Chemical Biological Threat
thanks to Lace to


This article provides a broad overview of the chemical and biological terrorist threat and, drawing on the lessons learned from the few chemical and biological incidents to date, suggests some basic means of detection, defense, and decontamination. The intention is not to alarm people but to enable employees and their family members to recognize and properly react to a chemical or biological situation in the event they encounter one. In 1995, the Aum Shinrikyo, a Japanese religious cult, launched a large-scale chemical attack on the Tokyo subway system. The attack focused on four stations using Sarin gas, a potent chemical warfare nerve agent. Twelve people were killed but the attack fell far short of the apparent objective to inflict thousands of casualties. Subsequent investigation by authorities revealed that the cult had previously conducted several unsuccessful attacks against a variety of targets using other chemical agents and the biological agents botulism toxin and anthrax. Since 1997, religious organizations, health clinics, and Government agencies in Indiana, Kentucky, Tennessee, California, Hawaii, and the District of Columbia, among other states, have received threatening letters purporting to contain the biological agent anthrax. While none of the letters were found to contain anthrax, they caused considerable fear and disruption where received. Disturbing as they are, these incidents serve to illustrate a potentially new type of terrorist threat of concern to law enforcement and emergency planning officials throughout the U.S. Government. The State Department and its Diplomatic Security Service share that concern and have taken, and will continue to take, appropriate steps to meet the potential consequences of this threat. If you or your family members require additional details about this or any security-related subject, please contact the regional security officer (RSO) at your post of assignment. Aside from their common lethality, there is no “one size fits all” when it comes to describing the types and effects of possible chemical or biological agents. Chemical agents are generally liquids, often aerosolized, and most have immediate effects or are delayed for a few hours. Many chemical agents have a unique odor and color. Biological agents differ in that the effects are delayed, often for days. The effects of toxins, such as botulinum toxin, occur typically in less than a day. Living biological agents, such as anthrax or plague, generally take 2-5 days for symptoms to appear. Biological agents have no odor or color and can be in either liquid or powder form. There are many different potential chemical and biological agents that a terrorist could use as a weapon, but we can make the following broad generalizations:

  • Although food or water contamination or absorption through the skin are possible attack routes, most experts agree that inhalation of chemical or biological agents is the most likely and effective means. Protection of breathing airways is therefore the single most important factor in a situation where chemical or biological agents may be present.[/list]
  • Many likely agents are heavier than air and would tend to stay close to the ground. This dictates an upward safehaven strategy.[/list]
  • Basic decontamination procedures are generally the same no matter what the agent. Thorough scrubbing with large amounts of warm soapy water or a mixture of 10 parts water to 1 part bleach (10:1) will greatly reduce the possibility of absorbing an agent through the skin.[/list]
  • If water is not available, talcum powder or flour are also excellent means of decontamination of liquid agents. Sprinkle the flour or powder liberally over the affected skin area, wait 30 seconds, and brush off with a rag or gauze pad. (Note: The powder absorbs the agent so it must be brushed off thoroughly. If available, rubber gloves should be used when carrying out this procedure.)[/list]
  • Generally, chemical agents tend to present an immediately noticeable effect, whereas many biological agents will take days before symptoms appear. In either case, medical attention should be sought immediately, even if exposure is thought to be limited.[/list]
  • Most chemical and biological agents that present an inhalation hazard will break down fairly rapidly when exposed to the sun, diluted with water, or dissipated in high winds.[/list]
  • No matter what the agent or its concentration, evacuation from the area of attack is always advisable unless you are properly equipped with an appropriate breathing device and protective clothing or have access to collective protection.[/list]

    Warning Signs of An Attack or Incident

    A chemical or biological attack or incident won’t always be immediately apparent given the fact that many agents are odorless and colorless and some cause no immediately noticeable effects or symptoms. Be alert to the possible presence of agent. Indicators of such an attack include:

    * Droplets of oily film on surfaces
    * Unusual dead or dying animals in the area * Unusual liquid sprays or vapors
    * Unexplained odors (smell of bitter almonds, peach kernels, newly mown hay, or green grass)
    * Unusual or unauthorized spraying in the area
    * Victims displaying symptoms of nausea, difficulty breathing, convulsions, disorientation, or patterns of illness inconsistent with natural disease
    * Low-lying clouds or fog unrelated to weather; clouds of dust; or suspended, possibly colored, particles
    * People dressed unusually (long-sleeved shirts or overcoats in the summertime) or wearing breathing protection particularly in areas where large numbers of people tend to congregate, such as subways or stadiums

