WEEK 9 DISCUSSION:ERADICATION OF SMALLPOX, POLIO, AND COVID-19

WEEK 9 DISCUSSION:ERADICATION OF SMALLPOX, POLIO, AND COVID-19

WEEK 9 DISCUSSION:ERADICATION OF SMALLPOX, POLIO, AND COVID-19

Some of the most notable epidemics include the bubonic plague in the 14th century, smallpox in the 18th century, influenza in the 20th century, and SARS-CoV-2 (COVID-19) in the 21st century. It is estimated that the bubonic plague caused 25 million deaths in Europe in the 14th century alone, and up to 200 million total deaths across centuries (Glatter & Finkelman, 2021). The COVID-19 pandemic spread at an unprecedented pace due to globalization and the mobility of society, killing millions worldwide. These are dramatic examples of the kinds of acute outbreaks that make epidemiology such an important field of study.

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At the beginning of the 21st century, many epidemiologists and healthcare professionals were concerned about the next potential pandemic or epidemic—and then it arrived in early 2020. Globalization means that when these infectious outbreaks occur, they can spread quickly, but we also have more knowledge and better tools (e.g., vaccine technology) to fight them. For this Discussion, you will compare lessons learned from two successful eradication efforts, that of smallpox and polio, and consider how they may be applied to COVID-19.

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  • Briefly summarize the epidemiologic differences among the three diseases and how principles of epidemiology are being applied—or could be applied—to address COVID-19.
  • Are there any lessons learned from the use of epidemiology in the eradication of smallpox and polio that could be applied to COVID-19?
  • Evaluate the benefits of addressing this health problem at the population level versus the individual level. Support your Discussion with information from this week’s Learning Resources and articles you have located in the Walden Library.

LEARNING RESOURCES TO USE FOR THE POST

Eradication of Smallpox, Polio, and COVID-19

Over the past centuries, the world has grappled with many burdensome epidemics that contributed to massive mortalities, life-changing complications, economic burdens, and altered quality of life for the affected populations. Examples of these epidemics include the bubonic plague of the 14th century, the smallpox of the 18th century, influenza (20th century), and various coronavirus strands like SARS-COV-2 (COVID-19) in the 21st century.

Despite the significant challenges posed by these diseases, it is vital to acknowledge landmark achievements in treating, managing, and eradicating these epidemics. According to Rodewald (2020), the World Health Organization (WHO) declared the eradication of smallpox in 1980 after decades of background research activities. D.A. Henderson, the Director of the Smallpox Eradication Program, acknowledged this significant achievement by highlighting the public freedom from deaths and health complications associated with smallpox, including blindness and disfigurement (Rodewald, 2020). Through the successful eradication of smallpox, there was renewed vigor to apply scientifically-inspired epidemiological methods to combat other subsequent epidemics. For example, the World Health Organization declared the elimination of poliomyelitis (polio) in the Western Pacific Region (WPR) two decades ago following breakthroughs in mass vaccination. Since past successes in disease eradication shed light on the management of current epidemics, this paper summarizes differences between smallpox, polio, and COVID-19, discusses lessons learned from the use of epidemiology in smallpox and polio eradication, and evaluates the benefits of addressing health problem at the population level instead of the individual level.

Epidemiological Differences Between Smallpox, Polio, and COVID-19

Smallpox, polio, and COVID-19 are viral diseases associated with massive and burdensome public health outcomes, including increased mortality rates, prolonged hospitalization, overwhelmed healthcare systems, and poor quality of life. For instance, smallpox alone contributed to about 300 to 500 million deaths globally in the 20th century (Berche, 2022). On the other hand, COVID-19 has resulted in almost 7 million deaths so far (World Health Organization, 2023). Poliomyelitis has a significantly low mortality rate compared to smallpox and COVID-19.

