Last century’s polio outbreak lessons may guide America’s return from coronavirus

From the offices of mayors and governors to the back rooms of the White House and Center for Disease Control (CDC), officials are scrambling to devise a strategy that would allow Americans to gradually emerge from home quarantine to work and life as normal.

President Trump has made clear that the safety of Americans is tantamount although he pulls no punches that he wants to get the economy up and running too. “This country was not built to be shut down,” he has said often during his COVID-19 White House briefings.

The CDC in conjunction with the White House Coronavirus-19 Task Force is working on a plan, as are many local officials. The theories guiding these discussions range from restarting gradually in regions with low incidences of the virus to continuing the quarantines until a vaccine is ready.

Dr. Zeke Emanuel, a cancer doctor in Chicago and former adviser to President Barack Obama, said on MSNBC that he does not think the economy should be re-opened until a vaccine is approved, which could take as long as 18 months.

Alternatively, Knut Wittkowski, Ph.D, the former head of the Department of Biostatistics, Epidemiology and Research at the Rockefeller University in New York, said the only thing that “stops respiratory viruses” like COVID-19 “is herd immunity” where there is a high percentage of the population infected serving as a natural immunity. He believes the social-distancing ban should be lessened.

Dr. Yonatan H. Grad, an infectious disease specialist and Assistant Professor of Immunology and Infectious Diseases at Harvard T.H. Chan School of Public Health, said “no one has the political will or public health interest yet for emergence.” So Grad recommended, “This time is better used for figuring out which mitigation measures work and that information should be used to figure a plan.”

Nevertheless, Grad said that if and when the economy opens he believes it will be “by location because of the fragmented reaction to the virus. Emergence may not be uniform.”

On Tuesday, Democratic New York Governor Andrew Cuomo tweeted, “We cannot restart life as we knew it without testing,” while Democratic Gov Phil Murphy of New Jersey said getting the economy going needs to be “careful.”

From Colorado to Massachusetts, governors are discussing how to monitor their citizens to figure out who is immune to COVID-19. Other governors in Texas and Maryland are working to set up task forces to get their citizens back to work.

Gradual emergence and lessening isolation during pandemics in hotspots is not a novel concept in America. That model was used during the polio and measles epidemics in the 20th century.

Polio outbreaks have ebbed and flowed through the last centuries. How America handled the polio epidemics in the early 1900s, which lingered into a polio epidemic spanning the 1940s and 1950s until a polio vaccine was discovered in the 1950s, is instructive.

Very young children were inflicted and the sudden onslaught of polio shocked communities. First, it was a cough and then a child was paralyzed days later. It was a travesty because polio hit so fast and inflicted for no reason. Schools and pools were closed, playtime among children was forbidden, families were terrified of having their children exposed because no one knew what was causing polio paralysis and what could cure it. 

Just like during the measles outbreak in the 20th century, fear gripped America. These were hard times for families because of the unknowns and no initial cures of these contagious diseases. Notices were put on family doors to inform the outside world that those inside the homes were gripped with disease and quarantined. When individuals did survive they were given certificates but the intention was never to stigmatize the individuals but to inform others because fear so gripped society.

One of the champions leading the fight was President Franklin Delano Roosevelt, who was a polio victim himself. After he died, President Harry Truman picked up Roosevelt’s mantle, calling upon America to remind the public that everyone was together in the fight against polio.

"The fight against infantile paralysis cannot be a local war," Truman said during a White House radio broadcast to the nation, "It must be nationwide. It must be total war in every city, town and village throughout the land. For only with a united front can we ever hope to win any war." 

Dr. Deborah Birx, Trump’s pandemic coordinator, praised Americans this week for their commitment to changing their behavior to help not only themselves but others. “Full mitigation will be reflected in coming weeks in regard to mortality rates,” she said.

In a moment of optimism, Birx reflected upon Americans’ response. “Today will change how people look at respiratory diseases,” she said. “We are still in awe of the American people’s strength in following through.”

The plans for re-emergence are still being written, and they are certain to be informed by changes in what scientists learn about the coronavirus and potential remedies. But if history is any lesson, patience is going to be a necessary part of the plan.