    What To Do In Case of Attack

    Protection of breathing airways is the single most important thing a person can do in the event of a chemical or biological incident or attack. In most cases, absent a handy gas mask, the only sure way to protect an airway is to put distance between you and the source of the agent. While evacuating the area, cover your mouth and nose with a handkerchief, coat sleeve, or any piece of cloth to provide some moderate means of protection. Other basic steps one can take to avoid or mitigate exposure to chemical or biological agents include:

  • Stay alert for attack warning signs. Early detection enhances survival.[/list]
  • Move upwind from the source of the attack. [/list]
  • If evacuation from the immediate area is impossible, move indoors (if outside) and upward to an interior room on a higher floor. Remember many agents are heavier than air and will tend to stay close to the ground.[/list]
  • Once indoors, close all windows and exterior doors and shut down air conditioning or heating systems to prevent circulation of air.[/list]
  • Cover your mouth and nose. If gas masks are not available, use a surgical mask or a handkerchief. An improvised mask can be made by soaking a clean cloth in a solution of 1 tablespoon of baking soda in a cup of water. While this is not highly effective, it may provide some protection. Cover bare arms and legs and make sure any cuts or abrasions are covered or bandaged. [/list]
  • If splashed with an agent, immediately wash it off using copious amounts of warm soapy water or a diluted 10:1 bleach solution.[/list]
  • Letters from unknown sources should first be screened by security personnel. If opened, letters allegedly containing anthrax or another toxin should be handled carefully. Note if there was a puff of dust or particles from the envelope when it was opened and be sure to report that when assistance arrives. Carefully place such a letter and its envelope in a sealed plastic pouch. Thoroughly wash face and hands with warm soapy water before calling for assistance.[/list]
  • If circumstances dictate, plan and prepare a chemical/biological safehaven in your residence using guidelines listed in this article.[/list]
  • At the office, familiarize yourself in advance with established emergency procedures and equipment at your post. See your regional or post security officer for details.[/list]
  • If in a car, shut off outside air intake vents and roll up windows if no gas has entered the vehicle. Late model cars may provide some protection from toxic agents.[/list]
  • In any case of suspected exposure to chemical or biological agents, no matter what the origin, medical assistance should be sought as soon as possible, even if no symptoms are immediately evident.[/list]

    Preparing a Safehaven

    In some remote but possible scenarios (such as the incident in Bhopal, India) an entire city or neighborhood could become endangered by lethal gas. If conditions at your post make this a possibility, you may want to plan and prepare a sealed chemical/biological safehaven at your residence as follows:

    Choosing a Safehaven Room

    * Select an inner room on an upstairs floor with the least number of windows and doors.
    * Choose a large room with access to a bathroom and preferably with a telephone.
    * Avoid choosing rooms with window or wall air conditioners; they are more difficult to seal.

    Sealing a Room

    * Close all windows, doors, and shutters.
    * Seal all cracks around window and door frames with wide tape.
    * Cover windows and exterior doors with plastic sheets (6 mil minimum) and seal with pressure-sensitive adhesive tape. (This provides a second barrier should the window break or leak.)
    * Seal all openings in windows and doors (including keyholes) and any cracks with cotton wool or wet rags and duct tape. A water-soaked cloth should be used to seal gaps under doors.
    * Shut down all window and central air and heating units.

    Suggested Safehaven Equipment

    * Protective equipment--biological/chemical rated gas masks, if available; waterproof clothing including long-sleeved shirts, long pants, raincoats, boots, and rubber gloves.
    * Food and water--a 3-day supply.
    * Emergency equipment--flashlights, battery-operated radio, extra batteries, can or bottle opener, knife and scissors, first aid kit, fire extinguisher, etc.
    * Miscellaneous items--prescription medicines and eyeglasses, fan, extra blankets, passports and other important papers, television set, toys, books, and games.

    Sheltering in Place During a Radiation Emergency

    With recent terrorist events, many people have wondered about the possibility of a terrorist attack involving radioactive materials. People who live near but not in the immediate area of the attack may be asked to stay home and take shelter rather than try to evacuate. This action is called “sheltering in place.” Because many radioactive materials rapidly decay and dissipate, staying in your home may protect your from exposure to radiation. The thick walls of your home may block much of the harmful radiation. Taking a few simple precautions can help you reduce your exposure to radiation. The Centers for Disease Control and Prevention has prepared this fact sheet to help you protect yourself and your family and to help you prepare a safe and well-stocked shelter.

