Too small a crisis?

The year I was born witnessed a terrifying culmination in the spread of a deadly disease.  This virus had been a growing threat throughout the 20th century, but in 1952, 57,000 cases were reported in the US, over 3,000 of them fatal.  It was the worst outbreak of polio in the nation’s history  Although parents were especially worried about it–I could probably trace my aversion to swimming pools to this period–in fact the focus of the illness was no longer on infants but rather on older children and adults, who were also more susceptible to paralysis–which could impair respiration and cause death.  Public places closed, people stayed indoors.  “Iron lung” was the first hospital term I recall hearing.  The polio mortality rate in 1952 was actually twice as high as for COVID-19, as of this writing.

The similarities between polio and the new corona-virus are striking: both had mysterious causes, both could come on suddenly and progress rapidly, and both called forth an urgent search for better treatment.  But the contrasts are equally remarkable.  Polio had been an annual scourge for decades by the time the Baby Boomers appeared on the scene.  From 1916 onward, a polio epidemic arose in some part of the country each summer.  It was accepted–though, of course, never acceptable–that thousands would be at risk every year.  In short, previous generations had learned to live with it.  Thanks in part to a President who had been stricken by the disease himself, public relations was enlisted in the search for a cure.  In the end, medical science produced not just one, but two effective vaccines.  From that time, polio became  a fast-fading danger, to the point where people could talk seriously about abolishing it worldwide.  By contrast, the new version of corona-virus has been regarded first as a negligible problem and then, increasingly, as an existential crisis.  In the search for meaning that naturally surrounds this pandemic, in the present and for the future, the history of the campaign against polio has much to teach.  

iron lungs
© AP This is a scene in the emergency polio ward at Haynes Memorial Hospital in Boston in 1955, showing critical victims lined up in Iron Lung respirators. Marco della Cava, For those who survived polio, coronavirus is eerily familiar’ USA TODAY  

On the one hand, there is the precedent of having overcome polio itself and so many other devastating illnesses in the past.  Expectations of modern medicine dictate that this novel virus should quickly become just one more victory.  Instead, as the outbreak spreads, the atmosphere of “crisis” has been heightened by the revelation of our shared weakness, often reflecting underlying patterns in national life.  The deepening impact of the virus has been been reasonably linked to all of these: the lack of health insurance for all, especially those with pre-existing conditions; the extent of food insecurity, especially among families with children; the vulnerability of institutions, from nursing homes and shelters to prisons; the large proportion of US workers in the ‘gig’ and sub-contracting economy; the lack of high-speed access and internet literacy in many communities. Interestingly, both the National Institutes of Health (the center of medical research) and the Centers for Disease Control assumed their current shape in the immediate post-World War II period.  Yet Americans seem to take little comfort from these powerful government entities. 

On the other hand, there is reluctance to take all the measures that we know will lessen the damage to health.  For some Americans, emerging restrictions on personal freedom only magnify skepticism about the ‘heavy hand of government.’  If people were willing to accept them, mandatory lock-downs and quarantine enforcement would make a difference–see China and South Korea–but any discussion of Federal action now seems to engender a constitutional controversy.  Who controls the military and who directs manufacturing production are not trivial questions, and even Gov. Cuomo of New York admits to sticking up for state’s rights occasionally.  In a time of emergency, however, why would the Federal Emergency Management Agency not have a predominant role from the get-go?  By contrast, there is little outcry about Federal-state cooperation in issuing unemployment benefits. 

At bottom, of course, the country remains confident that science will find the ultimate remedy–an effective vaccine.  (Whether everyone chooses to have it is less certain.  What to make, for instance, of the curious argument advanced by some: that because iron lungs have been replaced by ventilators, there is less need to vaccinate against diseases that can shut down your lungs?)  It turns out, though, that the defeat of polio 65 years ago should be credited largely to public charity, if only because Federal investment was so much smaller then (NIH annual funding has gone from $60 million to $40 billion in my lifetime).  The course of polio changed for good with the creation of the March of Dimes, which eventually raised $25 million for treatment and research.  An encounter between Jonas Salk and the head of the government’s efforts established a conduit for those funds.  “What the March of Dimes did was to turn an awful but relatively uncommon disease into our national disease and our national crusade. [The approach] was: We’ve got to raise money for this. The best way to raise money was basically to scare the hell out of the American public.  

Are we scared now?  In China, polio cases peaked in 1964 at 54,000.  Having tested a prototype vaccine on 4 million children in 1960–Salk started with about 40–the Chinese government proceeded to nationwide administration.  Cases went down steadily.*  Thanks to taking familiar extreme steps–the emergence of facemasks is virtually the global signal for a new virus–China has apparently passed the apex of its initial ‘corona curve.’ The US now has three times more confirmed cases than China, at least if one believes China’s numbers, which is increasingly difficult.  Instead of simply mandating it,  however, experts here refrain from recommending the use of facemasks–partly for fear that wearing one might encourage people to dispense with the other precautions!–and fashion trends alone are insufficient to ensure compliance.  Meanwhile, we simply wait to see when the wave will strike.  The lack of early testing skewed estimates of total cases–presumably that will improve–but even a better grasp on the initial spread does not guarantee against re-infection if people downplay the danger.  Perhaps America has grown wary of any ‘crusade.’  When the need for mass mobilization now is likened to the US response to World War II, some think first of Japanese internment and the segregated military rather than Rosie the Riveter and war bonds.  Indeed, the racial dimension of the current crisis is now starting to get attention.  Without concerted action, the power of the post-war economy and the ‘miracle’ of medical science are all too easily undermined.  But it seems we can no longer take that unity for granted, even when the threat is universal.

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SARS in Hong Kong.  photo: Felix Wong

*In a terrible irony, global efforts to vaccinate against polio, underway since 1988, have now been suspended out of caution about spreading COVID-19, a move that will surely lead to more deaths in coming years.

 

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