Smallpox was nothing new in 1721.
Exactly 300 years ago, in 1721, Benjamin Franklin and his fellow American colonists faced a deadly smallpox outbreak.
Their varying responses constitute an eerily prescient object lesson for today's world, similarly devastated by a virus and divided over vaccination three centuries later.
As a microbiologist and a Franklin scholar, we see some parallels between then and now that could help governments, journalists and the rest of us cope with the coronavirus pandemic and future threats.
Smallpox strikes Boston
Smallpox was nothing new in 1721. Known to have affected people for at least 3,000 years, it ran rampant in Boston, eventually striking more than half the city's population. The virus killed about 1 in 13 residents – but the death toll was probably more, since the lack of sophisticated epidemiology made it impossible to identify the cause of all deaths.
What was new, at least to Boston, was a simple procedure that could protect people from the disease. It was known as “variolation" or “inoculation," and involved deliberately exposing someone to the smallpox “matter" from a victim's scabs or pus, injecting the material into the skin using a needle. This approach typically caused a mild disease and induced a state of “immunity" against smallpox.
Even today, the exact mechanism is poorly understood and not much research on variolation has been done. Inoculation through the skin seems to activate an immune response that leads to milder symptoms and less transmission, possibly because of the route of infection and the lower dose. Since it relies on activating the immune response with live smallpox variola virus, inoculation is different from the modern vaccination that eradicated smallpox using the much less harmful but related vaccinia virus.
The inoculation treatment, which originated in Asia and Africa, came to be known in Boston thanks to a man named Onesimus. By 1721, Onesimus was enslaved, owned by the most influential man in all of Boston, the Rev. Cotton Mather.
Known primarily as a Congregational minister, Mather was also a scientist with a special interest in biology. He paid attention when Onesimus told him “he had undergone an operation, which had given him something of the smallpox and would forever preserve him from it; adding that it was often used" in West Africa, where he was from.
Inspired by this information from Onesimus, Mather teamed up with a Boston physician, Zabdiel Boylston, to conduct a scientific study of inoculation's effectiveness worthy of 21st-century praise. They found that of the approximately 300 people Boylston had inoculated, 2% had died, compared with almost 15% of those who contracted smallpox from nature.
The findings seemed clear: Inoculation could help in the fight against smallpox. Science won out in this clergyman's mind. But others were not convinced.
Stirring up controversy
A local newspaper editor named James Franklin had his own affliction – namely an insatiable hunger for controversy. Franklin, who was no fan of Mather, set about attacking inoculation in his newspaper, The New-England Courant.
One article from August 1721 tried to guilt readers into resisting inoculation. If someone gets inoculated and then spreads the disease to someone else, who in turn dies of it, the article asked, “at whose hands shall their Blood be required?" The same article went on to say that “Epidemeal Distempers" such as smallpox come “as Judgments from an angry and displeased God."
In contrast to Mather and Boylston's research, the Courant's articles were designed not to discover, but to sow doubt and distrust. The argument that inoculation might help to spread the disease posits something that was theoretically possible – at least if simple precautions were not taken – but it seems beside the point. If inoculation worked, wouldn't it be worth this small risk, especially since widespread inoculations would dramatically decrease the likelihood that one person would infect another?
Franklin, the Courant's editor, had a kid brother apprenticed to him at the time – a teenager by the name of Benjamin.
Historians don't know which side the younger Franklin took in 1721 – or whether he took a side at all – but his subsequent approach to inoculation years later has lessons for the world's current encounter with a deadly virus and a divided response to a vaccine.
You might expect that James' little brother would have been inclined to oppose inoculation as well. After all, thinking like family members and others you identify with is a common human tendency.
That he was capable of overcoming this inclination shows Benjamin Franklin's capacity for independent thought, an asset that would serve him well throughout his life as a writer, scientist and statesman. While sticking with social expectations confers certain advantages in certain settings, being able to shake off these norms when they are dangerous is also valuable. We believe the most successful people are the ones who, like Franklin, have the intellectual flexibility to choose between adherence and independence.
