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  • Back to the Future: Responses to Global Pandemic

    Explore the parallels between COVID-19 and trachoma, an ophthalmic pandemic. You will see why SARS-CoV-2 may not be so novel after all.
    Comparisons
    A drawing of a boy with large, swollen, purple eyelids. The boy has brown hair and wears a high collared coat. His eyes are closed, and his eyelids protrude greatly from his face.
    Practical Treatise on the Diseases of the Eye, 1820
    We are comparing the world’s response to COVID-19 with an ophthalmic disease known as trachoma. Trachoma outbreaks in the 19th and 20th centuries resulted in travel bans, new immigration policies, building of hospitals, and the rise of a worldwide effort to fight contagious disease. We saw many of these same reactions in 2020.

    Limits to Comparison

    On the surface, COVID-19 and trachoma may seem to have little in common. COVID-19 is a virus that attacks the lungs and has a high mortality rate. Trachoma is a bacterial infection that attacks the eyes. These differences are incredibly important to the etiology and treatment of these diseases, however, the world’s reaction to trachoma and COVID-19 are strikingly similar,

    What is Trachoma?
    A doctor inspects a man's eyes with a silver flashlight. The doctor is a dark skinned man with a dark beard, and he wears a gray plastic magnifier over his eyes. The man being inspected has dark skin and short dark hair, and wears a green collared shirt.
    Screening for Trachoma in Nepal
    Trachoma has been documented for thousands of years, labeled a pandemic at several points in its history, and is now simply hyperendemic in 37 countries, responsible for the blindness or visual impairment of 1.9 million people worldwide.
    Restrictions

    On April 1, 2020 the Pew Research Center reported that 91% of the world’s population (7.1 billion people) lived in a country with either complete or partial border closures due to COVID-19. Although the world’s news outlets were inclined to describe these measures as drastic, they were nothing new.

    Keep Disease Out
    A Chinese-style drawing of a man with red swollen eyes. The man has a bald head and wears a blue, high collared robe. He is holding a beige cloth in both hands, and he sits near a brown wooden table.
    Man with Trachoma, Jinan, China, c1920
    Between 1851 and 1938, 14 international conferences were held to discuss how pandemics effected commerce. These conferences gave countries a road map for how to react during a pandemic including instituting travel bans and quarantines. For many countries, including the United States, stricter immigration policies became one way to keep disease out.











    Ellis Island
    A large brick building with turrets sits on an island surrounded by water. The building is made of red and white brick, and has three visible turrets and a white water tower. An American flag hangs on a flag pole in front of the building, and the island has many brown, leafless trees.In 1891 the US established immigration stations such as Ellis Island where people would be screened for “loathsome or contagious diseases.” The first disease to be listed in this category was trachoma. By 1905, all immigrants to the US were to be examined by the Public Health Service for symptoms. Nearly 80,000 immigrants, or 1% of those seeking entry, were barred from the US between 1891 and 1930 for medical reasons including trachoma and low vision. For an in-depth history of Ellis Island and trachoma, read this history (PDF) created by the National Park Service.
    Building

    Combating a pandemic happens on many fronts. While physicians and scientists work to find a cure, governments fight by building infrastructure such as hospitals. By May 2020, the Army Corps of Engineers had created more than 30 field hospitals in the United States. The largest of these could accommodate 3,000 COVID-19 patients. Building on this scale to help fight a pandemic was also true during the 19th century trachoma outbreak.

    Moorfields
    A long red brick building sits in a row of buildings next to a modern street. The top two floors of the building are red brick, and the bottom floor appears to be white stone or plaster. It also has a gray, tiled, gabled roof. There is a signed shaped like a human eye hanging over the front door.
    Moorfields Eye Hospital's Third Location, 1897
    In 19th century Britain, 52 specialty hospitals for the eye, or the eye and ear, were built in part to isolate cases of trachoma from other patients. One of these new hospitals was the London Dispensary for Curing Diseases of the Eye and Ear, founded in 1805. Today it is the world famous Moorfields Eye Hospital. Learn more about the history of Moorfields and trachoma here.






    National Trachoma Service

    A small, faded sepia-toned photograph is taped to a black sheet of paper. The photo shows a two-story, wooden Victorian-style building. A large tree without leaves grows next to the building. A label is affixed to the left side of the paper, and it reads: Pierre M Foltz, 302 E Street NE, Washington DC.
    Trachoma Hospital, Pikeville, KY, 1915
    In 1912, the US Public Health Service (PHS) established the National Trachoma Service. They built 14 trachoma hospitals between 1913 and 1924, totaling almost 500 beds. The hospitals also served as group homes and schools for patients. Each hospital had one doctor and two nurses who were required to hold clinics in the countryside to contact trace and diagnose trachoma patients.
    Educating

    Stopping the spread of any disease is helped by educating citizens about preventative measures they can take at home. In 2020, many methods were used to educate the public on how to “flatten the curve,” including the internet and social media. In the 20th century, public education campaigns to combat trachoma were equally robust.

