An educational illustration depicts a negative pressure ventilator, or iron lung. The respirator stimulated breathing for patients who had lost muscle control.PUBLIC DOMAIN
Hannah Wunsch is a critical-care physician at Sunnybrook Health Sciences Centre and a professor of anesthesiology and critical-care medicine at the University of Toronto. Her upcoming book, The Autumn Ghost: How the Battle Against a Polio Epidemic Revolutionized Modern Medical Care, will be published in 2023.
I have spent the past three years researching a book about a disease I thought of as “dead.” That disease is polio, the same disease that is now the cause of a state of emergency in New York State and that the World Health Organization has declared to be “circulating” in the United States. It is imperative that we recall something we have collectively forgotten: the consequences of this devastating disease.
Back in 2018, despite being a critical-care physician, I wasn’t even sure if polio was a virus, or how it was transmitted. The entire topic was glossed over in medical school because none of us would ever need to care for a patient with the disease; vaccination had successfully eradicated polio from North America. I knew nothing about the nuances of the different vaccines. And I, of course, had never seen an acute case. Any conversation with someone younger than 60 began with them asking, “What was it exactly?” As for anyone older than that, it usually involved memories of shots and sugar cubes – an oral form of the vaccine, not a placebo – and the relief of receiving either or both. It was all tinged with the comfort of discussing a disease that was firmly in the past – the stuff of old newsreels and quaint, dated fundraising posters with images of kids with leg braces and in wheelchairs.
The story of the vaccine that eradicated wild polio from the U.S. and almost all countries around the world has been told many times, but I was focused on a lesser-known aspect of the polio story: how a major epidemic in Copenhagen in 1952 spurred the development of mechanical ventilation and the beginning of intensive-care medicine. I spoke with many survivors of that epidemic and others, both in Denmark and the U.S. Everyone who had had the disease was relieved that polio was no longer a concern for their children and grandchildren – and the many generations yet to come.
One woman I spoke with in Denmark, Maja Klamer Lohr, contracted polio in 1974. Ms. Lohr went to visit two cousins who had just received their sugar cubes (the Sabin vaccine, made with a live, attenuated virus). It was warm that spring, and they all played in a wading pool in the garden. Soon after, Ms. Lohr developed a fever and, to her mother’s horror, was unable to sit up. She was taken to the hospital, where they initially had no idea what was wrong.
She was ultimately diagnosed with polio – most likely the virus had been shed by one of her newly vaccinated cousins and had mutated back to a virulent form in the process, just like with the recent New York case. A sample of her spinal fluid had to be sent to the Centers for Disease Control and Prevention (CDC) in Atlanta, as the diagnosis was by that point so rare. Ms. Lohr spent three weeks in the hospital, then received physical therapy for many years to learn to walk again. She also needed surgery. But unlike the polio patients of 1952, who were surrounded by others going through the same experience, there were no other children like Ms. Lohr in the country. She was one of the last reported cases of polio in all of Denmark.
At the age of 11, Ms. Lohr moved with her family to Burkina Faso for a year. There she saw the ravages of polio in a population that at the time had neither consistent access to the vaccine nor the specialized rehabilitation and physical therapy she had received that allowed her to regain full mobility. She noted that beggars on the street had withered limbs, bent with contractures of the muscles. She saw one man who had to walk on his hands because his legs were paralyzed and he had no wheelchair.
Those sights made a deep impression. Despite her own experience, Ms. Lohr became a fervent advocate for vaccination against polio and other diseases, including COVID-19. She recognizes that it is because of vaccination that she is the only one her age with polio at the Specialized Hospital for Polio and Accident Victims in Denmark, doing physical therapy each week. Because of vaccination, the other polio patients she knows are mostly in their 70s and 80s – or immigrants from other countries.
Most people have no idea what a serious case of polio looks like. The doctors who cared for thousands of patients in Copenhagen in 1952 are now all dead, and the number of people who remember “the summer plague” – as the disease was once called in the U.S. – are dwindling. One polio survivor from 1952 made a documentary about contracting the disease at the age of 1. He titled it I don’t remember anything, but I’ll never forget. We must all do the same, and support those who don’t remember to not forget and to get vaccinated. I fervently hope that I never have to care for a patient with polio in the ICU in my lifetime.