    Preparing a Shelter in Your Home

    The safest place in your home during an emergency involving radioactive materials is a centrally located room or basement. This area should have as few windows as possible. The further your shelter is from windows, the safer you will be. Preparation is the key. Store emergency supplies in this area. An emergency could happen at any time, so it is best to stock supplies in advance and have everything that you need stored in the shelter. Every 6 months, check the supplies in your shelter. Replace any expired medications, food, or batteries. Also, replace the water in your shelter every 6 months to keep it fresh. Make sure that all family members know where the shelter is and what it is for. Caution them not to take any items from that area. If someone “borrows” items from your shelter, you may find that important items are missing when they are most needed. If you have pets, prepare a place for them to relieve themselves in the shelter. Pets should not go outside during a radiation emergency because they may track radioactive materials from fallout into the shelter. Preparing a place for pets will keep the radioactive materials from getting inside the shelter.

    Preparing Emergency Supplies

    Stock up on supplies, just as you would in case of severe weather conditions or other emergencies. Following is a list of things to consider when preparing your emergency kit.

  • Food with a long shelf life – Examples of this include canned, dried, and packaged food products. Store enough food for each member of the household for at least 3 days.[/list]
  • Water – In preparation for an emergency, purchase and store bottled water or simply store water from the tap. Each person in the household will need about 1 gallon per day; plan on storing enough water for at least 3 days.[/list]
  • A change of clothes and shoes – Check clothing every 6 months and remove clothes that no longer fit or are unsuitable for seasonal weather.[/list]
  • Remember to include underwear, socks, sturdy shoes or work boots, and winter or summer clothes as needed.[/list]
  • Paper plates, paper towels, and plastic utensils – Store disposable dishware and utensils because you will not have enough water to wash dishes and because community water sources may be contaminated.[/list]
  • Plastic bags – Because you may not be able to leave your shelter for several days, you will need to collect your waste in plastic bags until it can be removed.[/list]
  • Bedding – Store sheets, blankets, towels, and cots for use during the time that you cannot leave your shelter.[/list]
  • Battery-operated radio and batteries – Electrical power may not be on for several days. A battery-operated radio will allow you to listen to emergency messages.[/list]
  • Medicines – Have 2-3 days' dose of your current prescription medicines in a childproof bottle for your shelter medical kit; label with the name and expiration date of the medicine. (Discuss with your doctor the best way to obtain this small amount of extra medicine.) Be sure to check medicines in your kit every 6 months to make sure they are not past the expiration date.[/list]
  • Toiletries – Keep a supply of soap, hand sanitizer, toilet paper, deodorant, disinfectants, etc.[/list]
  • Flashlight and batteries – Electrical power may be out for several days. A flashlight will help you see in your shelter.[/list]
  • A telephone or cell phone – Although cell phone or ground phone service may be interrupted, there is still a chance that you will be able to use a phone to call outside for information and advice from emergency services.[/list]
  • Extra eyeglasses or contact lenses and cleaning supplies.[/list]
  • Duct tape and heavy plastic sheeting – You can use these items to seal the door to your shelter and to seal any vents that open into your shelter for a short period of time if a radiation plume is passing over.[/list]
  • Pet food, baby formula, diapers, etc. – Don't forget the other members of your family. If you have an infant, store extra formula and diapers. If you have pets keep a 3-day supply of pet food.[/list]
  • First aid kit – You can purchase a first-aid kit or prepare one yourself.[/list]
  • Games, books and other entertainment – Because you may be in your shelter for several days, keep items on hand to occupy your family during that time. Children are likely to get bored if they have to stay in one place for long periods. Think of activities that they will enjoy doing while in the shelter.[/list]

    Tips Before Entering a Shelter

    If you are outside when the alert is given, try to remove clothing and shoes and place them in a plastic bag before entering the house. During sever weather, such as extreme cold, remove at least the outer layer of clothes before entering the home to avoid bringing radioactive material into your shelter. Leave clothing and shoes outside. Shower and wash your body with soap and water. Removing clothing will eliminate 90% of radioactive contamination. By taking this simple step, you will reduce the time that you are exposed and also your risk of injury from the radiation. Before entering the shelter, turn off fans, air conditioners, and forced-air heating units that bring air in from the outside. Close and lock all windows and doors, and close fireplace dampers. When you move to your shelter, use duct tape and plastic sheeting to seal any doors, windows, or vents for a short period of time in case a radiation plume is passing over (listen to your radio for instructions). Within a few hours, you should remove the plastic and duct tape and ventilate the room. Suffocation could occur if you keep the shelter tightly sealed for more than a few hours. Keep your radio tuned to an emergency response network at all times for updates on the situation. The announcers will provide information about when you may leave your shelter and whether you need to take other emergency measures.