Truth, not victory
Perhaps the inoculation controversy of 1721 had helped him to understand an unfortunate phenomenon that continues to plague the U.S. in 2021: When people take sides, progress suffers. Tribes, whether long-standing or newly formed around an issue, can devote their energies to demonizing the other side and rallying their own. Instead of attacking the problem, they attack each other.
Franklin, in fact, became convinced that inoculation was a sound approach to preventing smallpox. Years later he intended to have his son Francis inoculated after recovering from a case of diarrhea. But before inoculation took place, the 4-year-old boy contracted smallpox and died in 1736. Citing a rumor that Francis had died because of inoculation and noting that such a rumor might deter parents from exposing their children to this procedure, Franklin made a point of setting the record straight, explaining that the child had “receiv'd the Distemper in the common Way of Infection."
Writing his autobiography in 1771, Franklin reflected on the tragedy and used it to advocate for inoculation. He explained that he “regretted bitterly and still regret" not inoculating the boy, adding, “This I mention for the sake of parents who omit that operation, on the supposition that they should never forgive themselves if a child died under it; my example showing that the regret may be the same either way, and that, therefore, the safer should be chosen."
A scientific perspective
A final lesson from 1721 has to do with the importance of a truly scientific perspective, one that embraces science, facts and objectivity.
J. A. Philip; Wikimedia Commons; CC BY 4.0
Inoculation was a relatively new procedure for Bostonians in 1721, and this lifesaving method was not without deadly risks. To address this paradox, several physicians meticulously collected data and compared the number of those who died because of natural smallpox with deaths after smallpox inoculation. Boylston essentially carried out what today's researchers would call a clinical study on the efficacy of inoculation. Knowing he needed to demonstrate the usefulness of inoculation in a diverse population, he reported in a short book how he inoculated nearly 300 individuals and carefully noted their symptoms and conditions over days and weeks.
The recent emergency-use authorization of mRNA-based and viral-vector vaccines for COVID-19 has produced a vast array of hoaxes, false claims and conspiracy theories, especially in various social media. Like 18th-century inoculations, these vaccines represent new scientific approaches to vaccination, but ones that are based on decades of scientific research and clinical studies.
We suspect that if he were alive today, Benjamin Franklin would want his example to guide modern scientists, politicians, journalists and everyone else making personal health decisions. Like Mather and Boylston, Franklin was a scientist with a respect for evidence and ultimately for truth.
When it comes to a deadly virus and a divided response to a preventive treatment, Franklin was clear what he would do. It doesn't take a visionary like Franklin to accept the evidence of medical science today.
Researchers analyze prehistoric viruses in animals dug out from the Siberian permafrost.
- Scientists in a Siberian laboratory in Russia began studying ancient viruses.
- The viruses come from prehistoric animals dug out from the melting permafrost.
- The research lab used to be a center for the development of biological weapons.
A state lab in Russia's Siberia is beginning research into prehistoric viruses preserved in the remains of animals found in melting permafrost.
Spearheaded by the Vector State Research Centre of Virology and Biotechnology and the University of Yakutsk, the study will start by analyzing tissues from a prehistoric horse from at least 4,500 ago. These remains were located in the region of Siberia called Yakutia, where Paleolithic animals like mammoths are often found.
Other prehistoric animals the researchers aim to study include elk, dogs, partridges, hares, rodents, the 28,800 year old Malolyakhovsky woolly mammoth, and more. Some of the remains are up to 50,000 years old. All the animals were found because of the thawing permafrost.
One might wonder if this kind of research is in some way's opening a Pandora's box to ancient viruses, but this it not the first time such viruses have been studied. In fact, with the Arctic warming at twice the global average rate, the melting permafrost is likely to reveal more of its frozen content.
Maxim Cheprasov, head of the Mammoth Museum laboratory at Yakutsk University, explained in a press release that the animals being examined have undergone bacterial studies previously. However, "We are conducting studies on paleoviruses for the first time," Cheprasov shared.
Vector scientist Dr. Olesya Okhlopkova explained that "the team of Vector Virology Centre is keen to find paleo-viruses that would allow to start development of paleo-virology in Russia and conduct leading researched in virus evolution."
The world's only known woolly mammoth trunk.
