One Exceptional Public Health Campaign

During the COVID-19 pandemic, we have all too often heard the words, “Follow the science.”  Unfortunately, the “science” has been inconsistent, recommendations one week turned on their head the next, generating seeds of doubt as to their veracity.  I myself have been frustrated as to the single-mindedness of the narrative, with a curious absence of healthy discussion of alternative approaches.   

That being said, the recommendations generated for fighting back against the virus this past year were not created in a vacuum.  An amazing story exists concerning the effectiveness of strikingly similar precautions implemented during an outbreak of typhus in the Jewish ghetto of Warsaw in the early years of WWII.

Over 400,000 people were squeezed into the 1.3-square-mile ghetto in Nazi-occupied Poland, and it was then sealed off from the rest of Warsaw in the fall of 1940.  Extreme overcrowding, poor housing conditions and starvation were the perfect ingredients to fuel an epidemic if one should arise.  And, sure enough, when typhus broke out within the ghetto in 1941, the rapid demise of the Jewish population seemed inevitable.

Typhus is caused by a bacterium, Rickettsia prowazekii, and is transmitted insanely quickly by infected fleas or body lice.  Symptoms are a high fever, chills, coughing and terrible muscle pain, leading to death in over 40% of cases.  Explosive epidemics are common when people are crammed into close quarters with poor hygiene.  Indeed, in the Jewish ghetto, soap and water were extremely scarce and food rations were below subsistence levels.

Despite this, less than a year after the epidemic emerged in the ghetto, the disease shockingly began to dissipate, and new cases dropped by over 40%, with only 10% of the population showing signs of the disease.  The surviving residents felt they had witnessed a miracle.

When researchers used mathematical modeling to map the spread of the disease among the ghetto population, it showed that the epidemic should have continued to infect people during the fall and winter months and would have sickened nearly every person in the ghetto.  But something stopped it.

It turns out that the Warsaw ghetto had many experienced doctors as inmates, and some survived to write about their experiences during the epidemic.  Discovered rare publications documented the types of interventions employed to fight the disease.  Jewish doctors and community leaders enforced social distancing and quarantines for those infected as much as was humanly possible under the crowded conditions.  A public relations campaign was also implemented to inform the public about the disease and the importance of personal hygiene.  In addition, Nazi policy changes that permitted more food and water and soap to be brought into the ghetto was also instrumental (the motivation was to keep them healthy enough to extract more work from them).

The defeat of the disease under these appalling conditions is remarkable and serves as a testament to what public cooperation in the face of a serious disease threat can accomplish.  Hmmm, practicing good hygiene, social distancing, self-isolation when sick.  Sound familiar?