Although the three diseases share similarities, various aspects contribute to their epidemiological differences. These aspects include the severity rate, the transmission rate, and the at-risk population. Smallpox is the severest of the three epidemics regarding the severity rate since 3 out of every ten people (about 30%) with variola virus succumbed to the disease (Centers for Disease Control and Prevention, 2021b). Besides a high risk of death, smallpox survivors sustained easily identifiable scars. Conversely, poliomyelitis results in mild to asymptomatic illness, although less than 1% of polio infections result in flaccid paralysis. The Centers for Disease Control and Prevention [CDC] (2021a) argues that the fatality rate for paralytic polio is around 2% to 5% in children and about 15% to 30% in adolescents and adults. On the other hand, COVID-19 results in asymptomatic to severe complications. The severity rate of COVID-19 is about 2%, although people can encounter various post-COVID conditions, including altered functioning and psychological sequelae that affect their quality of life (Munblit et al., 2022). Exact post-COVID consequences are a topic of further scholarly exploration.

From the perspectives of the transmission rate and at-risk populations, smallpox is the most contagious of the three, followed by COVID-19 and poliomyelitis. According to Rodewald (2020), smallpox was devasting and lacked pre-symptomatic transmissibility. Conversely, COVID-19 transmits from asymptomatic, pre-symptomatic, and ill individuals (Rodewald, 2020). Similarly, smallpox affected almost everybody regardless of non-modifiable determinants, including age and gender. Poliomyelitis primarily affects children aged ≤5, although unvaccinated people of any age are susceptible to the disease (World Health Organization, 2022). Finally, everyone is vulnerable to COVID-19, considering its volatile transmission patterns. However, older adults and people with other underlying chronic conditions like hypertension, diabetes, and respiratory conditions are more susceptible to the disease (Zhang et al., 2022). Pre-existing co-morbidities can contribute to weaker immune systems, exposing people to an increased risk of COVID-19.

How Epidemiological Principles Can Address COVID-19

Epidemiology entails studying various elements of health-related states or events, including their occurrence, distribution, and determinants (Friis & Sellers, 2021). Epidemiological principles that play a significant role in explaining the occurrence, distribution, and determinants of health issues are public health surveillance, field investigation, analytical studies, evaluation, linkages, and policy development. These principles can significantly inspire evidence-based interventions for addressing the COVID-19 pandemic. For example, public health surveillance and field investigation can inform systematic information collection regarding the disease, prevalence, incidences, and determinants.

Similarly, analytical studies can evaluate the credibility of clues and hypotheses from surveillance and field investigations. Thirdly, the evaluation principle enables epidemiologists to determine the relevance of data regarding COVID-19 and assess the efficiency of the established goals and response activities. Fourthly, linkages entail interdisciplinary partnerships with other healthcare professionals that facilitate information sharing, informal networking, and coordination of activities pertinent to disease response, management, and prevention. Finally, policy development entails making informed recommendations based on data from the target population and other evidence sources, including scholarly literature. In COVID-19 management, policy development encompasses recommendations on hygienic measures, social distancing, quarantine, and contact tracing.

Lessons from the Eradication of Smallpox and Poliomyelitis

The landmark eradication of smallpox and poliomyelitis can provide various lessons for COVID-19 management. The most profound takeaway from past successes in eliminating smallpox and poliomyelitis is the central role of vaccines in intercepting diseases’ transmission patterns. According to Rodewald (2020), vaccines can provide a pathway out of the COVID-19 pandemic, although there are challenges associated with widespread vaccination processes. Secondly, it is crucial to appreciate the role of various precautionary measures in managing global pandemics. Based on past successes in smallpox and poliomyelitis eradication, the role of hygienic protocols is profound. Wilson et al. (2021), border control, physical distancing, mask-wearing, and contact tracing are vital public health and social measures for slowing COVID-19 transmission. These strategies obtain inspiration from traditional approaches to disease management, including isolation and quarantine.