Credit: Semyon Grigoryev/NEFU
So far there has only been limited research on soft issues but the Vector team is looking to monitor the infections in the animals by segregating out total nucleic acids and sequencing the genomes to get more information on the biodiversity and the microorganisms in the ancient beasts.
"Should nucleic acids preserve, we ought to be able to get data on their composition and establish how it changed, shared Okhlopkova. "We will be able to determine the epidemiological potential of currently existing infectious agents."
During Soviet times, the Vector laboratory, located in Novosibirsk, used to be a center for the development of biological weapons. It's one of the two places in the world that currently stores the smallpox virus. It has also developed Russia's second coronavirus vaccine - the EpiVacCorona.
The positive steps we are taking to prevent disease might have a negative side effect.
- A new study out of Princeton suggests that measures to prevent COVID-19 are also preventing certain other diseases.
- The nature of seasonal diseases means that people who avoid them this year may just be putting it off, leading to a large wave later.
- These estimates don't mean we should be less preventive now, only that we must be sure to take care in the future.
As the United States continues to struggle with the pandemic, the proven effectiveness of face masks to reduce the rate and risk of infection continues to be underutilized. Places that have implemented mask and distancing mandates are seeing generally lower rates of transmission and infection than those without these mandates, as more fully explained here, here, and here.
However, one of the three iron laws of the cosmos is the law of unintended consequences; no matter what you do, there will be at least one.
As a study out of Princeton has just shown, this also applies to live-saving mask mandates. Given that many other diseases follow predictable cycles, a team of researchers has shown that the steps we're taking to prevent the spread of COVID-19 now may lead to larger outbreaks of seasonal diseases later.
Before we go any further, we want to make it clear that we are not telling you stop wearing a mask, social distancing, or taking all the precautions against catching and spreading COVID. The point of this study and this article is to make people aware of a side effect of these measures so that we can better deal with them later, not to suggest that these measures not be taken.
A team of researchers based out of Princeton published a study in the Proceedings of the National Academy of Sciences showing the predictions of a model that estimates the after effects of our current efforts to avoid COVID-19.
As it turns out, Non-pharmaceutical interventions (NPIs) such as social distancing and wearing masks help prevent more than just COVID-19. Instances of other diseases, such as respiratory syncytial virus (RSV) and the flu, are also lower than they would otherwise be due to people taking these precautions. Cases of RSV may have declined by as much as a 20 percent already.
This makes a lot of intuitive sense. Your mask doesn't care what kind of virus it keeps you from exhaling towards other people; it stops all of them. If you stay inside to avoid catching a particular disease, you still avoid all of them. This kind of thing has happened before. The precautions taken during the 1918 flu pandemic probably reduced measles cases by a third.
However, these diseases come back seasonally and will be there waiting for us when the current pandemic ends. This might be a bit of a problem, as lead author Rachel Baker explained:
"While this reduction in cases could be interpreted as a positive side effect of COVID-19 prevention, the reality is much more complex. Our results suggest that susceptibility to these other diseases, such as RSV and flu, could increase while NPIs are in place, resulting in large outbreaks when they begin circulating again."
Think of it like this: As fewer and fewer people get these diseases due to our current mask and social distancing tendencies, fewer and fewer people have immunity to them. Immunity to RSV lasts only a few years. If people who would have gotten it this year don't, they may contract and spread it next year when they aren't working so hard to avoid respiratory infections, along with all the other people who were likely to get it next year anyway for typical reasons.
The model is less exact for the flu, given the number of variables affecting how contagious the flu is from year to year, but a similar principle applies.
So while we can't know exactly what that next flu season will look like, the essential finding of this study is that it is likely to be worse than it otherwise would be, everything else being equal. Various measures, such as getting more people vaccinated against the flu and keeping people home when they are sick with seemingly banal colds, will be necessary in the years to come. Hospitals should also brace for higher than average numbers of people coming in as a result of this.
There is a fair amount of uncertainty to these findings, as the authors admit. Outbreaks in some areas have been better studied than others. The behavior of these seasonal outbreaks is more thoroughly understood in Florida than in Minnesota, for example, and these predictions may not be as applicable there. The models are also highly dependent on what measures we take and when to fight COVID-19, and the worst-case ones rely on a lot of things happening in tandem.
