The Public Health Interventions for Polio Were Restrictive, and So Were the Iron Lungs

On August 30, 2021, the Nebraska Department of Health and Human Services posted a link to a picture of parents waiting in line to have their children vaccinated against polio during the 1954 polio vaccine trials in the United States. You can see the post below.

As is the case with social media these days, the comments (over 51,000 as of this blog post) devolved into arguments about the safety and efficacy of vaccines, and about vaccination mandates. One comment in particular stuck out among the rest, and we decided to research further. The comment asked if there were any social restrictions put in place because of polio. While it is hard to ascertain tone from a written comment, subsequent comments from the author made it seem that polio was not a big deal back in the 1950s because there were no restrictions on movement and businesses like there are now for the COVID-19 pandemic.

First, if polio was “not a big deal,” then why would parents stand in line for hours for a 50/50 chance of their children receiving Salk’s vaccine? Remember, this was a field trial, and half of the children received a placebo instead of the actual vaccine. It would be a year before everyone was eligible for the vaccine once it was shown to be highly effective and safe.

Next, there is the question of the iron lungs. Although less than one percent of polio cases resulted in paralysis, so many children caught polio that it resulted in many of them needing the help of iron lungs to breathe. Entire hospital wards were dedicated to housing paralyzed victims who needed help to breathe.

Letters to the Editor: I cared for polio patients in iron lungs, and I'm  sick of anti-vaxxers - Los Angeles Times
This seems restrictive, no?

In Virginia in 1950, the town of Wytheville found itself in the middle of a polio outbreak, and the restrictions on people and businesses were just as “severe” as those imposed by the COVID-19 pandemic response. According to Mental Floss:

“Town officials imposed a quarantine that kept families indoors and included signs telling travelers to stay out. Residents kept their windows tightly shut in their cars and houses, despite both lacking air conditioning to combat the Southern humidity. The streets emptied, playgrounds were abandoned, and school books remained closed. It prompted people to call the polio season of 1950 the “summer without children.”

People didn’t know how to prevent infection, and they followed the advice of old wives’ tales—holding handkerchiefs in front of their faces, wearing garlic around their necks, and bathing in bleach. To avoid stores, families ate from backyard gardens or arranged to have their groceries delivered.

Parents were also tasked with entertaining their children indoors for months. School was canceled and lessons were given over the radio. Parents burned their children’s belongings to destroy any possibility of the virus spreading.”

“How the Polio Epidemic of 1950 Gave Wytheville, Virginia, a ‘Summer Without Children’,” Mental Floss, December 2020
Reed Counts, Visit Wytheville

Sound familiar?

The National Museum of American History has a web page dedicated to how other communities dealt with polio. In it, they show a sign provided by the March of Dimes:

How a virus brought New York to a standstill in the summer of 1916
More public health restrictions due to polio

In 1916, New York City was hit by polio, with a toll of 20,000 paralyzed victims and 6,000 deaths. Professor Gareth Williams, Emeritus Professor of Medicine and Honorary Senior Research Fellow in English, University of Bristol, describes the epidemic thus:

“Quarantine meant shutting off entire streets, then neighbourhoods. In response, more than 1,000 children left New York City every day, armed with a medical certificate that confirmed freedom from symptoms (but inevitably missed many asymptomatic and highly infectious cases). Police were posted at exit points on the city’s railways, roads and rivers to turn back all those who attempted to flee illegally.

Public hygiene measures began with hand washing and sewage disposal, and when those failed, the city’s sidewalks were scrubbed with four million gallons of water each day. War was declared on possible vectors, notably flies and cats (50,000 of which were shot during that summer).

Out on the streets, people blamed Italian immigrants who were ostracised, vilified and beaten up. And even though their infection rates were low, they remained the villains of the piece until the 1950s.

When the polio epidemic finally died down after several harrowing months, it left carnage, with nearly 20,000 people paralysed and 6,000 deaths in New York City alone. It also left a toxic, ingrained legacy of fear.

During the epidemic, fear fed on many things: the horrific damage inflicted by the virus, the shocking realisation that nothing was going to stop it, and the obvious desperation of the authorities.”

“How a virus brought New York to a standstill in the summer of 1916” The Conversation, April 14, 2020

These stories of towns and cities being hit by polio, public health authorities imposing restrictions, and people being afraid, repeat themselves many times for decades in the 1800s and 1900s until the polio vaccines were developed by Jonas Salk (injectable) and Albert Sabin (oral). The same measures put in place due to COVID-19 were put into place because they had worked well against things like polio, measles, and smallpox. Fortunately, and unfortunately, many people do not remember these events because they were not alive when they happened; and similar deadly epidemics of polio and other vaccine-preventable diseases have not happened in the United States in recent years because vaccine uptake has been high enough to prevent them. You can find those people arguing about rights — but, interestingly, not responsibilities — in comment sections on social media.

Author: René F. Najera, DrPH

I am the editor of the History of Vaccines site, an online project by the College of Physicians of Philadelphia. All opinions expressed on these blog posts are not necessarily those of the College or any of my employers. Check out my professional profile on LinkedIn: https://www.linkedin.com/in/renenajera Feel free to follow me on Twitter: @EpiRen