Finally, it is crucial to appreciate the role of early disease detection in preventing its progression and averting health complications. Although there were constraints in early detection mechanisms during the smallpox era due to technological and scientific deficiencies, the subsequent emphasis on mass testing and vaccination provides sought-after lessons for COVID-19 management. Healthcare professionals are responsible for educating communities on the merits of early detection of COVID-19 and engaging them in mass vaccination to achieve herd immunity.

Advantages of Tackling COVID-19 at the Population Level Instead of the Individual Level

Like other highly contagious disasters, the COVID-19 pandemic requires population-centered rather than individualized interventions. According to Shahzad et al. (2019), a population-based approach to integrated care delivery results in multiple benefits, including the plausibility of collecting, using, and sharing epidemiological information from a large sample size, the likelihood of implementing preventive interventions like mass screening and outreach programs, and the subsequent use of population-based analytical tools for enhancing public health practices, including risk assessments, cost-effectiveness analysis, and health needs assessment. In COVID-19 management, a population-based approach would enable epidemiologists to effectively identify determinants of health and obtain data regarding the disease’s prevalence, incidences, and severity. Further, they can effectively advocate for preventive measures like social distancing, hand hygiene, and mask-wearing by adopting a population-based approach to achieve the desired outcomes amidst the pressure to prevent COVID-19 transmission.

Conclusion

Smallpox and poliomyelitis eradication represent landmark public health achievements that can inspire practices for addressing current epidemics like COVID-19. In this case, it is possible to appreciate the role of vaccination, social distancing, isolation through quarantine, and contact tracing in altering the pandemic’s transmission patterns. Equally, epidemiologists can apply various principles in preventing and managing COVID-19. These principles include public health surveillance, field investigation, analytical studies, evaluation, linkages, and policy development. Amidst the pressure to prevent COVID-19 transmission, healthcare professionals can favor a population-based approach instead of individual-level interventions.

References

Berche, P. (2022). Life and death of smallpox. La Presse Médicale, 51(3), 104117. https://doi.org/10.1016/j.lpm.2022.104117

Centers for Disease Control and Prevention. (2021a). Poliomyelitis. https://www.cdc.gov/vaccines/pubs/pinkbook/polio.html

Centers for Disease Control and Prevention. (2021b, February 20). History of smallpox. https://www.cdc.gov/smallpox/history/history.html

Friis, R. H., & Sellers, T. A. (2021). Epidemiology for public health practice (6th ed.). Jones & Bartlett Learning.

Munblit, D., Nicholson, T. R., Needham, D. M., Seylanova, N., Parr, C., Chen, J., Kokorina, A., Sigfrid, L., Buonsenso, D., Bhatnagar, S., Thiruvengadam, R., Parker, A. M., Preller, J., Avdeev, S., Klok, F. A., Tong, A., Diaz, J. V., Groote, W. D., Schiess, N., & Akrami, A. (2022). Studying the post-COVID-19 condition: Research challenges, strategies, and importance of core outcome set development. BMC Medicine, 20(1). https://doi.org/10.1186/s12916-021-02222-y

Rodewald, L. E. (2020). Forty and twenty years ago and now — virus elimination successes and new challenges. China CDC Weekly, 2(50), 953–954. https://doi.org/10.46234/ccdcw2020.259

Shahzad, M., Upshur, R., Donnelly, P., Bharmal, A., Wei, X., Feng, P., & Brown, A. D. (2019). A population-based approach to integrated healthcare delivery: A scoping review of clinical care and public health collaboration. BMC Public Health, 19(1), 1–15. https://doi.org/10.1186/s12889-019-7002-z

Wilson, N., Mansoor, O. D., Boyd, M. J., Kvalsvig, A., & Baker, M. G. (2021). We should not dismiss the possibility of eradicating COVID-19: Comparisons with smallpox and polio. BMJ Global Health, 6(8), e006810. https://doi.org/10.1136/bmjgh-2021-006810

World Health Organization. (2022, July 4). Poliomyelitis. https://www.who.int/news-room/fact-sheets/detail/poliomyelitis

World Health Organization. (2023). WHO COVID-19 dashboard. https://covid19.who.int/

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