Why you should still wear a mask
A chart from another study on the effectiveness of masks and lockdowns. The grey line in the bottom two marks when mask mandates were imposed.
Credit: Zhang, Li, Zhang, and Molina
Again, before you decide that this means mask mandates are just delaying some kind of reckoning, we can look at the numbers. Several sources agree that the coronavirus is deadlier than the flu. We also don't have a vaccine for it yet, unlike for the flu, and keeping yourself and others from getting sick now remains extremely important for keeping people alive.
A friend of mine remarked at the beginning of the pandemic that certain events in society leave marks on the people in it, much like growth rings on a tree showing years of drought decades after it occurred. If the findings of this study are accurate, then COVID-19 will leave rings visible in seasonal outbreaks over the next few years alongside the slew of others it will create.
Given what this study shows us and the hard-learned lessons we have about what happens when you don't listen to scientists, maybe we'll do a better job at controlling those potential epidemics.
The program aims to notify people after they've come in close contact with someone who tested positive.
- The program currently involves 25,000 contract tracers who are capable of tracing 10,000 contacts per day.
- Participation in the program is voluntary, though officials said it may become mandatory if necessary.
- The program will eventually include a smartphone app that records who you've come in close proximity to.
England started a test-and-trace program on Thursday that aims to contain the spread of COVID-19 as the nation eases its lockdown.
Under the new program, anyone who tests positive for COVID-19 will be contacted by staff with the National Health Services (NHS), and they'll be asked to share the contact information of people with whom they've recently come in contact. People who've crossed paths with someone who tested positive for COVID-19 will be asked to self-isolate for 14 days.
"As we move to the next stage of our fight against coronavirus, we will be able to replace national lockdowns with individual isolation and, if necessary, local action where there are outbreaks," U.K. Health Secretary Matt Hancock said in a statement. "This new system will help us keep this virus under control while carefully and safely lifting the lockdown nationally."
TIMOTHY A. CLARY / Getty
Hancock said the program will be voluntary at first, but that the government will make it mandatory if "that's what it takes."
"If we don't collectively make this work, the only way forward is to keep the lockdown," he said. "The more people who follow the instructions, the safer we can be and the faster we can lift the lockdown."
The NHS wants people who are experiencing symptoms to visit nhs.uk/conditions/coronavirus-covid-19. The agency also wants to automate its Test and Trace program through the NHS COVID-19 app, which is currently being tested by more than 52,000 people on the Isle of Wight. If the test on the Isle of Wight is successful, the app is expected to be available for the rest of England in June.
How the contact-tracing app works
The app doesn't ask for names or personal information, except for a partial postal code. Rather, each user's phone is assigned a randomized identifier number that's transmitted to a centralized database. The app doesn't do much else, besides ask users how they're feeling each day.
Other governments have already been using digital contact tracing apps to limit the spread of COVID-19. South Korea, for example, made a tracing app mandatory for new arrivals to the country, and people who violate quarantine are required to wear location-tracking bracelets. As of May 29, South Korea has reported less than 300 deaths. The U.K. has suffered more than 40,000.
Manual contact tracing has been used for decades to help contain viruses — the NHS describes it as a "tried and tested method used to slow down the spread of infectious diseases." But the prospect of digital contact tracing has raised concerns for privacy advocates who question how governments and private companies might use the technology.
Speaking about the new NHS app, Ian Levy, the technical director of the National Cyber Security Centre (NCSC), told Wired U.K.:
"In theory, that's a privacy risk, but it's only stored on the NHS app system and there's no way to link device 123456 to 'Ian Levy' or a particular place," Levy said. "If you discover that my app ID is 123456, there are some theoretical things you can do to try to understand my contacts if you've followed me round. But if you've followed me round, you've probably seen my contacts anyway."
In the U.S., federal officials haven't indicated that they're developing a national contact-tracing app. But several states — Alabama, North Dakota, and South Carolina — are working individually with Apple and Google to implement their own contact-tracing apps.
