Living with a pandemic: Polio in the 1940s - The Daily Tar Heel

Posted: 21 Feb 2021 04:27 PM PST

"Roll up the windows — there's a case of polio at that house."

This warning from 9-year-old Dan Moury's sister wasn't an uncommon one in the summer of 1944, as polio was sweeping through North Carolina in one of its worst outbreaks yet. Moury's family was taking a trip to Carolina Beach from Greensboro, where about 20 of them would stay in a "big old house," as they did every summer.

When they got to the beach for the week, Moury wasn't feeling well. He played outside with his cousins, but he was also spending more and more time in bed. When he got home and his mom took him to the pediatrician, a spinal tap diagnosed the disease so many families dreaded:

Polio.

Suddenly, there was a quarantine sign on the family's front door. His mom was going to try to nurse him back to health, but it was too much — polio required intense physical therapy and medical intervention, and there was a lot that doctors didn't know about the disease. She'd heard about a new hospital that opened up in North Carolina for children like Moury: the Hickory Emergency Infantile Paralysis Hospital, which would aptly be nicknamed the "Miracle of Hickory."

It was where Moury would spend almost a year of his life.

For polio survivors, the ongoing COVID-19 pandemic is not the first infectious disease to upend their lives. Now, decades after polio ripped through North Carolina and the world, medical experts and researchers at UNC are looking to this past disease outbreak to give context to a modern one.

***

The first U.S. polio epidemic was recorded 50 years before Moury's diagnosis. But the 1940s and '50s brought more cases than the country had ever seen. Parents kept their children inside for the summer to avoid contracting the paralyzing disease. Public areas like swimming pools were shuttered. Newspapers showed iron lungs lined up in hospitals with only children's heads poking out. A nationwide panic took hold.

June 1944 brought a quickly escalating polio outbreak to Catawba County in North Carolina. Three doctors conceived of a plan to form an emergency hospital in Hickory.

Although most hospital administrators preferred not to take polio cases, this one would cater specifically to them. Setting it up meant emptying out a summer camp that was built as part of President Franklin D. Roosevelt's Works Progress Administration.

As legend has it, Dr. H.C. Whims, a health official involved in setting up the hospital, called the woman who was running the camp and asked her to clear it out. She said the campers were picking blackberries and she'd promised them a cobbler — but once they got their cobbler, she'd send them home.

And when she did, the patients started pouring in.

What stands out about the hospital is how quickly it developed — the first patients were admitted to Hickory less than three days after the doctors decided to open a hospital. By 1945, it had treated hundreds of patients and Hickory proudly wore the title of "Polio City."

Life magazine featured the town's response, and writers would continue to chronicle the "Miracle of Hickory," given its name in a March of Dimes pamphlet, for decades to come.

Moury was one of the first patients of the nationally known medical marvel. When he got to Hickory in 1944, there was an army tent pitched out front served as the admissions office. The buildings sat up on a hill, away from the road, and in the grass a patient sat on an ambulance stretcher. The hasty planning and architecture set Hickory apart from other hospitals, like Charlotte Memorial, that also housed polio patients.

At the hospital, treatments included "hot packs," where boiled wool was placed on the skin, and extensive physical therapy. This contrasted with earlier treatments, which put serious patients in full body casts. When they got out, they often spent the rest of their lives unable to walk.

Thanks to his treatment at Hickory and a later series of operations, Moury has walked with a fairly normal gait his whole life.

Looking back, Dan remembers sleeping in a ward with about 15 or 20 boys about his age. They built model airplanes, played board games and, of course, went through physical therapy to get better.

"It was really a great year for me because I hated school — I was always in trouble," he said. "And there wasn't any school going on."

***

Researchers at UNC's Southern Oral History Program are beginning a project to observe polio outbreaks, in light of the ongoing COVID-19 pandemic. Seth Kotch, the director of the program, said looking at polio is meant to provide "a different way of learning about what it's like to live with a pandemic."

The Hickory phenomenon is something researchers are interested in knowing more about, Kotch said. It involved a community rallying around medical professionals to fight a disease and treat children, most of whom weren't even from Hickory. Kotch said echoes of that exist now, too, as health care workers come together to fight this pandemic.

But Kotch also sees echoes of the opposite: people mobilizing to spread misinformation about COVID-19 and the vaccine.

Dr. Myron Cohen, the director of UNC's Institute for Global Health and Infectious Diseases, said people were far less hesitant to get the polio vaccine when it was developed and introduced in 1955.

"There were always people who were concerned about anything new," Cohen said. "But there was certainly a lot more faith in science and scientists in the communications that existed in the '50s."