    There are two "camps" on the use of or need for gas masks in these troubled times. Some say they are essential, and others say "Your're crazy!" The decision of their value is one that only you can make for yourself and your familly. Those who say you're crazy to think about getting gas masks for you and your family question how they could be of any use at all. First, if germs of terrible diseases come from the sky, how quickly can you get to your gas mask? Will you keep it with you every where you go? If a vial of deadly germs is thrown into a public area, will you have time to put your gas mask on? These are definitely valid questions to consider in your decision. For those of you who think gas masks won't be of much use for you and your family, or if you just can't find any, there are some things that you can do to help protect yourselves. If you did manage to get antibiotics in advance from your doctor, don't rush to take them. Prescription antibiotics taken in advance of exposure will not only do no good, they will put your body at even more risk. A lot of bacteria is killed by antibiotics, including the helpful bacteria that your body uses to fight off disease and infections. You would cause your body to be more susceptible to germs by taking antibiotics before exposure. And, most people won't have prescription antibiotics on hand. Since you know that a biological attack is possible in the immediate future, start a fasting regimen now. This doesn't mean to stop eating. A fasting regimen includes eating less, which puts your body in its own protective mode. Besides eating less food overall, a fasting regimen includes giving up fast foods, junk foods, and most sugars; adding natural fruit juices; and making all of your food healthy, whole or raw foods as much as possible. In addition to eating correctly, start taking multi-vitamins now. And, take natural Vitamin C with rose hips. colloidal silver (a natural antibiotic) would be good second addition, and grapeseed extract is further protection. Natural apple cider vinegar with honey should be taken daily (see Safe Natural Cures). Would prescription antibiotics be able to help you personally? Many people have caused their bodies to become almost immune to prescription antibiotics by using so many antibacterial products. Antibacterial soap in the shower, antibacterial soap for the dishes, antibacterial cleaners for the kitchen counters, antibacterial bandaids, etc. The use of antibacterial soap on your body kills bad germs, but it also kills good germs our bodies need to stay clean and healthy (see Safe Natural Cures under Yeast Infection and Athlete's Foot.) Stop using antibacterial soap now so your body can rebuild its own immunities, so it can rebuild its supply of good germs. Using antibacterial cleaners on your kitchen counters is very dangerous. If you don't clean every inch, the bacteria in the areas you missed become immune to the antibacterial cleaner that was used - they start mutating to defend themselves from the next "attack" of cleaner. Stop using these cleaners and dish soaps now. Stop putting antibacterial cleaners in your wahsing machine now. If your neighborhood is exposed later to biological attack, that is the time to use all of the antibacterial cleaners, dish soap, laundry soap, etc., that you can on anything but your body (with the exception of your hands). Since you may be on your own for all your first-aid and health care needs, it is a good idea to learn now how to take care of any special needs for yourself and your family. If you are warned of an attack in your area, you can in advance seal your windows with plastic and duct tape. Also seal all exit doors but one (until the last), including any doors that lead to the garage. Close the fireplace flue and seal the hearth opening with plastic and duct tape. Seal all vent openings: inside the attic, under the house, above the stove, for the dryer hose, plumbing vents on the roof (if you can't get on the roof, you can instead cover the sink, washer, bathtub and shower drain holes and the toilet bowl), and any other openings you may have where outside air can come in. If there is time, be sure that all windows in all your cars are rolled up tight, and you can seal these windows and any vents with plastic and duct tape. This will not prevent air from coming up from under the car, but it will keep out poisons that fall from above. In the event that your area does become contaminated, get yourselves and your pets indoors immediately and stay there, and seal up the last door. Poisons in the air outside will eventually be blown away or diluted by clean air. Remain sealed inside until the air outdoors is safe (24 hours??? 48 hours??? 72 hours???). If your home was actually in the drop zone, clean up everything you can when you do go back outside. First, put on a gas mask or a mask with a filter, safety goggles, and gloves (if you use disposable gloves, use two pairs at once) then go out and use an antibacterial spray on any area of your home, car and yard that anyone may touch (doorknobs, doors, windows, windowsills, fencing, etc.). Wash the outside of your car. (You may want to stop cleaning at this point and simply drive away.) Wash doors, door handles, windows and windowsills on the outside of your home. Wash fencing, outdoor furniture, and tools and toys that were outdoors. Wash your hose - and anything else you or your family may touch. Many antibacterial cleaners and dish soaps and anti-bacterial sprays are available in most grocery stores. After cleaning, wash your goggles, remove the goggles and spray the goggles, remove your gas mask and spray your gas mask then wash it, and bag up the disposable gloves and sponges you used (and disposable mask if you used one). How you deal with your shoes is up to you. You may want to dispose of them. If you need to keep them, spray them with antibacterial spray, wash them the best you can, then let them dry outdoors. After they are dry, you could try one of several things: put them in the mircrowave (if they don't have metal grommets) and nuke any remaining germs, put them in the clothes dryer on hot for at least two hours, or bag them tightly and put them in the farthest area of your yard for a few weeks, or a combination of these. Put the bag of waste in a place as far from your home as possible. Now (and only now) wash your hair and body with antibacterial soap. It should be noted that some biological agents are spores instead of germs, like anthrax. Anthrax spores are said to not be killed with antibacterials sprays or washing. They instead are killed with intense heat for a long time. Extra care should be taken when dealing with anthrax because the spores can be put back up into the air when you walk or clean. It is said that anthrax spores can remain alive in the yard for 40 years. Maybe government officials and their experts will give more advice on this area later.


