Polio Epidemic Offers Guidance For Getting Through COVID-19

Clues on how to fight the coronavirus lie within history’s past epidemics, including devastating outbreaks of polio.

A vaccine was developed in 1955, the same year thousands were infected by the polio virus — including Here & Now host Robin Young and her siblings. In some states, 50 new cases popped up each day.

During the summer of 1955, beaches and playgrounds were empty. Dr. Howard Markel teaches the history of medicine at the University of Michigan, and he says measures taken in the 1950s like containment and closing schools offer some hope in fighting COVID-19.

“What we can learn is that our predecessors have met these contagious crises with far less armaments and tools in their tool box,” he says. “And they came through on the other end. And we can do this and we will do this with COVID-19.”

On the severity of the polio epidemic

“It really was the epidemic of [the] era. Just like if you're my age, HIV/AIDS was the epidemic in the ‘80s. And now COVID-19 is. It's a real binding kind of moment for a society.

“The first epidemic was actually in 1916, and it was in New York City and was quite terrible. And there were several in the ‘30s. And, of course, the ‘40s and the ‘50s. And most sadly, there was a big wave in 1955. But what was most striking about polio compared to many other infectious diseases today was that it struck children way out of proportion to adults. Poorer children, who did not have access to clean running water because polio is a gastrointestinal virus, were probably ingesting small amounts of polio virus their whole lives and developed antibodies to it. But those kids who did not have exposure to polio were really walloped. If you're lucky, you're in an iron lung. But there are other children who got it higher up in the brain stem. Those children, of course, died.”

On why polio targeted children

“Adults did get polio. It was just those that had had antibodies to it were more immune to it. Children are only developing their immune system. You know, when they're an infant, they hardly have an immune system at all. And even under five years old, the immune system of that child is quite different than an older child or an adult.

“They closed theaters and summer camps. And [Franklin D. Roosevelt] was actually swimming at a Boy Scout camp a week before he was stricken at Campobello in 1920.”

On why COVID-19 isn’t hitting as many children

“We don't know. I mean, we hopefully will know later on. It seems to be hitting most heavily the elderly and those with preexisting serious health conditions. What we are finding is that there probably will be a lot more children who are infected once we get better epidemiological data. But they are developing mild cases. They are not getting really sick. And it may be just because it's the type of respiratory virus that causes, in some adults, acute respiratory distress syndrome. And that requires ventilation and intensive care and so on, that this is not something that's striking children. And I, for one, am delighted to say that's true.”

On whether some children are more vulnerable to this disease

“Children with asthma. Don't forget, there are a lot more people, both children and adults who are walking around today who would never be alive 50 years ago. People with cancer who are getting chemotherapy or radiation or immunotherapy, people with transplants, people with other immunocompromised disease. And you don't really have a label when you're walking around. But those people and respiratory diseases like serious asthma or emphysema or cystic fibrosis, those people are at risk. And that's sort of the rationale behind school closures, that even if a kid gets it and that child has a mild disease, if he or she goes home and has a parent or a sibling who has a serious other disease, that could put them at risk.”

On why school closures are effective

“We were really privileged to do a study with the Centers for Disease Control [and Prevention], where we looked at 43 major American cities in 1918 to 1919. And we looked at these non-pharmaceutical interventions. So isolation and quarantine is one. Public gathering bans is another. And school closures is the third. And those cities that acted early — because you have to do it early before the virus hits an inflection point and is spread and circulated throughout the town — that layered more than one of these NPI and did them for a long period of time, did far better than those cities that did not.”

On when to close schools

“That's the million-dollar question. When it reached about two times the rate of flu in that particular city when compared to the year before, if you pass that point, there was no return. But of course, they had data from the year before of influenza and its occurrence in that city. And we don't have that for COVID-19 because it's a novel virus. So what I'm prescribing is better safe than sorry.”

On the importance of closing schools before the inflection point is reached

“The virus already circulates. And, you know, I had a professor in graduate school who said, ‘Howard, you have to remember that the first word in public health is public. And sometimes we do things for political or show reasons. You know, people complain to their leaders, don't just stand there, do something.

“The history of public health is littered with health officers that acted either too early and then people complain or too late and then people get sick or die. And to use a baseball metaphor, to hit that sweet spot, you have to be basically the Babe Ruth of public health to do it absolutely right. We also have at risk children who are actually safer in school because they may come from homeless families or they come from families where there's abuse or other bad things going on. So there's a lot of planning that needs to be done. A lot of considerations that, by the way, a hundred years ago would never even enter into public health people's minds because the idea of a quarantine was to get those sick people far away from us. And there was no treatment for them anyway, so they concentrated on the healthy.”

Karyn Miller-Medzon produced and edited this interview for broadcast with Todd Mundt. Allison Hagan adapted it for the web.