Social media, the 24-hour news cycle, people seeking attention — these are all things Cohen suspects contribute to widespread hysteria about vaccines. Medical technology is remarkable, Cohen said, but the anthropological and sociological elements of society are suffering.

In other words, even the best vaccine isn't effective if people refuse to get it.

When Moury took his son to get his polio vaccine at a school in Winston-Salem in the 1960s, he cried because he was so relieved his son would never have to go through what he did.

He likely wasn't the only one. Parents everywhere lined up to get their children the long-awaited inoculation. More than 60 years since the first polio vaccine was developed, Cohen said the medical community still discusses polio vaccination programs as an example of global cooperation to wipe out a devastating disease.

To eradicate a disease, Cohen said, is "both amazing and romantic."

"And to try and do it nowadays, with the way the world's organized, would shockingly maybe be more difficult, not less difficult," he said.

***

The local post-polio group now-85-year-old Moury belongs to used to have about 50 members. Just before COVID-19, it was down to four polio survivors who met for lunch once a month. Some died, while others moved away to be close to their children.

"We're a dying breed," he said.

As polio becomes medical history rather than a present threat, Moury has also noticed that fewer and fewer doctors know about Post-Polio Syndrome, a disorder that can show up in individuals who were once infected with polio.

And about 30 years ago, Moury went to an orthopedic surgeon for an elbow problem. Knowing that Moury had polio and had surgery as a child, the surgeon traced every incision on his foot and named the operation.

"We studied these, but I've never seen them before," he told him.

Moments like these are reminders that polio is a thing of the past in the U.S. — and can remain that way if widespread vaccination continues. Researchers hope looking back at the moments in history when polio was widespread can help them shine a light on the pandemic the world faces right now.

"We want to learn about what it's like for our country to live through, to endure, to suffer with a disease this serious," Kotch said. "And what are the long-term effects of that experience?"

As for the hospital where Moury was treated so many decades ago, a historical marker stands in downtown Hickory to remind passersby of the miracle that occurred there. Moury, of course, was there the day they unveiled it.

Story and graphics originally produced for UNC Media Hub.

@MaeveSheehey

@DTHCityState | city@dailytarheel.com

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How a debate over two competing vaccines gripped the medical community — in 1961 - Salon

Posted: 21 Feb 2021 05:00 AM PST

In 1916, a major polio epidemic occurred in the United States, with the epicenter being in New York City. Approximately 27,000 people fell ill, 6,000 died, and many children were paralyzed. As not much was known about the virus, and most infected people were asymptomatic, it seemed that randomly selected children suddenly became paralyzed. This situation was frightening. In 1921, Franklin Delano Roosevelt was infected with polio at age 39. Roosevelt had just lost the election for vice president of the United States. That a wealthy and powerful American politician could be afflicted by the disease and become paralyzed exacerbated the fear. Cases of paralysis from polio grew in number each summer, causing parents to dread summer vacation for their children. Many parents forbade their children from going to swimming pools, the beach, movie theaters, and bowling alleys. To address the national health crisis, Roosevelt started a philanthropic organization whose major goal was to develop a polio vaccine. This organization came to be called the March of Dimes.

Two New Yorkers and graduates of New York University medical school, Jonas Salk and Albert Sabin, would take two different approaches toward developing a vaccine for polio and in the process would become bitter rivals. The rivalry would pit those who believed in inactivated vaccines against those who believed in live attenuated vaccines. Salk and Sabin were not the first to advocate for these two different approaches for developing a polio vaccine. But when these strategies were first tested in the 1930s, clinical trials using both types of vaccines were believed to have caused polio. These events dampened enthusiasm for any further trials for the next 20 years.

In 1949, three scientists — biomedical scientist John Franklin Enders, virologist Frederick Chapman Robbins, and virologist Thomas Huckle Weller — learned how to grow poliovirus in the laboratory. Salk immediately took advantage of this breakthrough. He scaled up production of the virus, and then determined just the right amount of formaldehyde required to inactivate it while keeping it intact. The March of Dimes decided to use all its resources to back the development of a polio vaccine based on Salk's inactivated virus. Given the national anxiety about polio, the US media focused on Salk's work. In a clinical trial, Salk was able to establish that his vaccine was safe, and also determine the vaccine dose required to elicit an antibody response. In three short years phases I and II of the trial were completed. In 1953, Salk announced that he was ready to test the efficacy of his vaccine.

