Parallels and differences between the polio epidemics and Covid
Patrick Cockburn is the author of War in the Age of Trump (Verso)
Cross-posted from Counterpunch
Patrick Cockburn aged seven, in a wheelchair after catching polio in 1956 in Ireland.
I was unlucky in catching polio. It was in Cork, Ireland in 1956 during one of the last polio epidemics ever in western Europe and the US. A vaccine had been successfully tested the previous year and, at the time I fell ill, mass inoculation was being rolled out for the first time to stop the spread of the virus in Chicago.
The number of new infections declined as herd immunity was established, marking a turning point in the effort to stop epidemic polio. The success of this decades-long campaign was one of the greatest US achievements in the 20th century. Not that it did me any good at the time as I was admitted to St Finbarr’s fever hospital in Cork city on 30 September.
When I was released three months later, I was at first confined to bed or was in a wheelchair and learned to walk again with metal callipers on my legs and wearing a plastic waistcoat to keep my back straight. Though my mobility improved markedly over the years, I could not run and have always walked with a severe limp.
I was conscious of my disabilities, but I never thought much about why this had happened to me. Only in the late 90s, when I was in Iraq as a journalist talking to doctors and patients in ill-equipped hospitals hit by UN sanctions, did I start to feel it strange that I knew more about sickness in Baghdad than I did about polio in Cork, when it had been me lying in a hospital bed.
I started reading about the disease, which has probably been around for thousands of years. But it was not 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 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 pandemics. 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 protection.
When collective immunity faltered, epidemics would surge periodically through cities like New York, Melbourne, Copenhagen, Chicago. Devastating though these outbreaks were, they seldom occurred at the same time in different places because vulnerability to the virus would vary.
Nobody had written a history of the Cork epidemic, which had paralysed part of Ireland for the best part of a year, although it lived on in popular memory as a terrifying event and there were plenty of victims still alive since they were crippled as small children.
I asked surviving doctors from that period why this was the case. They said they believed that people in Cork had been so frightened of the disease that they wanted to forget about it once vaccination had removed the danger. Polio had always carried an extra charge of terror compared to other diseases because its victims, whom it crippled or killed, were young children.
In 2005, I published a memoir about the epidemic called The Broken Boy. I described my experiences in the context of my family and of Ireland in the 50s. Much of the text made gloomy reading but it ended on an upbeat note that later turned out to be over-optimistic.
At the end of the final chapter, I had written dismissively of the last prophetic line in Albert Camus’s novel The Plague, in which he wrote that “the day will come when, for the instruction or misfortune of mankind, the plague will rouse its rats and send them to die in some well-contented city”.
I found this a bit portentous and out of date, writing that polio might have been among the last of the life-threatening plagues, such as leprosy, cholera, tuberculosis, typhus, measles, malaria and yellow fever, to be eliminated or brought under control during the 20th century.
Polio epidemics had a surprisingly short career: less than 70 years between the end of natural immunity and the widespread use of the Salk vaccine. It was a story with a seemingly happy ending and this was the topic of my original book. Few people realised – certainly I didn’t – that if polio epidemics were a product of modernity and not of backwardness, then the way might be open for other epidemics of equal or greater severity.
I was surprised but not very alarmed when Covid-19 was first identified in Wuhan at the end of 2019 because previous coronavirus outbreaks, such as Sars 1 and Mers, had not spread far and had been suppressed. As more information about the virus emerged in the early months of 2020, it struck me that in some respects the pandemic more resembled a polio epidemic on a world scale than the 1918/19 Spanish flu outbreak to which it was often compared.
Covid-19 and poliomyelitis – to give it its full name – are alike in being highly infectious and most of those infected have few if any symptoms and swiftly recover. But they become carriers all the same, infecting others, some of whom may belong to theunlucky 1 or 2 per cent – there is great dispute about the fatality rate among victims of Covid-19 – who will feel the virus’s full destructive impact.
There are similarities in the treatment of both illnesses, particularly in trying to keep people breathing: the “iron lung” was invented in the US in 1929 and the first intensive care unit was created in Denmark in 1952, both in response to polio. Simple methods of combating the two viruses such as handwashing are the same.
The poliovirus was worse for the very young; for the coronavirus it is the old who are hardest hit. For both illnesses, respiratory aids – the “iron lung” and the ventilator – have been symbols of the struggle to keep people alive. In Cork in 1956, doctors did not seem to grasp how frightening such machines were for children: when I was in St Finbarr’s, one girl screamed and struggled when doctors tried to put her inside an iron lung because she thought it was an actual coffin and she was being buried alive.
