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In autumn 1941, inmates in the Warsaw Ghetto faced catastrophe. Typhus had been spreading through the Nazi ghetto throughout the summer, and, as temperatures were falling, rates were expected to skyrocket.
But mysteriously, the opposite happened. Cases suddenly plummeted, and the disease receded.
Now, a team of researchers say they know what happened. In a paper published today in the journal Science Advances, an international team of researchers describes how the inmates beat the typhus outbreak through cooperation and education. Political leaders organized lectures on cleanliness. The community practiced social distancing. And community aid groups sprang up to help distribute food and other essentials.
“It’s one of the great medical stories of all time,” says Howard Markel, the University of Michigan physician and medical historian who coined the term “flatten the curve” in relation to the novel coronavirus outbreak. “We should take heart and inspiration from the courage, bravery, and unity of doctors, nurses, and patients alike to combat an infectious foe. We need to do that today, and they did it under much more dire circumstances.”
To some witnesses, it simply didn’t make sense.
“This is really an irrational phenomenon,” wrote the Polish historian Emanuel Ringelblum, in notes found after his execution by the Gestapo. “There’s no explaining it rationally.”
It was November 1941 in the Warsaw Ghetto, the sliver of Poland’s capital that the Nazi occupying government had transformed into a squalid holding pen for the area’s Jews, Romani, and others deemed undesirable. Typhus had raged through the community all through the summer and early autumn. But then, just as infection rates were expected to have skyrocketed as winter approached, cases fell dramatically.
“I heard this from the apothecaries, and the same thing from doctors and the hospital,” Ringelblum wrote that month. “The epidemic rate has fallen some 40 per cent.”
The Warsaw Ghetto should have been an optimal site for an outbreak. More than 450,000 mostly Jewish inmates were crammed into 1.3 square miles, making for a population density between 5 and 10 times that of today’s busiest cities. Nazi authorities deliberately kept resources from entering the area, all the while using fear of disease in anti-Semitic party propaganda. Nevertheless, typhus rates in the Warsaw Ghetto were plummeting.
The only explanation, according to research published today in the journal Science Advances, is that the inmates did it themselves, by sheltering in place, promoting and enforcing hygiene, and practicing social distancing.
Editor’s note: As a public service, all our coronavirus coverage is free. No paywall.
This remarkable story of an oppressed community rallying together to combat a public health crisis holds obvious implications for today, as the novel coronavirus pandemic continues to claim thousands of lives around the world daily and debilitate national economies.
“It’s one of the great medical stories of all time,” says Howard Markel, the University of Michigan physician and medical historian who coined the term “flatten the curve” in relation to COVID-19. “We should take heart and inspiration from the courage, bravery, and unity of doctors, nurses, and patients alike to combat an infectious foe. We need to do that today, and they did it under much more dire circumstances.”
A pretext for oppression
The Germans’ fear of a typhus outbreak provided an excuse for the formation of ghettos. Influenced by and promoting anti-Semitic ideas of Jews being disease-ridden, in the autumn of 1940 the Nazis forced the Jews living in Warsaw and the surrounding areas into a tiny restricted area, and sealed it off with a wall.
“The ghettos were in no way treatment, but a tool to separate the Jewish population from its surroundings, and imposed more misery on the Jews,” says Havi Dreifuss, a professor of history at the University of Tel Aviv and the head of the Center for Research on the Holocaust in Poland at Yad Vashem, Israel’s official memorial to the victims of the Holocaust.
Officially known as the Jewish Residential District in Warsaw, the ghetto was immensely crowded. The Nazi authorities blocked most food from entering the ghetto, at one point allowing at most rations of 200 calories per day. Throughout 1940 and 1941, famine killed thousands. With no money, physical energy, or a place to bury them, residents left the corpses of loved ones unburied in the streets.
Such overcrowding, filth, and poor hygiene fostered a breeding ground for typhus. Official numbers suggest that there were a total of 20,160 cases, but the researchers behind the new Science Advances paper dug into other historical reports and estimate that 80,000 to 110,000 residents were infected. They suggest that the official numbers are likely low because residents were afraid to come forward in fear of repercussions from the Nazis. Some 20,000 residents died of typhus, and many more died from hunger while suffering from the illness.
“They’re surrounded by Nazis, at best they’re going to get moved to a concentration camp, and at worst they’re going to get shot,” says Dr. Markel. “And they knew this.”
But the Nazi’s efforts to ghettoize Jews in Warsaw inadvertently created a hub of doctors. There were about 800 physicians among those imprisoned there, and many more nurses and scientists, according to Miriam Offer, author of “White Coats in the Ghetto,” which chronicles ghetto inmates’ struggle against a series of public health calamities.
This community established a health council, procured vaccines as much as they could, held public lectures on preventative health, sanitation, and hygiene, set up an underground medical school, and conducted scientific studies.
“In the Warsaw ghetto there were excellent and devoted medical experts, who tried to do what they were trained and studied for, in unbearable conditions, which, of course, endangered them as well,” says Dr. Dreifuss.
The political leaders of the Jewish Council had to do as the Germans dictated, says Dr. Offer, who teaches Holocaust studies at Western Galilee College and Tel Aviv University. But the new health council advocated for a decentralized approach to fight the epidemic. While the Nazi authorities forced draconian quarantines and mobilized punitive sanitation squads, she writes in an email to the Monitor, the health council focused on education and independent empowerment whenever possible. Cleanliness was encouraged and often enforced. Self-isolation and social distancing became basic practice and common sense. And community kitchens were set up by volunteer groups and food smugglers to help feed the starving population.
Dr. Offer says, there were political tensions and conflicting ideologies among some different groups in the ghetto. Still, she says, the medical leadership “managed to negotiate these differences, creating collaboration, even amidst great tension, and thus succeeded in establishing a medical system.”
And it worked. Three times as many people would likely have contracted typhus had it not been for these behavioral measures taken, according to the new paper.
Biomathematician and lead author Lewi Stone of Tel Aviv University and RMIT University and his co-authors examined the scientific literature on typhus, conditions in the Warsaw Ghetto, and the reported typhus rates there to graph different scenarios of what may have caused the epidemic to collapse. The only scenario that fits with what happened, he says, was the community mobilization and behaviors described in historical documents from the ghetto.
“Inmates and the doctors there, they must’ve been working hard, because that’s what the model shows,” Dr. Stone says.
Social distancing methods have been used for a long time, Dr. Markel says. Before vaccines and other modern medicine, “these public health methods were really the only tools in the toolbox,” he says. “And yes, they work.”
Typhus in the Warsaw Ghetto is another example, but it may have been easier to motivate such behaviors because people’s lives were already so disrupted and overturned.
“In the ghetto,” Dr. Markel says, “there was a remarkable, almost inspirational esprit de corps of this community in the face of insurmountable odds.”
Indeed, says Dr. Offer, “what was needed primarily was hope, creativity, dedication and thinking out of the box, as well as a set of values of humanity, daring, public responsibility, and unity to overcome the epidemic and save lives.”
Regardless of how the typhus epidemic disappeared, she says, “This also gives us hope that COVID-19 will not be with us forever.”
Editor’s note: As a public service, all our coronavirus coverage is free. No paywall.