    National Trachoma Service
    A small, faded, sepia-toned photograph is taped to a black sheet of paper. The photo shows a large group of people posed on the stairs of a building. The group is a mixture of men, women, and children, and they wear suits and long dresses. Some of the women are wearing large brimmed hats. There is a small, handwritten label across the bottom of the photo that reads: US Public Health Service. There is a label affixed to the bottom of the paper that reads: Pierre M Foltz, 302 E Street NE, Washington, DC.
    Residents of Pikeville, KY Trachoma Hospital
    Nurses in the US National Trachoma Service taught health education to mainly rural communities in the southern states. They were provided with photographic slides that promoted basic hygiene and infection control (wash your hands!) along with heart felt appeals to citizens to avoid contracting trachoma.









    Testimonial
    A small, faded, sepia-toned photograph is taped to black sheet of paper. The photo shows a young, white person with short dark hair and a dark jacket, and they are leaning forward with their eyes squinted closed tightly. There are several lines of type-written text under the photo that is too small to be read. There is a label affixed to to the left side of the paper that reads: Pierre M Foltz, 302 E Street NE, Washington, DC.
    Trachoma Patient, December 29, 1915
    Images like this one were part of the National Trachoma Service education program. This image of a trachoma patient was meant to either scare or shame people into following practices of good hygiene in order to control infection.
    Searching
    A black and white photograph of two men standing shoulder to shoulder. The man on the left is a tall, white man with dark hair, wearing a dark suit with his hands clasped over his front. He stands in front of a round mirror with a square frame. The man on the right is a shorter, white man wearing a dark suit and vest with his hands tucked into his pants pocket. This man is wearing an eye patch over his left eye.
    Dr. Phillips Thygeson & Patient, 1934
    There is no doubt that the best way to halt a pandemic is to find an effective treatment or cure. Viruses like COVID-19 are prevented by vaccines. On August 11, 2020, Russia became the first country in the world to approve a vaccine for COVID-19. Other countries around the world continued clinical testing other treatments. At the time, 202 vaccines were still in development, 24 of these were in clinical testing. Researchers were also looking into 316 potential medical treatments. As was the case for trachoma, searching for a definitive cure takes time and many people working together.







    Identification
    A drawing of a human eye where the bottom eyelid has been pulled down, and the inside of the eyelid is very red and swollen. The eye has a brown iris, and the red swollen eyelid has a scale-like texture. The title of the image reads: Fig. III.
    Illustration of Trachoma, 1839
    Trachoma is a bacterial infection, caused by Chlamydia trachomatis. Prior to its identification in 1957, physicians were at a loss as to the root cause. The bacterium is so small that some mis-identified it as a virus. Of those who studied it closely was Dr. Philips Thygeson who sat down for an oral history interview in 1988.

    Medical Treatment

    Prior to the advent of antibiotics, treatment for trachoma fell intro three categories. The first was the use of medicine applied to the site of infection. The second was a surgical approach in which infected tissue was cut or cauterized. The third was a combination of these. It often included scraping the eyelids and then applying medication to them.

    Sulfa Drugs

    A yellow, faded newspaper clipping. Most of the two columns of text is too small to read. The large, black title reads: SULFANIMIDE PROVES AID IN TREATMENT OF TRACHOMA. style=In 1935 Gerhard Domagk (1895-1964) discovered synthetic antibiotics (sulfonamides) which were then successfully used to treat trachoma infections. This was heralded at the 1937 Annual Meeting of the American Academy of Ophthalmology and Otolaryngology as the greatest advance in the treatment of trachoma in 100 years.
    Vigilance

    As we reflect on what we experienced during 2020, it is worthwhile to remember that the future of our world with COVID-19 in it may well mirror our past experiences of pandemics. Comparing two very different diseases like COVID-19 and trachoma has its limits, but it is very likely that, like trachoma, the COVID-19 virus will become hyperendemic in countries with poorer populations and limited access to healthcare.

    World Health Organization

    A large, gold-colored logo hangs on a brown wall. The logo has an image of a globe surrounded by two laurel branches, and a coiled snake with a needle or staff through it is superimposed on the globe.In 1998, the World Health Organization (WHO) targeted trachoma in an attempt to eliminate it as a global health problem. WHO Member States are currently working toward this goal, recognizing that clean water, sanitation and socioeconomic development are their largest barriers eradicating the disease. Read more about WHO efforts to combat trachoma at the World Health Organization website.