The post is a follow up to the discussion regarding vaccine refusal as an indicator of public health collapse. Here we present the 1934 epidemic in Los Angeles of "infantile paralysis", otherwise known as polio. We chose this particular example because polio at that time was a highly disruptive disease capable of nearly collapsing local medical response when caught by surprise. We highlight Los Angeles as a reminder that vaccines played a key role in effectively removing this threat to children, despite claims that vaccines hurt children in today's world. Part 1 of this series focuses on the epicenter of the polio crisis; subsequent posts will highlight the ripple effect as the epidemic spread to other parts of California.
This website provides a simple contextual view of Los Angeles in the 1930s. Below is a map of 1930s LA, which in 1934 had a population of 2.39 million. The new acute care unit of the LA County General Hospital was dedicated the month before the epidemic.
In May 1934, an outbreak of polio was documented in LA. By the 25th, 100 cases were reported, along with a request to President Roosevelt for a portion of the $17,394,015 (adjusted for 2013 equivalent) funds in the newly formed Warm Springs Foundation in Georgia. This fund had been established to combat the spread of polio in the country at the time. Additionally, Governor Rolph was asked to release $434,850 (adjusted for 2013 equivalent) to the State Health Department for response efforts in LA County. Medical countermeasures at the time included 15,000 cubic centimeters of "serum". We will find later in this story this countermeasure was occasionally lethal to those children who received it.
By May 31st, 48 sanitary inspectors, 17 nurses, and 3 additional physicians were mobilized to support the strained medical infrastructure. One hundred beds were added to isolation wards in the hospital, but the hospital was overflowing with patients despite these additions. Recovery for these patients was often protracted, adding to strain. By this point, 215 patients were hospitalized. Schools closed their cafeterias and avoided mass congregations. All swimming pools were closed. An additional $3,565,773 (adjusted) was released by the County Board of Supervisors to pay for additional medical staff and supplies. By this point, the situation was clearly an IDIS Category 3 crisis, with shifting probabilities for a Category 5 disaster.
By June 6th, pressure was on for school officials to release the 300,000 matriculated children in the county home for summer break. The case count had reached 264 with a dozen fatalities (4.5% CFR-apparent). The Southern California swimming championships were called off. The University of Southern California elected to close its swimming pool.
On June 8th, the case total had risen to 482, and infectious disease researchers were dispatched from the Rockefeller Institute of Medicine to assist in the discovery of a better medical countermeasure. These men would scramble for access to Rhesus monkeys, where 100 were requested from zoos all over the west and animal dealers. This proved to be difficult to procure.
The county health officer, Dr. Pomeroy, attempted to put on a good public face on June 12th as the case count rose to 643 with 18 fatalities. He referred to international statistics quoting a CFR of 24%, proposing the situation in LA was better than expected with a CFR-apparent of 2.8%.
By June 13th, Pomeroy's office reported to the press their belief the epidemic had peaked. The situation remained an IDIS Category 3. On the 18th, 700 cases were reported.
Then, on June 19th, it was disclosed that 5 physicians and 30 nurses were hospitalized, infected with polio. A request for 50 additional nurses was issued. Case resurgence was noted with a new case count of 911. Volunteers from community clubs and the Parent Teacher Association stepped forward, and 500 provided "several gallons of serum". Extension to Hollywood was mentioned, and a famous actress' (Jean Harlow) estranged husband, a cameraman, was infected. Warnings were renewed for parents to immediately report symptoms to their physicians.
By June 25th, 325 patients were hospitalized and an additional 155 were placed under hospital-based observation as "suspected". People noted the unusual number of adults infected with polio.
On June 30th, 1000 cases were reported with 15 fatalities. While the media reported varying case counts and fatality statistics, we believe this is a decent approximation for the total recognized impact. By this point in the epidemic, the Journal of the American Medical Association had decided to issue a travel advisory for LA, recommending visitors stay away from the county. Pomeroy, the county health officer, issued a telegram in response, saying the epidemic had concluded.
Months later, on September 27th, it was disclosed that 137 physicians, nurses, and laboratory workers were still hospitalized, recuperating from polio. They were referred to as "martyrs" and
were afflicted more severely than most of the patients under their care, because the workers' resistance had been undermined by long hours and irregular sleep
Their situation was classified by the state of California as "industrial accidents" in order to receive state compensation.
Below is our best approximation of the epidemic curve:
LA's experience with the polio crisis in the end was managed through heroic effort on the part of clinicians and public health. It is unlikely any of the measures undertaken were effective in blunting the natural course of the epidemic, however we are open to feedback from historians on this point. The experience of LA county was passed by media and word of mouth throughout the state of California ahead of extension of polio into other communities. These communities were preempted by this information, but also fueled anxiety as we will see in subsequent posts.
We are fortunate to have had a vaccine for this destructive pathogen... a battle won by those generations ago for their future generations.