We Didn’t Vanquish Polio. What Does That Mean for Covid-19?

We Didn’t Vanquish Polio. What Does That Mean for Covid-19?

We Didn’t Vanquish Polio. What Does That Mean for Covid-19?

The world is still reeling from the pandemic, but another scourge we thought we’d eliminated has reemerged.


I must have been unlucky to catch polio in Cork, Ireland, in 1956, as this was one of the last polio epidemics ever in Western Europe and the US. Jonas Salk had discovered a vaccine that 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. Across the city, health workers took over vacant shops, the forecourts of gas stations, the backs of trucks, parks, and street corners to vaccinate people. 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 American achievements in the 20th century.

And yet again and again, just as polio appears to be close to elimination, it reappears—as it did with a case in July in Rockland County, N.Y., and earlier in the summer in London, where the virus was detected in the city’s sewage. What frightens the medical authorities is that they know that the great majority of people infected with polio show no symptoms but instead become unconscious carriers of the virus. By the time an outbreak is detected, it may be already out of control. Going by past experience, the fear generated by polio is greater than in the Covid-19 pandemic because it suddenly cripples its victims, who are usually children.

Polio has reemerged in Pakistan, where there have been 13 known cases since April and where Islamic militants killed three people carrying out door-to-door immunizations. Overconcentration on Covid-19 may have given the polio virus a fresh chance to spread, which it does quickly because—as with Covid-19—most carriers show few or no symptoms and only a minority of cases are severe or fatal.

I caught polio after an effective vaccine had been discovered, but it did me little good at the time since I wasn’t vaccinated. I was admitted to St. Finbarr’s fever hospital in Cork on September 30. When I was released three months later, I learned to walk again with metal calipers on my legs and 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 or about the epidemic in general. I could not have said with any certainty—and this self-inflicted ignorance was to continue until I was well into middle age—in what year it had taken place or whether it was caused by a virus or by bacteria. I sensed that thinking about this, picking at the emotional scar tissue, was not going to help me. Only in the late 1990s, 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 find it strange that I knew more about sickness in Baghdad than I did about polio in Cork, when it had been me lying in that hospital bed.

And so I started reading about polio, a disease that has probably been around for thousands of years. There is an ancient Egyptian sculpture of a man with a wasted leg looking very much like my own. Walter Scott was made lame by it as a child. But these were individual cases, and 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 to 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.

I was surprised that nobody had written a history of the Cork epidemic, which had paralyzed part of Ireland for the best part of a year. I asked surviving doctors from that period, who were far older and therefore less numerous than their patients, 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 with other diseases because its victims were mostly young children. As I read government documents and newspapers about the epidemic, I came to understand that a further reason for the silence was that many Irish people were ashamed of what had happened, mistakenly imagining that the epidemic was caused by Irish underdevelopment, and that this was a symptom of the failure of independent Ireland to successfully modernize. I interviewed any medical staff and polio survivors I could find for a long article on myself and the epidemic published in 1999. I planned to write a book on the subject, but this was delayed by the post-9/11 wars, when I was to spend much of my time reporting in Afghanistan and Iraq.

In 2005, I published a memoir about the epidemic as I experienced it called The Broken Boy. I described my experiences in the context of my family and of Ireland in the 1950s. The title was something of a misnomer, since I felt singularly unbroken, but it did at least tell the reader that the book was about the suffering of a small child.

I am glad I researched and wrote the book when I did, because many of the best-informed witnesses died soon after its publication. Much of the text made gloomy reading, but it ended on an upbeat note. 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 “perhaps the day would come when, for the bane and the enlightening of men, it would rouse up its rats again and send them forth to die in a happy 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. That turned out to be overoptimistic.

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 realized—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 to appear.

I was surprised but not very alarmed when Covid-19 was 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 because 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 the unlucky 1 or 2 percent—there is great dispute about the fatality rate among victims of Covid-19—who will feel the virus’s full destructive impact.

There are also similarities in the treatment of the 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: When Queen Elizabeth II visited Australia during a polio epidemic in 1954, there were fears that the crowds of schoolchildren assembling to greet her might pass the virus to one another and maybe even to the young monarch herself. So the Australian government launched a mass handwashing campaign, leading to a drop in the number of children who contracted polio during the royal visit. Nobody seemed embarrassed by the fact that no such effort had been made before the queen’s arrival.

The polio virus is 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 actually a 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 the need to see visible action to counter it are a feature of all epidemics. In Cork, doctors were convinced that the disease would be stopped only when it ran out of victims. In my book I quoted Jack Saunders, the city’s chief medical officer, who insisted 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 65 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 underreaction and overreaction succeeding each other as the authorities lurched from commercial shutdowns to overly rapid reopenings. Wuhan in central China, with a population of 11 million, could scarcely be more different from Cork, with around 336,668 inhabitants in 1956, but the popular reaction had points in common.

