teams moved fast to quarantine them, vaccinate their contacts and the contacts of those contacts to prevent re-introduction of smallpox, a daunting challenge among a nomadic people.”

Bee Bloeser in working title: Vaccines & Bayonets: Fighting Smallpox in Africa amid Tribalism, Terror and the Cold War

A critical part of the above scenario is the process of contact tracing, and we’re doing it now with COVID-19.

Learning from Smallpox

I’ll also share excerpts of something I wrote a couple of years ago on the Bee’s Articles section of my website. https://beebloeser.com/blog/

It’s a glimpse of how one virus operates. Can we learn something from it that’s meaningful for this novel Coronavirus? The one that’s on our minds and changing our lives today.

Smallpox Virus—an Equal Opportunity Borrower

No discrimination here. Viruses don’t care who they borrow cells from. A virus is glad to lodge with a host on either side of any demographic divide. It’s all the same to the virus.

A virus has to live—is driven to live.

A virus has to replicate itself in order to live.

A virus has to borrow human cells in order to replicate (make copies of itself). 

While a virus is using up the cells in one human host, it is already finding the next host, preferably more than one.

Jump to the next host.  

Viruses Don’t Ring Doorbells

You’re going about your daily life. Going to work, playing with your children, shopping for groceries, working out at the gym, chatting with a neighbor.

What you don’t know is that the friend you just had a long lunch with is –

–Incubating a viral disease.

Incubating smallpox. She doesn’t yet know. She hasn’t noticed that a few red spots have appeared in her mouth and throat. Not only did the two of you talk for a long time. She had a bit of a cough, and maybe she sneezed a time or two. That’s like adding jet propulsion to an exhale. And—

The Virus Hitched a Ride

The virus swooped right in through your nose or mouth. It can’t thrive outside human cells, so it quickly slipped into some of yours. Moved in—sneaked in in the middle of the night so to speak.

And since you hadn’t been vaccinated, the virus sees the welcome mat and instantly goes to work.

Staying Alive – If You’re a Virus

Hunkered down in your dark and cozy cells, the virus quickly does what a virus has to do.

In order to stay alive this smallpox virus, hurriedly scans its little DNA blueprint and uses the machinery inside your cells to crank out copies of itself. Hurry. Hurry. Hurry.

It shoots out copies of itself to neighbor cells. Now there are lots more of these hard-working microbes multiplying and shooting out copies of themselves to more neighbor cells. Always working. Making more. More. More.

Your immune system should be getting a message to mount a counterattack. But smallpox is a virus that can evade your defenses.

By the time you finish your errands, return home and put your groceries away, smallpox is gathering speed. It’s growing like a brush fire. 

Smallpox has established a beachhead

You don’t know that. So far, you feel fine. 

In fact, you’ll feel fine for the next seven to nineteen days.

(Unfortunately, your friend didn’t remember to mention your name to the contact tracer. So no one could protect you.) And because you feel fine, you carry on with life as usual. You cuddle with your spouse, bathe your toddler, blow raspberries with your baby, go shopping with your mom, have coffee with your best friend.

These people you love are safe from your frantically multiplying smallpox virus. For now.

Then, you suddenly don’t feel so well—chills, high fever, headache, backache, and perhaps nausea. Three days of misery. But then you think, “Oh, must have been the flu. Thank goodness that’s over.” 

The Day That Will Change Your World

Then the variola major virus lunges out of hiding. 

Your life, assuming you live, will never be the same.

Once the rash appears, your family is no longer safe. But, like your friend, you haven’t yet noticed those little red spots in your mouth and throat. You begin sharing copies of the virus with the people closest to you.

At least a thousand more sores can appear on your body within twenty-four hours. And even more on internal organs. Now you know.

But it’s too late.

The Virus on the Move

Smallpox virus invades every nook and cranny of your body. 

It’s doing its job, using up your cells. Staying alive.

Then, worse than the most ungrateful guest, the virus moves out leaving physical and emotional chaos behind—even blindness—and immediately sneaks into new digs.

Just like you, the owner of these new digs doesn’t know the squatter has moved in and is borrowing her cells. 

Smallpox had to find another host. 

*It’s as simple as that. Finding another host is what a virus has to do. And there’s a good chance your baby is it. Or your dad or your spouse. Maybe all of them.

WHAT TO DO ABOUT A VIRUS?

Stop it in its Tracks – Interrupt Transmission

Deny the virus access to a new host. But how? 

*Whether out in the bush or in the choked warrens of the city, here’s what Carl had to do and what health care workers are doing today.

Contact tracing: 

Try your best to help the patient remember every person they’ve had close contact with over the period they were infectious, find those people, let them know they’ve been exposed, and protect them. (Contact tracing is no easy task. It requires great skill and sensitivity.)

For smallpox, protecting those contacts meant vaccinating them. Then the contacts of those contacts. That built a firewall around the virus—interrupted transmission.

Since there is no vaccine against this Coronavirus, The Centers for Disease Control and Prevention (CDC) issues other guidelines for protecting contacts. It’s important to follow their latest guidance.

Quarantine. 

Quarantining a person with the viral disease is another aspect of interrupting transmission. Since this host to the virus is isolated, the virus using up their cells can’t jump to a new host. 

The smallpox containment hospital’s reason for being was just that–to stop the virus from finding new hosts. The unbroken chain of transmission that had reached back into history, many think as far back as the pharaohs, was finally interrupted.

Smallpox vaccination poster, Nigeria. 1969.
Carl Bloeser in front of the containment hospital, boarded up after global eradication, 1980
Because of vaccine–                                                                                              Because of contact tracing–                                                                                 Because of isolation–                                                                                                              The virus finally had nowhere to go.

 

A Different Virus

The novel virus, COVID-19, is—thankfully—a far cry from smallpox. But it is not benign. If it can gain access to my cells, or yours, it will. It will make copies of itself to invade more cells. 

COVID-19 virus will do what a virus has to do in your body to stay alive. And it will have to look for the next person, and the next.

There was only one reason I could be up close with smallpox and with people who could be incubating smallpox.

Vaccine.

I was protected. 

How Will We Protect against this Coronavirus?

Carl vaccinated against smallpox. He trained and led teams of vaccinators.

There is no vaccine to protect against the Coronavirus COVID-19 and no evidence-based treatment. Not yet.

Smallpox plagued humans for thousands of years. Scientists know its characteristics and its behaviors. They know what it will do and what humans must do to be safe from it.

Beyond what scientists know about viruses in general, there is still too much unknown about COVID-19. It’s too new. We don’t even know all we need to know about how it passes from one host to another.

No one knows how to stay safe. Except – 

Distance and Barrier

With no vaccine to deny the virus access to our cells, we’re left with:

*Quarantining anyone with a confirmed or suspected case of COVID-19.

*Finding out who has been exposed so we can alert them.

*Washing and sanitizing to kill the virus on surfaces.

*Using distance and barriers to deny the virus a new host.

In large part because there’s so much we don’t know, 

I’ll stay at home, keep a six-foot distance if on an absolutely essential errand, religiously wash my hands, avoid touching my face, wear a mask. 

I’ll faithfully do these things to protect myself, protect those close to me, protect those I’ve never met. Protect you.

* * *

Things to Ponder

What did you know about smallpox?

What are your feelings about the current pandemic of COVID-19?

How are you protecting yourself?

How have you felt about contact tracing? And do you have a better understanding of why it’s important?

Thank you for reading.