ZKEA

Biological Warfare : Biological Terrorism : Emerging Diseases

Smallpox, History

Smallpox is perfectly adapted to humans and lives nowhere else. Unlike many pathogens, there is no animal reservoir to which the virus can retreat. In addition, smallpox is relatively fragile and can not survive long outside a human being. Further, the virus never lies latent; it either quickly kills its host or moves on to a new victim. These facts make smallpox uniquely susceptible to eradication, for once eliminated from human bodies it has no where else to flee. Therefore, through a global program of vaccinations lasting many years, the virus was gradually corralled into ever-smaller geographic zones. This massive coordinated effort was perhaps the most successful health program of all time. It reached it's conclusion in 1977, when the last wild smallpox virus was tracked down and killed in Somalia. Since then no cases have ever occurred, anywhere in the world. Vaccinations soon ceased and the world rejoiced. Smallpox is extinct.

Well, almost. Just in case, two storage sites were permitted to keep the last surviving frozen samples of the virus. One of these sites was in the United States, the other in Russia. Needless to say, both sites had the highest biosecurity levels and were heavily guarded.. The demon might be captured and on ice, but no one doubted what would happen should it escape. In a world of unvaccinated billions with absolutely no immunity, a global apocalypse was a certainty should the virus ever reach the open air. A small laboratory freezer held prisoner a monster that could literally destroy the world. Presumably the freezer door had a padlock on it.

As you might guess, this made people a bit uneasy. Proposals were put forward to destroy these last remaining stocks. Why keep something so insanely dangerous? Various counter-arguments were put forth. Some felt that it was ethically wrong to drive any species to extinction, even a killer virus. Others felt that the value to future genetic research outweighed any hypothetical concerns about viral escape. The Clinton administration, however, seemed inclined to destroy these stocks because of their intrinsic danger. The Russians agreed.

But then reality interfered, as it often does. Intelligence reports began to indicate that the virus had been acquired by other countries, including Iraq and North Korea. Where did these countries obtain the virus? No one is sure, but one likely candidate is Russia. It turns out that, for many years, the Russian viral store was not so well-guarded after all. Through theft or bribes a few test tubes had gone missing. Once seed stock was in the hands of a rogue regime, it was easy to breed up fresh stores. In this way the demon was given a fresh lease on life.

Smallpox is just too good at killing people and thus makes a terrifyingly perfect biological weapon. Mankind couldn't pass up such an opportunity.

Because of all these developments the American policy went into sudden reverse. The U.S. smallpox stores were not destroyed. Instead, an emergency vaccination program was initiated. A number of other countries followed suit. In the space of a few years smallpox went from a historical abstraction to a clear and present danger. The sunny optimism that once surrounded the biological weapons treaties has been replaced by a gritty realism.

It takes very little to get smallpox - breathing in just a handful of viral particles is sufficient. After you acquire the virus, it takes 12-14 days for symptoms to appear. The classic course of the disease is this: first, you develop a fever, then a splitting headache. A couple days later a rash develops. Unlike chickenpox, smallpox lesions develop uniformly and all over the body (whereas chickenpox comes in crops, are much more superficial and more variable in size). At this stage patients often develop a "worried" face - an expression that is considered diagnostic of of the disease. You become very sick.

The rash spreads, covering the body. The lesions are hard and filled with pus, and painful to touch. Just lying on a sheet causes excruciating pain. Sometimes the lesions spread down the throat, constricting breathing. Often they infest the eyes, the mouth, the throat, the anus. Convulsions are common at this stage. In some cases the rash then merges into sheets. These sheets blacken and peel off the body in bloody layers. You begin to bleed internally. This is known as "black pox" and is invariably fatal. (Weapons designers prefer this form, of course). A sweet and penetrating stench comes from your body which can be discerned from quite a distance. This is the "smallpox smell". Those who have smelled it never forget the experience.

After a week the lesions begin to crust and harden. The patient may take this as a good sign and feel they're recovering. In fact, this is one of the more dangerous stages. Patients often die at this point from immune system shock.

Should you survive smallpox, you will forever bear marks from the experience. If lucky, this means your face will be deeply scarred. If unlucky, you will be both scarred and permanently blinded. The mortality rate for adults and children is similar. However, should they survive, babies and children often exhibit less scarring than adults. In indigenous societies that survived smallpox epidemics, it was often noted that entire generations had partial or full blindness, plus the deep facial scarring.

Even if scarred and blinded, once a person survives a bout with the disease he is no longer contagious. However, smallpox scabs themselves remain infectious for up to two years. Given these scabs invariably rub off onto a number of surfaces during the course of the disease (such as beds, clothing and blankets), the potential for disease spread remains very high.

There is no cure for smallpox. However smallpox vaccine is quite effective in preventing the natural form of the disease. Also, it's important to note that this vaccine can be effective in preventing death even if given a few days after acquisition of the virus. Once the disease is in full course, however, there is no treatment. Also, note that it may be the case that weaponized smallpox is immune to the vaccination.

Of course, much research is going into finding anti-virals for smallpox. To date no drugs are available, although Cidofovir (Vistide) has shown promise in early testing.

Typically smallpox comes in 14-day waves: an initial wave, a lull, a bigger wave, another lull, and so on, building to a terrifying crescendo. The virus can attack at any time and any season, but seems a bit partial to cooler and drier weather. Because of the nature of the virus and these waves, the usual health tactic for a smallpox epidemic is ring-vaccination. In ring-vaccination the primary carrier of the virus is isolated, while all those who had contact with him are vaccinated. In this fashion vaccinated "rings" are established around the virus, preventing its further propagation. This method was quite effective in dampening and eliminating natural smallpox epidemics. However, it is not likely that it would be effective in the case of a full-blown attack: there would simply be too many primary carriers and thus too many rings. The entire population would have to be vaccinated instead to be effective. That is, of course, if the smallpox had not been specifically engineered to resist this vaccine.

Today, with smallpox officially extinct from the wild, it is easy to for us to be sanguine about such a seemingly remote topic. Yet this is not a remote topic. The weaponized virus is out of the freezer and is perhaps growing more deadly over time. Few doubt that this virus will appear again, one way or another.

The following links document the history, progression and symptoms of the disease. It is a fascinating read. But be warned, this archive can also be a bit gruesome.

Link: The Demon In The Freezer [A MUST READ!]
Link: CDC Clinical Report
Link: Extremely Thorough Review Of Smallpox And Eradication In The Wild
Link: World Health Organization - Fact Sheet On Smallpox
Link: World Health Organization - Smallpox FAQ
Link: Camelpox as the next smallpox? (Iraq, Camel, pox, camels)