    If a vial of poison is broken near you in a public place, you may not even have time to get a gas mask on. Will you wear it every time you're out?.

    In the event of a chemical attack while you are in your home, stay indoors. You can follow all of the steps listed above under Biological Attack. It may also help to keep a good air filter working in your home. It could be 48 hours before the outdoor air is safe.[/QUOTE] from blue gecko

    I recieved this from a friend and fellow poster. I'm sure he won't mind my passing it along. It really got me thinking and upped my level of preparedness for the unexpected considerably. BG

    Subject: small pox patient care at home.

    Fw: Smallpox patient's room
    lots of issues to deal with when it comes to smallpox. This is "guerilla home nursing, if you will. Please improve on my suggestions. I'm always looking for 'quick & dirty'. "Let's "set this up" first:
    Assume first of all, that the reaction from all levels of gummint will be "don't anybody move"... in other words, some kind of lockdown. In this case, I'd heartily approve. Even with a lockdown, realize that other than those researchers who've had reasons to work with smallpox, none of us have valid antibodies left from our childhood vaccines. It will realistically probably be too late to prevent spread. Also, a lot of info on smallpox historically is a bugger to get. Recent info is tough... the attitude seems to have been "why research a non-issue? This disease has been eliminated." Right. Sure. Whatever. No doubt USAMRIID & other interest groups know some of this stuff & I'm digging my way to China trying to find it...
    In a world population unvaccinated, I don't know how many of a hundred people exposed to an infectious amount would get smallpox. There is no doubt some degree of natural immunity; I can't find anything on that... time for me to go digging through old issues of journals.. if they're online; argh!
    Never mind that. If as few as ONE case is discovered in your locality, don't set foot outside the house after you hear the news report. I suspect no gummint is gonna say anything until they're ready to enforce "movement restrictions". When they do, assume people are gonna try anyway & get shot & killed. Ignore it. Callous as this sounds, THIS IS NOT YOUR PROBLEM. Your concern is keeping you & yours alive, perferably without having to go through a case of smallpox. Okay, you've sat down after hearing the news, had your weeping & shaking fit, taken as many cleansing breaths as you need... what are you missing? The only reason you;re going to leave the house is to quickly pick up essentials; assuming you CAN leave the house. Don't do so without gloves, mask & plastic overwrap which you'll shed coming home & which will go into a tub of bleach/water... more on that later.
    First thing I'd do if I heard of a case in my area is... clear out a room in my house. I mean completely clear it out, strip it to bare walls, flooring & wood. No carpets, no curtains. Dust down, then wash everything. You'll see why later. Use plastic or other washable blinds. Get rid of the bed. Just put the mattress(es) on the floor lying on some thick plastic. Have the plastic edging long enough to make a sort of small wall. Cover the mattress in plastic. In a pinch, plastic garbage & duct tape work. Make sure you have LOTS of clean linen & I mean lots. Buy it, make it, beg, borrow or steal it... can't have too many sheets, pillow cases, washclothes, rags & towels. Get lots of plastic basins, pails; whatever. 5 gallon paint type buckets are handy. You'll see why later. Anybody here who curently doesn't have 20 gallons of bleach in the house should. It's cheap. Get some bottle type sprayers... again, can't have too many. While you're at it, lots of permanent markers & more duct tape. A cheap handpump type garden sprayer or 2 is worth its weight in gold. Heck... get three.
    Invest heavily in plastic sheeting... thick... or rubber aprons. Fishermens's slickers are an option. You can also & I have; get tons of those cheap drug store rain ponchos... you can do a lot with those & duct tape. You'll see later. Tarpaulins are good, just make sure it's not a "textured" plastic... ya want everything slick & easy to wipe.
    Here's how you set up your patient's room, assuming you think you have a case of smallpox. You've emptied it out & set up the matress on the floor. It's as clean as you can manage. Outside the room, which is now a "hot zone", set up a "grey area". Things in there are not considered clean, but are not as dangerous as in the patient's room. In that area, place a 5 gallon bucket gilled with clean water & a couple of good "glug glugs" of bleach. You want the water to really smell of bleach. Mark the pail :"Decon" for decontamination. It's nice to have it sitting on a rubber mat with a lip, to prevent spills. Keep it handy but not close enough to trip over. On a clean table there, you want gloves, masks & overgowns, preferably of rubber or plastic. Lots of garbage bags too for double bagging laundry until you clean it. A flashlight & good strong overhead light or lamp. Did I mention you'd want to be able to boil lots of water? Make sure you have kettles, pots, whatever. Gonna be lots of laundry in your immediate future. Out in our grey zone, a flashlight is good & perhaps a small table with extra linen. Inside the room, lots of garbage bags & another rubber floor mat with a lip. Also, several spray bottles filled with a mix of 3/4 water to 1/4 bleach. Maybe that's overkill but with what I've learned about variola, I'd not be comfy with less. You also want a supply of drinking water in there & more linen. Okay, your loved one is sick & you suspect smallpox. IMMEDIATELY get her into your isolation room. She'll be ill, complaining of fever & uncomfortable eyes, kind of like a bad cold or flu. Probably no rash yet, but you know smallpox is around so you can't go wrong presuming that's what it is. While you've told your patient to get into the room, you have stopped where you are... stripped down completely... including ALL jewelry & piercings & places them in a double bag. Bring that with you to the 'grey zone' where you put on some comfy clothing. Yeah, that's the other thing you need out there, clothes for any caregivers... you can there wash glasses, false teeth, anything else you need to wear to function. So a 'clean' bucket for that kind of stuff...
    Right, you sat your bag of stuff on top of a bleach/water bucket while you were getting dressed. Spray it with loads of bleach/water & wait several minutes. You can speak to your patient through a CLOSED door. You're having her strip right down & 'wearing' a sheet while you prepare yourself... her clothing & all jewelry & piercings can go into the bag... might be a good idea to have a plastic container with lid to put that kind of stuff in. Include false teeth, glasses & definitely contact lenses. ALL come out/off.
    I forgot, inside the room you also have at least one, preferably 2 large plastic buckets with lid, ready to go with water & bleach. If not ready, you can prep them really quickly. Your patients laundry & other items go right into that & stay there for at least 15 minutes. I'm being arbitrary; probably need less but why not 15? Everything out of the bag, unfolded or whatever & into the bleach/water. Don't shake anything, Be very gentle moving stuff... don't wanna spread the virus. Put the bag in too. Gotta think of re-use as much as possible.
    Okay, laundry temporarily dealt with, get yer patient comfy. In bed with light, comfy EASY TO WASH & DRY clothing. Be as reassuring & fear free as you can/ If you can't... fake it. You don't need hysteria at this point & if your patient is old enough... she knows what's going on anyway. Many an epidemic almost contained has been lengthened by patients panicking & running out among other people. Nasty though, but you also might want to think of how to lock someone into a room... more on that later.
    You'll want a notebok or clipboard. You want some way of keeping track of how your patient is, fever levels, time of any symptoms showing up, etc. Later on when you're dead tired you'll forget when you gave medication or water... trust me on that, you will.
    So start by writing the date & time. Take her temperature & note what that is. Mention her mental state. Is she calm or not? Is she mentally "all there", meaning is she or is she in touch with where she is & what's happening. With a flashlight, carefully look over her body. You're looking for rashes. That's how it starts... a red rash kibnd of like chickenpox. Blisters come later.
    So what's the rest of the family doing? Hopefully, you have someone else strong, perferably adult. Have them shut down the house... doors, windows, etc. Lock 'em. You don't want someone blundering into a house with smallpox. Have them all mask & glove up. BEFORE changing clothes, have them clean the house. Wipe down everything with a water/bleach mix from one of your umpteen LABELLED sprayers. Tap water is fine... just make sure you didn't skimp on bleach. If smallpox IS in the house this won't get it all, but it increases the odds in your favour. Once that's done, have them change clothing too... into a garbage bag. Someone start laundry using HOT cycles. Add bleach, forget fading. You've got bigger fish to fry.
    Have your other strong one feed them all, then set the older kids to doing dishes or something. Now a this stage depending what's going on outside your little world, you may want to "post guards" to advise you of the approach of strangers. Not sure about how I feel about "quarantine" sings. Could backfire if folks decide YOU are the source & they decide to torch your house.. it's happened in the past. Put a few folks to bed; you'll be on shift for a while. Actually a few family meetings discussing all of this held soon is a great idea. If everyone has assigned chores, duties, etc. they feel a bit better.
    NO ONE but designated care givers gets into that room for ANY reason... unless it's the gummint at gunpoint or whatever. But keep family & pets out. Virus particles can settle on a pet's fur too. The designated family caretakes, 2 is the minimum you SHOULD have, from now on do NOTHING but care for the sick AND for themselves. You get sloppy when you're tired & hungry.