“There were rumors 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 dutifully 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 just as they would many years later in America and Europe. My family had unwisely returned to Cork from London at the height of the epidemic because my parents believed that we would be isolated and safe in the middle of the Irish countryside. But our quarantine was never complete: My father, Claud Cockburn, needed to travel by train and boat between London and Cork to boost his journalistic earnings and was necessarily brought into contact with carriers of the disease. He may have underestimated its prevalence, because by then the main local paper, The Cork Examiner, which normally carried comprehensive reports of all events in the county, had stopped carrying all but the most meager accounts of the epidemic. My father told me the paper’s owners had been pressured into silence by local store owners and businessmen, who said that they were being ruined as the epidemic frightened off customers and would withdraw their advertising unless the press stopped reporting on the disease. I did not quite believe this when my father first told me about it, but when I looked at the files of the newspaper, I discovered that reportage comes to an abrupt halt several weeks before I was admitted to St. Finbarr’s.

Rescue came as the epidemic burned itself out and the first doses of the Salk vaccine arrived in Cork in 1957. There was little surprise that the life-saving inoculation had been developed in the US, which many people throughout Western Europe saw in the aftermath of World War II as the source of all good things—and of scientific breakthroughs in particular.

Perception of American competence and capability was partly shaped by the country’s conquest of polio. Compare this with 1.04 million fatalities from Covid-19 in the US at the time of writing. 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 President Donald Trump had minimized 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.

I was particularly interested in the social difference between those targeted by polio and by Covid-19. The first was sometimes called a middle-class disease in Europe because it was the better-off who suffered worst. As explained earlier, they had lost their natural immunity because they drank clean water and used modern sanitation systems. My parents never realized that their children were far more at risk in our isolated country house.

The opposite was true of the Covid-19 pandemic, during which it has been the poor living in cramped accommodations and with preexisting health conditions who have been the most likely to die. Health inequality exactly replicated wealth inequality. In Britain there was a sour joke that the lockdown applied only to the middle class, because they stayed at home while the working class brought them food and other necessities.

I live in the cathedral city of Canterbury in northeast Kent in southern England. I noticed in the first half of 2020 that, though television newscasts and newspaper reports focused almost exclusively on the pandemic, there was little describing its impact from ground level. Were people really staying at home? Were they frightened? Did they know people who had caught the disease and had died from it? What did they think of the government’s efforts to control it? As when I started my research about polio two decades earlier, I found that there was limited local reporting in my town.

Worse, news gathering was even sparser than it had been in the 1950s. Local newspapers, the main source of local news, had been largely wiped out by competition from the Internet, which had taken away their advertising revenue. In Cork in 1956, the business community had successfully threatened The Cork Examiner with a withdrawal of advertising in order to stop it from reporting on the epidemic. But in much of Britain and the US during the Covid-19 pandemic, there would have been no need for such threats, because little was being written at the local level and what did appear was mostly reassuring comments from the county health authorities.

I did some reporting myself to get an on-the-ground sense of what was happening during the pandemic. There were some difficulties in doing so, because during such a crisis people do not welcome others into their homes, even if they know the visitors. I decided to take a single small district in Canterbury called Thanington that I had written about in the past in relation to Britain’s leaving the European Union. I had local contacts there who knew me and would willingly talk on the phone.

Overall, I could get an accurate impression of how people in Thanington were coping with the first wave of the pandemic, which was not very severe in Kent. This period ended when—despite the warnings of government scientists—the authorities overconfidently lifted the national lockdown on July 4, 2020, when the infection rate was low. Again, there was a difference from polio, which was sometimes called the “Summer Plague” because the epidemics normally took place in the summer months.

The Covid-19 virus, by way of contrast, flourished alongside flu during the winter. As the number of infections began to rise again in September 2020, there were fresh lockdowns across the UK and a consequent fall in the number of people testing positive for the coronavirus. But in two districts, Thanet and Swale, on the north coast of Kent, infection rates inexplicably soared in November. At first, health experts sent to investigate suspected this had something to do with the behavior of the people in the area. But they soon discovered that it was the behavior of the virus that had changed and that it was spreading faster and was possibly more deadly than before.

This was the “Kent variant,” which quickly spread to the rest of Britain and to the rest of the world. It was predicted to become the dominant variant in the US by March 2021 and by then was present in every continent apart from Antarctica. I was singularly well-placed geographically to write about this, because British government scientists said that it had first been detected “near Canterbury.” This was confirmed by a senior local health official, who revealed privately that it had originated in Margate, a run-down seaside town 17 miles from the city. Given that Margate was on my doorstep, I had local contacts who helped me research the beginnings of the Kent variant and why the north Kent coast had provided such a perfect breeding ground for the virus to mutate into a more deadly form.

The Kent variant was finally displaced by a more infectious but less deadly form of the virus. As with polio in Cork, open fear dissipated after mass vaccination, while news outlets shifted from overreporting the epidemic to seldom mentioning it. But an undercurrent of fear remains, as it did in Cork several years after the polio virus had gone. Maureen O’Sullivan, a Red Cross nurse, told me that “at the sight of my ambulance in their street people would think that polio was back. They would run into their houses and a few would get down on their knees to pray. They had lost all hope—they were that frightened.”

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