The decision to start a large clinical trial was controversial. Enders and Sabin both questioned the safety of an inactivated vaccine, as well as whether an antibody response was a meaningful surrogate for protection from infection. Many clinicians also felt that a double-blind clinical trial was unethical as individuals in the placebo group would not benefit. Others were concerned that mostly children would be enrolled in the trial. Some worried that the wealthy would be more likely to volunteer their children since the disease afflicted them more, and this would bias the study. In the end, the phase III clinical trial used multiple approaches.

The clinical trial was an organizational tour de force. About two million children, almost all between 6 and 8 years of age, were enrolled. Since polio infections occurred mainly in the summer, all vaccinations needed to be completed before the end of the 1954 school year. The trial was conducted in counties with high rates of infection. One trial was a double-blind trial, with neither the physicians nor the children knowing which was the placebo group. In the other trial, the enrollees were first-, second-, and third-grade elementary school children. Only the second graders were vaccinated. Since no single company was able to manufacture the number of vaccine doses needed for the trial, many manufacturers were used. Vials of vaccines from different manufacturers were labeled similarly, but because there could be differences in product quality, the origin of each dose needed to be monitored.

At the end of the summer, the trial ended. Because of the massive amounts of data obtained, the computer company IBM was invited to help analyze the data. Finally, in the spring of 1955, on the tenth anniversary of Roosevelt's death, the March of Dimes announced the exciting results of the trial, which showed that the Salk vaccine worked.

Almost ten years older than Jonas Salk, Albert Sabin greeted these results with mixed emotions. Sabin had been working on polio for almost his entire career. He was the one who recognized that polio infected the intestines first because of fecal contamination of food or water. After multiplying in the intestine, the virus then spreads to the blood before being cleared by the immune response. In some cases, the virus is able to enter the nervous system from the blood, resulting in paralysis. Based on this work, Sabin believed that a good vaccine needed to provide protective immunity to the intestinal tract.

Sabin spent years weakening or attenuating the poliovirus by growing it repeatedly in different animals and in cells in the laboratory. Eventually, he was able to isolate a weakened form of the virus that he felt was safe to use in humans. The United States and the March of Dimes felt that Salk's vaccine had solved the polio problem and there was no need for another vaccine. So, Sabin turned to other countries for support. In the Soviet Union, millions of people participated in a clinical trial. With its success established, the Soviet Union began manufacturing Sabin's vaccine. It is remarkable that at the height of the Cold War an American polio vaccine got its first foothold in the communist world. Eventually, Sabin's vaccine would be approved for use in the United States in 1961 and, in a victory for Sabin, replaced Salk's vaccine in 1962.

Sabin's live attenuated virus vaccine had many advantages over Salk's vaccine. It was easier and cheaper to manufacture because, unlike Salk's vaccine, inactivation of the virus by careful treatment with formaldehyde was not required. Sabin's vaccine was also efficacious at lower doses, thus requiring fewer quantities to be manufactured. Administering Sabin's vaccine did not require syringes or needles. Vaccination involved swallowing a drop of fluid on a sugar cube. The live attenuated virus first infected the intestine, and elicited both IgG- and IgA-type antibodies. (IgG protects the blood and IgA protects surfaces of organs.)

IgA antibodies induced by Sabin's vaccine prevented the poliovirus from attaching to and infecting intestinal cells. Salk's vaccine, in contrast, only induced an IgG response, so it was able to block the spread of the virus only in the blood and nervous system. If someone vaccinated with Salk's vaccine got infected, the virus could still infect the intestine and potentially spread to others via the feces. For reasons that are not completely understood, Sabin's vaccine induces lifetime immunity, while Salk's offered protection only for a few years. For these reasons, Sabin's vaccine soon became the standard vaccine used around the world.

Mainly because of the large-scale use of Sabin's vaccine, poliovirus has largely been eradicated from the planet. Only a few natural infections occur now, mainly in Pakistan and Afghanistan where polio is still endemic. Sabin's vaccine is a live RNA virus. While it does not thrive well in humans, it does replicate in us. Since RNA replication is error prone, the virus in the vaccine could mutate to become dangerous again. The mutated virus could spread to others and cause paralysis. Indeed, most of the cases of polio seen today outside the endemic areas are caused by such mutations of the live virus in Sabin's vaccine. Because of this, many countries, such as the United States, have returned to using Salk's vaccine as the standard method of childhood polio vaccination. In hindsight, it was fortunate that we had both the Salk and the Sabin vaccines. This is something to remember as we hope for a vaccine that can protect us from COVID-19.

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Living with a pandemic: Polio in the 1940s - The Daily Tar Heel

Living with a pandemic: Polio in the 1940s - The Daily Tar Heel

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