Viruses: A Time to Recall Polio and Its Epidemics

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As best can be determined, polio, a viral disease, has been with us at least throughout recorded human history.  The result for some of those infected was varying degrees of paralysis and even death.  Until the beginning of the twentieth century, the virus survived by infecting new additions to the community while the majority had previously developed immunity.  This is the “herd immunity” discussed today.  In this situation the virus is said to be endemic.  Infections would occur but they would not be widespread.  It would take human intercession, in the form improved sanitation and hygiene, to turn polio into one of the most feared pathogens of the modern era.  As we learn over and over again, human actions can have unintended consequences.

Wikipedia provides us with this perspective.

“In children, paralysis due to polio occurs in one in 1000 cases, while in adults, paralysis occurs in one in 75 cases. By 1950, the peak age incidence of paralytic poliomyelitis in the United States had shifted from infants to children aged 5 to 9 years; about one-third of the cases were reported in persons over 15 years of age. Accordingly, the rate of paralysis and death due to polio infection also increased during this time.  In the United States, the 1952 polio epidemic was the worst outbreak in the nation’s history, and is credited with heightening parents’ fears of the disease and focusing public awareness on the need for a vaccine. Of the 57,628 cases reported that year 3,145 died and 21,269 were left with mild to disabling paralysis.”

“At its peak in the 1940s and 1950s, polio would paralyze or kill over half a million people worldwide every year.”

The Wikipedia account also included this note attributed Richard Rhodes taken from “A Hole in the World.”

“Polio was a plague. One day you had a headache and an hour later you were paralyzed. How far the virus crept up your spine determined whether you could walk afterward or even breathe. Parents waited fearfully every summer to see if it would strike. One case turned up and then another. The count began to climb. The city closed the swimming pools and we all stayed home, cooped indoors, shunning other children. Summer seemed like winter then.”

Patrick Cockburn was an Irish lad of age six when he was infected during an epidemic in 1956.  He wrote about his experiences with the illness and its effect on his subsequent life in a note in the “Diary” section of the London Review of Books.  The piece was titled The 1956 Polio Epidemic.  Cockburn suffered a degree of paralysis that left him, after several years of physical therapy and some surgery, with a severe limp.  As an adult he was moved to research the disease that had assaulted him and would eventually produce a memoire titled The Broken Boy.

“I started reading about polio, a disease that has probably been around for thousands of years. There is an ancient Egyptian sculpture of a man with a wasted leg, looking very much like my own. Walter Scott was made lame by it as a child. But these were individual cases and it wasn’t until the first half of the 20th century that polio epidemics began to sweep through cities. Before then most people contracted the virus in infancy, when their mother’s antibodies helped them to gain immunity. Long before the Covid-19 pandemic made the phrase ‘herd immunity’ infamous, the pool of people who had polio without knowing it was large enough to prevent epidemics.”

“It was modernity that gave the polio virus its chance: as 19th-century cities acquired clean water supplies and efficient drainage systems, babies were no longer contracting the virus in large enough numbers to provide collective immunity. The most vulnerable populations were in the cities, though some lost protection through geographic isolation…”

“…polio epidemics hit hardest in New York, Melbourne, Copenhagen, Chicago. Disease in such places was assumed to be associated with poverty, dirt and deprivation, but in fact it was the better off in newly built housing who constituted the majority of the victims. An epidemic in New York in 1916 killed 2343 people and crippled many more. Efforts to keep people alive by mechanical means were similar to those in use now against Covid-19: the world’s first ICU unit was established to combat the polio epidemic in Copenhagen in 1952, with two hundred medical students recruited to pump oxygen and air manually into the lungs of patients who could no longer breathe on their own.”

“These epidemics were terrifying because people didn’t understand why children were falling ill when they hadn’t been in contact with any other sufferers. In reality, everybody was infected without knowing it. Various communities, usually immigrants, were scapegoated. In New York in 1916 animals were suspected of spreading the disease and 8000 dogs and 72,000 cats were killed. Many communities made ineffectual efforts to quarantine themselves: towns in Long Island and New Jersey sent out deputy sheriffs armed with shotguns to police the roads and turn back cars containing children under the age of 16.”

It is often said that we should not expect the world to be the same after Covid-19 releases us from its terror.  The polio experience provides a case in point.  Much of the support for polio vaccine development and for aid to those disabled was provided by the March of Dimes.  This charity was funded by small donations from millions of individual citizens, a novel approach then, and collected hundreds of millions of dollars, more than all other charities combined at the time (save for the Red Cross).  The legions of people disabled by the disease would require the development of new techniques for treatment and physical therapy.  Their existence would also inspire the growth of a disability rights movement to generate the legal basis for incorporating the disabled into our society.  Today, one can only guess at the future that lies ahead for us.

Cockburn provides a comment that reminds us that our future plans after Covid-19 should—must—include the assumption that this will happen again.

“In 2005, having come to feel that I had learned as much about the epidemic as I ever would, I published a memoir, The Broken Boy. In the final chapter, I wrote that polio was probably the last in the line of diseases – cholera, typhus, malaria, yellow fever – capable of causing serious epidemics around the world. Polio epidemics had a surprisingly short career: less than seventy years between the end of natural immunity and the widespread use of the Salk vaccine. It was a story with a seemingly happy ending. Few people realised – certainly I didn’t – that if polio epidemics were a product of modernity then the way might be open for other epidemics of equal severity.”

There is a lot of human intervention with unintended consequences involved in the origin of Covid-19 and that of other viral pathogens that have emerged in recent years.  The rapid increase in our population provides greater human densities that are ideal locations for propagating diseases.  We are spreading out and inhabiting locations where humans were once few and far between.  We should not be surprised when we discover new and dangerous viruses lurking therein.  Diseases once easily controlled within local regions are now at risk of wide dissemination by denser and more mobile populations.  We have changed our relationship to animal populations.  Our industrialized treatment of vast herds of animals for our food supply also creates new opportunities for new pathogens to develop that can be transferred to us.  Bats tend to nest in highly dense configurations that invite the transmission of diseases and have been identified as likely sources of the viruses that plague us these days.  But we should realize that our population spread is also limiting the areas acceptable for bat inhabitation altering the communication paths between different bat populations and forcing them to reside in locations physically closer to us and the animals with whom we reside.  Our interest in pursuing exotic food sources has also put us at greater risk.  And we should not forget that our ubiquity puts animals at risk of being infected by pathogens transferred from us.

We are disturbing the world and its ecologies in a major way by our mere presence.  Add to that the impact of our climate change and we can expect diseases unknown to us to migrate along with their hosts as they follow the temperature changes.  Our southern states are already at greater risk as tropical diseases move northward.

We must assume that escaping from Covid-19 is not the end of a story.  The lesson to be learned is that it can happen again, and it might be much worse next time.  The world will never be quite the same again.  Life could be worse, or life could be better.  The choice is ours to make.  Hopefully, wisdom will prevail.