    Okay, you've got all that done. Everyone has been fed & watered, house is clean & everyone is either busy, asleep or resting, or doing other vital chores. Oh yeah, anyone handling 'unbleached laundry' should always be masked/gloved/gowned. Ideally, only caregivers handle it except for when it goes to the washer/dryer. Btw, your room is as close to the patient's as possible. Think of yourself as being in semi-seclusion. Have a radio, tv, book or something else handy for yourself. Book that go into the sickroom don't come out except as a sodden pile of water/bleach soaked paper.
    All you have to do at this point, before your patient gets REALLY sick is make sure they rest & eat & drink as much as they can handle. Several chamber pots are good, unless you have an ensuite. Later, they'll be too sick or eat/drink much & they'll need all the strnegth they can get to fight this off. Make them drink lots. Keep track of fever or other symptoms, every 3-4 hours at first. Once they start really breaking with it, you'll be checking constantly. Encourage them to sleep if possible & whatever form of medecine; western, naturopath, homeopath, veterinary... whatever your preference, treat as needed.
    Right, 12-72 hours has passed & now it's getting interesting. Your patient feels lousy. She complains of aches/pains, her eyes are sore, she may be nauseated. Treat the symptoms according to your preferences. At some point, she'll have developed a rash. This one tends to begin on the extremities first; that is, hands & feet, then work "in towards the middle". Being covered by a sheet may become annoying or painful. YOu might want to rig, with old coat hangers 3-4 "U" shaped 'sheet racks'. Make sure they ae tall enough to keep sheets off a patients & bend your cobbled together hangers at the bottom, to slip under the mattress. So these are 3-4 "bars" about the width of the bed, about a foot off the surface of the patient & with your "wings" to slip under the mattress about 12-18" long. Can always use duct tape to steady them.
    Once the blisters form, your patient won't tolerate much "handling", so touch as little as possible. When in the room, you're fully gloved/gowned & masked anyway. Don't worry about really "washing" them thoroughly, just do the best you can, trying not to break the blisters. Each bit of fluid in the blisters is LOADED with infectious viruses or virions. That's an excellent reason not to pop them, if no other. Keep the face, groin area & armpits clean, again as best you can.
    Okay, now the talk is gonna get a bit ugly; sorry but it's an ugly disease. First thing you'll notice I've read, is that this disease STINKS once the blisters form. I've read it's hard to describe but unforgettable. You might want to put your favorite essential oil on your mask, a drop or 2. Lavender works for me as it's also mildly antiseptic. As well as forming all over the skin, the pocs may form inside the eyelids & right on the eyes. Inside the mouth too. They will form inside the anus & vagina... nothing you can do abut that. Do NOT douche your patient or give an enema... just more contaminated stuff hard to get rid of & you may harm rather than help. For the eyes, about all you can do is bathe them using distilled water. So yeah, buy or distill your own water.
    Until the pocs start drying up or breaking, don't change the bed linen with abandon. Wait until it's dirty. Your family has enough laundry to do. Oh yeah, after doing any patient/caregiver/sickroom laundry run your washing machine empty with cold water & bleach. Helps keep it safer for family who are not sick yet also need to do laundry. YOur clothing should never leave the patient care eara, that is, your overclothing, the plastic stuff. If you must leave the sick zone, strip off, wash down, (personally I'm not shy about spraying myself with water/bleach), & get into clean clothing. Limit contact with other family/household members. Don't forget to eat & switch off with your co-caregiver. Sleep when you can. Forget the rest of the world. Someone can give you a "highlight package" of significant news a few times a day. Have someone moniter local broadcasts for 'civil defence' instructions & that sort of thing.
    Forget getting to a hospital on this. This will spread far, wide & fast. They'll be overwhelmed very quickly. Stay home. There will be lots of 'home nursing' advice given on your local media. If it sounds sensible, quicker, easier, do it. Save YOUR strength.
    Plan on someone else in the household catching it from your first patient. They may have been infectious for a day or so before you all catch on that this may be more than a cold. Have another mattress ready to be brought in to your sick room.
