The first outbreak of polio in the United States struck Rutland County, Vermont, in the summer of 1894. The disease began with fever, sore throat, and fatigue; it sometimes went on to damage the brain and spinal cord, paralyzing or even killing its hosts. Charles Caverly, a local physician, chronicled the devastation using detailed maps and notes. Boy, 10 years; died within twenty-four hours with convulsions, he wrote. Boy, 10 months; died on sixth day, all extremities paralyzed.... Girl, 11 years; died on third day, no paralysis noted.... Male, 22 years; died on third day, both legs paralyzed. Within weeks, a hundred and thirty-two people, mostly children, had been paralyzed, and eighteen had died.
In the coming decades, polio became a familiar menace. Summer, when the virus exacted its heaviest toll, was dubbed polio season. The virus crippled children and adults, often paralyzing their respiratory muscles and confining thousands to iron lungs. In 1916, New York City recorded nine thousand cases of polio and six thousand deaths. In August of 1921, Franklin Roosevelt, then a thirty-nine-year-old lawyer, fell off a sailboat and into the icy waters of the Bay of Fundy; the next day, he noticed lower-back pain, and within a week he could no longer stand. The pace and size of outbreaks accelerated. Even though the polio death rate declined in the decades that followed, owing to advances in medical care, the virus still disabled more than thirty-five thousand people a year during the nineteen-forties. In 1952the year the virus peaked in Americanearly sixty thousand people were infected, and more than three thousand died. Parents refused to let their kids play outside. Cities introduced social-distancing measures. Summer camps were cancelled; schools were shut down; bars and theatres closed.
As bad as polio was, it wasnt the only infectious disease stalking mid-century America. In the early nineteen-hundreds, tuberculosis began to compete with influenza for the title of the worlds deadliest disease. TB, which is caused by a bacterium that burrows into the lungs and other organs, spreads through coughing, sneezing, and talking; the Industrial Revolution, which brought huge crowds together in urban neighborhoods and workplaces, made it more likely to spread. In some people, TB lies dormant, sometimes for decades. In others, it becomes active, causing a quick and violent death: bedsheets drenched in sweat, sputum mixed with blood, a wasting away so severe that the disease was known as consumption. TBs toll was greatest among vulnerable populations: immigrants, prisoners, the poor. The death rate for minorities was three times higher than for whites. In 1953, the United States saw more than eighty-four thousand new infections, and nearly twenty thousand deaths. In 1962, forty-one years after her husband was diagnosed with polio, Eleanor Roosevelt died, at age seventy-eight, from complications of tuberculosis.
The total elimination of polio in the United States and the near-complete eradication of tuberculosis are two of this countrys greatest public-health success stories. And yet they are strikingly different in their details. Polio was defeated by a silver bullet: Jonas Salk introduced a polio vaccine, administered by injection, in 1955; a few years later, Albert Sabin developed an oral version. As a result, in the nineteen-sixties, the number of polio cases plummeted to fewer than a hundred, and in the seventies it fell to fewer than ten; no one has contracted the virus in the United States since 1979. By contrast, there is no comparable vaccine for tuberculosis. The B.C.G. vaccine, introduced in 1921, is effective against TB only about half the time, and is not given to the vast majority of Americans.
Instead, TB has been beaten back incrementally, using a host of imperfect medical and public-health advances. In the nineteen-forties, Selman Waksman, a microbiologist at Rutgers University, isolated streptomycin, the first antibiotic effective against tuberculosis. Streptomycin had serious side effects, including nerve damage, and quickly led to bacterial resistance; as a result, several other drugs were developed. Used alone, none works particularly well, but a cocktail given over a period of months can cure the infection. Meanwhile, testing for TB became readily available across the United States. (For some people, such as hospital workers, it became required.) Public-health protocols were developed: new cases of TB were reported immediately to departments of health, which moved to isolate patients and trace their contacts. (Those systems remain in place today: as a physician, the first time I wore an N95 mask was while treating a patient with TB.) Along with ongoing improvements in American housing and sanitation, these developments made the virus both less infectious and less deadly. Today, around the world, ten million people contract TB each year, and a million and a half die of it; multidrug-resistant tuberculosis, which is harder to treat, is spreading in some developing countries. But the United States is recording fewer tuberculosis infections now than at any point in the nations history: about nine thousand cases each year, and around five hundred deaths.
In fighting the new coronavirus, we all want a silver-bullet cure: the polio model. In April, the federal government launched Operation Warp Speed, a ten-billion-dollar effort to expedite, through government-industry partnerships, the development, manufacturing, and distribution of a coronavirus vaccine. The goal is ambitious: three hundred million doses by January, 2021. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, believes it is plausible. My hope, my expectation, is that well have not one but multiple vaccines in 2021, he told me.
In the popular imagination, a coronavirus vaccine will bring the pandemic to a decisive end. And yet not all vaccines are as powerful as the one Salk developed. Many vaccines are only partly effective, or work better for some age groups than others; the immunity a vaccine confers can wane with time, and a shot thats hard to manufacture or distribute could remain unavailable to many of us. Last week, the Centers for Disease Control sent a letter to state governments telling them to prepare for the possible distribution of a coronavirus vaccine this fall; it described the progress of Vaccine A and Vaccine Balmost certainly the vaccines being developed by Pfizer and Moderna, respectively. Though these vaccines are promising, there is no guarantee that they will be cure-alls. Unless you have a perfect vaccine, which very few are, youll always have people who end up getting sick, Fauci said. With or without a vaccine, were going to need other treatments.
We could get lucky. But we need to be prepared for the possibility that, in the absence of a single-shot cure, it will be the tuberculosis modelincremental, simultaneous progress on multiple frontsthat gets us through the coronavirus pandemic. Its a good thing, then, that vaccine research programs arent the only ones progressing at unprecedented speed. Three kinds of therapies currently in developmentantiviral drugs, antibodies, and immunomodulatorsmay be ready soon. Alone or in combination with a vaccine, they could help us turn the tide.
There are lots of ways to fight back against SARS-CoV-2 and COVID-19, the disease it causes. We can limit the viruss spread in the population at large; we can also build barriers against infection for at-risk people, such as caregivers or essential workers, in particular. We can devise therapies that prevent the newly infected from getting worse, and we can create interventions that target the sickest and give them a fighting chance. By surrounding the virus in this way, we can make it less contagious and lethal, changing the character of the pandemic.
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It Will Take More Than a Vaccine to Beat COVID-19 - The New Yorker
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