How to Contain an Epidemic
Health workers carry the body of a victim of the Ebola outbreak in Guinea.Getty Images
An outbreak of Ebola originating in Guinea has crossed borders, infecting at least 143 people and claiming 86 lives as of the latest World Health Organization (WHO) situation update. The WHO has labeled the outbreak a "pandemic," and Doctors Without Borders calls the situation "unprecedented."
Fears of a widespread outbreak have gripped public health professionals, as well as those who could be affected by the disease who are unfamiliar with how it spreads. On Friday, a Doctors Without Borders treatment center was attacked by an angry mob, forcing staff to shut down the center, according to NBC News.
If history is any guide, then it's clear that panic certainly won't stop an epidemic. But public health officials have historically had many tools at their disposal to attempt to slow down, if not stop, the spread of the deadly virus.
This building is one of the facilities where those afflicted with the Ebola virus in Guinea are being isolated.Corbis Images
Individuals infected with a disease that is transmitted as an airborne contagion or through personal contact, as is the case with Ebola, require care and attention, but also must be isolated from healthy populations.
Isolating sick individuals is one of the oldest methods of preventing disease spread. In the 6th century, one of the most severe plagues in history invaded the Byzantine Empire and its capital city, Constantinople. In what was likely the first outbreak of bubonic plague ever recorded, the epidemic claimed an estimated 25 million lives.
Emperor Justinian attempted to contain the plague's spread by isolating populations that had been infected by it. Unfortunately, infected people themselves weren't the only disease-carrying agents; rodents and insects transmitted the disease between people and communities.
A painting of Venice, titled "Venice Across the Basin of San Marco," by Francesco Guardi.Corbis Images
Similar to isolation, quarantine is a means of separating groups from the larger, healthy population. Quarantine may apply not only to those who have potentially come into contact with a particular pathogen, and therefore require monitoring to ensure they don't develop an infection, but also susceptible populations that may be especially vulnerable to the outbreak.
The word "quarantine" originates from the Italian quaranta giorni, meaning 40 days. During the 14th century, coastal cities along the Mediterranean endured waves of plague throughout their history. In an effort to prevent potential infection, ships arriving in Venice from infected ports had to wait 40 days before they were allowed to dock.
Quarantining populations can take place at an even larger scale today, with countries shutting down borders to nations infected by a contagious disease, as Senegal recently did in response to the Ebola outbreak.
A tent encampment is set up for those afflicted with the Spanish flu.Corbis Images
Evacuation is a last-resort method of preventing a population from coming into contact with a contagious disease.
In 1918, the world saw what may have been the most widespread epidemic in history. Spanish flu occurred in three waves over two years, and infected an estimated one-third of the world's population at the time, leaving some 500 million people ill. Of those who were infected, up to one in every five died, according to the Centers for Disease Control and Prevention (CDC). In cities and towns that saw high rates of infection, public health officials advised citizens to stay at home and avoid public group events. In some areas in the United States, particularly eastern Arkansas, infection rates and morbidity was so high that whole towns were abandoned.
A health worker is sprayed with disinfectant after exposure to the H1N1 flu.Getty Images
Disinfecting means fighting a potential disease outbreak right at its source.
According to "History of disinfection from early times until the end of the 18th century (PDF)," prior to the discovery of pathogenic microorganisms, the three primary methods of disinfection could be classified chemical (sulfur, mercury, etc.), physical (heat, water, etc.) and biological (burial). Sulfur and mercury are among the oldest chemical disinfectants, used in ancient Greece and in ancient China, India and Egypt. Fire and fumigation were thought to purify the air and were methods of controlling an epidemic advocated by Herodotus, the father of medicine, in 429 B.C. Burial is not only an ancient religious rite, but an effective means of containing disease outbreaks.
Modern antiseptics, sanitation and sterilization are effective extensions of these ancient practices.
A recreation of a plague costume.Getty Images
Protective clothing meant to guard against infections has been around for centuries.
According to the "Encyclopedia of Infectious Diseases," during an outbreak of plague in the 17th century, physician Charles de Lorme, who served the French court over the reigns of three kings, developed what would become the iconic plague doctor costume, as seen in this modern recreation. The mask of the costume included a beak for a nose that was half-a-foot long and was filled with aromatic herbs. The doctor would also be covered head-to-toe in a brim hat, long leather gown and boots.
Today's protective biohazard suits might not have the same flair as the plague doctor costume, but they do effectively serve the intended purpose of their forebear's design.
Edward Jenner administers the smallpox vaccine to an infant in this illustration.Getty Images
Immunization can not only stop epidemics in their tracks; they can also prevent future disease outbreaks.
Smallpox is a disease thought to have originated around 10,000 B.C. in the first human agricultural settlements in Africa. The earliest evidence of the disease was found on ancient Egyptian mummies dating as far back as the 16th century B.C. Smallpox produced waves of epidemics over the centuries, claiming millions of lives.
Before the discovery of a vaccine, inoculation for smallpox took the form of variolation, performed with "a lancet wet with fresh matter taken from a ripe pustule of some person who suffered from smallpox," according to an article published by the U.S. National Library of Medicine.
In the late 18th century, an English doctor named Edward Jenner created the world's first vaccine, when he observed that those who had been infected with cowpox had immunity from smallpox. Jenner first tried out his hypothesis by infecting an eight-year-old boy with cowpox and then exposing him to smallpox, a move as ethically questionable today as it was in 1796. In that trial and others that followed, Jenner proved his vaccine effective.
Just as Jenner created the first vaccine, so too did he face the world's first anti-vaccination movement. Anti-vaccination advocates pointed not to the work Jenner did in creating the vaccine, but rather a disputed study he conducted nearly 10 years earlier on the cuckoo bird in an attempt to discredit him. Thankfully, the horrors of smallpox far outweighed the cuckoo concerns of the anti-vaccination movement. Within 200 years of Jenner's discovery, the WHO declared smallpox eradicated, the first infectious disease in history to receive such a designation.
An AIDS ribbon is surrounded by candals in this observation of World AIDS Day.Corbis Images
One of the most powerful tools in preventing disease epidemics, particularly those that prove fatal, is through public health education. This lesson was one painfully learned as a result of the AIDS epidemic that has claimed millions of lives since the 1980s.
Originally stigmatized as a virus that targeted sexually active gay men, HIV spread in part thanks to public misinformation. Vulnerable groups did not properly understand their risk factors and the population at large generally had the wrong impression of how the disease was transmitted, despite early evidence that HIV was not easily communicated. A 1985 poll found 47 percent of American believed AIDS could be transmitted by sharing a drinking glass and 27 percent thought a contaminated toilet seat could pass on the HIV virus.
The 1990s ushered in a change in the public's perception of the AIDS crisis, with new health information efforts, red ribbon campaigns to support AIDS victims and public figures dealing with AIDS themselves, such as Roc Hudson, Magic Johnson and Ryan White, an Indiana teenager who became infected with the disease through a blood transfusion. The result was sexual education about the dangers of unprotected sex, needle exchange programs for intravenous drug users and other efforts to curtail the AIDS epidemic.
Thanks to public education and other preventative measures, the HIV transmission rate has declined 89 percent since the mid-1980s, according to the CDC (PDF). Worldwide, UNAIDS, the United Nations agency dedicated to the disease, reported a 50 percent decrease in HIV infection rates in 2012.