    As for feeding/watering; LOTS of fluids. Fed them along the lines of light & nourishing, preferably cooling when they have a fever. Treat urine as contaminated & pour it into a bucket with some bleach/water. Let it sit for a bit... 15 minutes?... before it goes into the one designated bathroom toilet. Feces I'd put in the toilet bowl, (careful of any splashing), add some bleach & let sit before flushing into the sewer/septic system.
    ALL linen items in the room must soak in 1 bucket of bleach/water before leaving the room. Then wring em out & put them to soak again in your 'grey zone'. Then & only then do they go for washing. Balance the need for freash air against the fact that this sucker is airborne... no easy answers there, I'm afraid.
    Needless to say, this is a lousy time to welcome visitors. How you deal with official agencies coming to your door is up to you & how you feel about them. There may be central points to pick up food/water... would be nice, eh? But don't count on it. Smallpox will close down an awful lot of what we take for granted very quickly. Preps are a good thing, a VERY good thing. Food, water, etc may simply not be available. Someone has to harvest it, ship it, can/box it, deliver it, etc. Once a pandemic is really under way... ain't gonna happen, I don't think. I'm not counting on it.
    After the rash develops, your patient may have blisters/more rash for up to 3-4 weeks. During all of that time, they're extremely contagious. During the last week, the postules start drying, scabbing & falling off. All that stuff contains virus. Whenever you sweep the floor in the room, lightly spray water/bleach first... anything to keep dust flying. Between uses your broom/dust pan rest in... you got it, a bucket with bleach/water... in the room. You'll need another such bucket with water/bleach mix for dishes. And another smaller one for chamber pots, urinals, thermometers... any medical gear that's not consumable. Label them all.
    Once your patient's last scabs are off for a few days, they can 'resume normal', whatever that is by this stage. Others, yourself included, may by now be sick. They take over as best the can... your first patients I mean.
    I can't predict what would happen. I strongly feel that a single case will quickly be followed by others & by the time it's discovered, it will be incubating all over the country, all over the world. Modern travel, eh? Plan on it taking a year to 'burn through' the world's population. As well, after a few months, you'll start seeing flu, food poisoning, water contamination... all because people are already weakened & your infrasctructure people, those left on their feet, will be working like stink & some stuff won't be picked up on, especially water treatment & that sort of thing. Of course, there will be opportunists who feel free to whatever they choose. Be prepared to guard you & yours as best you can.
    Variola has been documented to survive on letters for a few weeks, then sicken the recipient. It survives on linen, pets, clothing, skin, just about any surface. It's one tough little virus. You & yours will spend a great deal of time wiping, cleaning, scrubbing, etc. That's just the way it has to be to try & minimize the case numbers.
    Forget the gummint, forget the hospital system. They'll do their best, but don't anybody kid themselves. They can't cope with a fraction of the number of cases your country could expect. No one could. People with other medical conditions WILL die. NO hospital beds or staff to treat all who need anything in terms of medical care.
    So that brings me to the last part... bodies. With such a high fatality rate, you may lose your loved one. YOu will probably have been given instructions on how to notify authorities & what to do. I expect some kind flag of a certain colour hanging will be used to communicate the message that a body has to be recovered. They'll probably be cremated... both to kill the virus & because there's no room to bury that many or people to do it.
    There's no specific treatment for smallpox. All you can really do is keep patients as comfy as possible & make sure they eat & drink as much as they can handle. The scarring can be awful & pocs on the eyes results in blindness most of the time. I wouldn't put anything on the pocs to prevent or minimize scarring while the blisters are not dry. The lotion/cream gets transferred to clothing/linen & itself is loaded with virus. Mind, if much of the population is scarred, it's a bit easier to take, I suppose.
    Pre-existing medical conditons obviously make smallpox harder to survive. Yeah I know, this makes for depressing reading, but this would be the reality of it.

    Important points:

    1) you can't clean enough
    2) you can't rest enough
    3) the gummint can't do enough
    4) have to remove all jewelry, piercings, contacts, glasses, hearing aids
    5) Label your buckets
    6) lots will die

    Reading through this, you'll gather a list of what you need to buy that you don't already have. I'm loathe to recommend too many medications. Something for fever, sure but only use it if the fever gets over 103. As nasty as a fever feels, it's an important part of killing off virus internally. Have something for cough & nausea around. Lots of juices & "liquid meals".