Politicians often compare the campaign to suppress the coronavirus to waging war against a dangerous enemy: they wrap the flag around themselves and call for national solidarity. Fear and a need to see visible action to counter it are a feature of all epidemics. In Cork, doctors were convinced that the disease would only be stopped when it ran out of victims.
In the book I quote Jack Saunders, the city’s chief medical officer, insisting that a real quarantine was impossible because “for every case detected there were one or two hundred undetected or undiagnosed in the community, principally among the children.” Similar words were to be used 66 years later in Sweden and in US states like Texas, Florida and North Dakota to downplay the Covid-19 pandemic or suggest that there was no way of stopping it.
There were similarities too in the response of governments and peoples to the threat. At every level of society and the state, fear of death – or, more accurately, fear of being held responsible for deaths – drove decision-making.
As a consequence, this was often ill-judged with under-reaction and over-reaction succeeding each other as the authorities lurched from commercial close-downs to over-rapid reopenings. Wuhan city in central China with a population of 11 million could scarcely be more different from Cork with just 114,000 inhabitants in 1956, but popular reaction had points in common. As in Wuhan, local people in Cork convinced themselves that they were being fed false information downplaying the severity of the epidemic.
“There were rumours everywhere in the city,” said Pauline Kent, a physiotherapist who treated victims, “that dead bodies were being carried out the back door of St Finbarr’s at night.”
The medical authorities in Cork were truthfully announcing the number of new cases and fatalities each morning, though they were simultaneously undermining their own credibility by issuing upbeat statements, dutifully reported in the local newspapers, with headlines such as “Panic Reaction Without Justification” and “Outbreak Not Yet Dangerous, Say Doctors”.
Arguments about lockdowns, commercial closures and quarantines raged on a miniature scale in Cork during just as they were to do many years later in America and Europe.
Rescue came as the epidemic burned itself out and the first doses of the vaccine developed by Dr Jonas Salk arrived in Cork in 1957. It was in such demand that part of the first consignment was stolen.
There was little surprise that the life-saving inoculation had been developed in the US, which many people in western Europe saw, in the aftermath of the Second World War, as the source of all good things and of scientific breakthroughs in particular. Perception of American competence and capability was partly shaped by its conquest of polio.
Everything that was done right over polio was done wrong over Covid-19. President Franklin Delano Roosevelt, himself crippled by polio, had been the driving political force behind developing a polio vaccine, while Donald Trump minimised the danger posed by Covid-19, refusing to wear a mask and recommending quack remedies.
In 1956 Elvis Presley was filmed on the vastly popular Ed Sullivan Show on television baring his upper left arm to be vaccinated, while in January 2021 Trump was vaccinated in secret in the White House. Presumably, he did not want to offend those of his followers who were dubious about vaccination and considered it unmanly.
Polio was sometimes called a “middle class” disease in Europe because it was the better off who suffered worst. They had lost their natural immunity because they drank clean water and used modern sanitation systems. My parents never realised that their children were far more at risk in our isolated country house than if we had been living in the slums of Cork.
The opposite was true of the Covid-19 epidemic during which it has been the poor living in cramped accommodation and with pre-existing bad health who have been the most likely to be infected and to die. Health inequality exactly replicated social inequality. In Britain there was a sour joke that the lockdown only applied to the middle class, because they stayed at home while the working class brought them food and other necessities.
One great difference between the two epidemics and their consequences is that Covid-19 killed far more people, but even with long Covid, the long term impact of coronavirus is less visible and destructive than polio. The latter affected young children and left a proportion of them crippled for life. This was why it caused such terror at the time – and indeed now, with reports of the polio virus being found in sewage in London– while the fear of Covid-19 was never so pervasive.
Polio shaped my life. I cannot remember what it was like not to be disabled and it became part of my identity. But I never felt sorry for myself and threw away my crutches when I was at boarding school aged about 10. Nobody bullied me, though I would certainly have hit them if they had tried.
I found out in later life that I was at ease in violent places from Belfast to Baghdad and I assumed that this had something to do with my experiences in hospital in Cork in 1956 when I had stopped eating and my parents thought that I was dying.
I was stoic or fatalistic about my own suffering from an early age but that did not mean that I had enjoyed it. Time passing did not make the experience less horrible, merely that I had become used to coping with memories of it.
On occasion, people would say supportively that perhaps I had benefited in terms of character and resilience from facing challenges early in life. No doubt their comment was meant to be a sort of morale-boosting compliment. But I could not help being irritated, feeling sourly that these qualities, supposing they existed at all, had been bought at too high a price.
This an edited extract from The Broken Boy by Patrick Cockburn. A new edition is published on 7 July (OR Books)
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