Similar to the NHS app, Apple and Google's system uses Bluetooth signals to record when users come in close proximity with each other. The companies said their system won't collect users' personal information.
Apple and Google develop the contact-tracing apps themselves. Rather, they've made the technology available so that individual health agencies to do so. In addition to the three U.S. states, 22 countries have also signed on to use Apple and Google's system.
Creators of the popular protein-folding game, Foldit, are seeking help to design a treatment for COVID-19.
- Since being founded in 2008, the crowdsourced protein-folding game, Foldit, has helped solve many novel problems.
- In recent months, the Foldit team has presented its community with problems relating to COVID-19.
- Foldit founder, David Baker, says over 20,000 different designs for potential COVID-19 antiviral proteins have been submitted.
In 2008, University of Washington professor David Baker created the Foldit research project. As a protein research scientist he had spent a good portion of his career designing methods to predict three-dimensional structures associated with proteins. His group initially developed an algorithm for protein structure prediction called Rosetta, which they then turned into a distributed computing project.
The initial incarnation, Rosetta@home, allowed citizen scientists to help out, much as astronomy enthusiasts have crowdsourced research and discovered new planets. Foldit is the evolution of Rosetta@home. Upon the project's launch it boasted 240,000 registered users. By gamifying protein folding, Baker's team helped the field of citizen science blossom.
There have been many rewards. Since its launch, Baker's team has posed over 2,000 design puzzles to their community. Foldit players helped to solve a 15-year problem relating to a monkey virus in 2011. The following year, gamers successfully redesigned a protein initially created by Baker's team. Now this community is being asked to help out with another daunting task: solving the coronavirus problem.
Foldit Lab Report 7: Quarantine Edition
While most Americans are self-isolating, which certainly helps stop the spread of COVID-19, Baker is asking Foldit gamers to help hunt for proteins that could stop the virus in its tracks. They're specifically seeking proteins that block the viruses's entry into new cells upon entering the human body. If successful, new antiviral drugs could be developed that would reduce the symptoms once you're infected.
Brian Koepnick, who works in Baker's lab and helps run Foldit, says the diversity of responses they receive to problems posed is a necessary step in discovering new solutions.
"We find that the creativity of crowdsourcing is really, really useful—if you ask 100 people to do something, they'll do it in 100 different ways. That's really valuable for us in protein design problems."
As COVID-19 plagues the entire planet, driving fear and uncertainty in citizens, at least there is precedent for this disease. We know that this type of virus infects cells through its spike protein, which latches onto certain cells and proliferate. Baker says that a protein that "grabs the coronavirus's spike protein might be able to run interference," preventing it from attaching to other cells and spreading.
Every puzzle Baker's lab publishes is online for roughly a week. They work with up-to-the-minute information about COVID-19; thus, the team is constantly updating its puzzles. According to Baker, a few entries seem promising—there have been 20,000 different designs submitted already—though as with any treatment, each design will require real-world testing.
Baker notes that they've successfully crowdsourced strategies for dealing with flu, which brings hope that a treatment could be found in this situation. "In general, the coronaviruses appear to mutate less than influenza viruses. So that makes them a little bit easier of a target."
Foldit players have come up with more than 20,000 different designs for potential COVID-19 antiviral proteins. Scientists plan to test 99 of the most promising designs (shown here) in the lab.
This is truly an unprecedented moment in history. While researchers have worked on pandemics across the planet before, there has never been such a sense of urgency. Our global response to this coronavirus is likely to set the stage for how we treat diseases of this magnitude in the future. And as science writer Ed Yong says, there is reason for hope.
"The first steps so far have actually been encouragingly quick. A vaccine candidate has already entered early safety trials after a record breakingly short time from actually identifying and sequencing the genome of this new virus."
There is a long road from trials to implementation, Yong says. We're 12 to 18 months away from a vaccine. Still, the rapidity of this process has been aided by the sheer number of researchers simultaneously working on the problem.
Give the number of players on Foldit's platform, it's not about expertise as much as, in Baker's words, persistence and ingenuity. Citizen science is one of the greatest benefits of the digital age. In many ways, platforms like Foldit are leading the way to a new form of education. If you're interested in contributing, download the software and start playing.