The Warsaw Ghetto, November 1941. Some 450,000 people, most of them Jews, were packed into an area of some 1.3 square miles, ten times the density of modern-day high-rise cities.
Typhus was spreading like wildfire through the dirty, crowded streets of the ghetto. Typhus, the Nazis said, was why a ghetto was necessary in the first place; Jews spread disease.
Ten of thousands lay ill and dying, and a harsh winter — when the sickness caused by the typhus bacterium is especially virulent — was still ahead.
The Nazis blocked food and supplies from getting in. Thousands were dying from famine, and those who lived were more susceptible to infection and death.
Then, inexplicably, miraculously, despite the ideal conditions for typhus’s spread, the disease ebbed away. Historians couldn’t explain it, and witnesses at the time called it miraculous.
Now, a team led by Tel Aviv University bio-mathematician Lewi Stone thinks it has an answer to the mystery, and it is the very thing helping to combat the spread of COVID-19: social distancing, hygiene and education.
When the Nazis herded hundreds of thousands of Jews, Roma and others into the ghetto, some 800 doctors and thousands of nurses and other medical professionals went with them.
Typhus is spread by lice, and can be stopped in its tracks by good hygiene and social distancing.
The doctors interned in the ghetto knew that, and embarked on a far-reaching program that included lectures, the opening of a secret underground medical school and calls to socially distance.
“Residents were terrified of accidental contact and practiced social distancing,” the researchers wrote.
They added: “There were hundreds of public lectures on the fight against typhus and epidemics. An underground university was set up to train young medical students, and scientific studies on the phenomenon of starvation and of epidemics were undertaken. Building and apartment cleanliness was encouraged and often enforced. Social distancing was considered basic common sense by all, although not enforced. Home self-isolation was put in practice, although not comprehensively.
“Last, complex and highly elaborate sanitation programs and measures were developed by the Health Department and [Jewish] Council with the goal of eradicating typhus. These efforts under the given conditions were what Adina Blady-Szawjger, a surviving doctor of the Warsaw Ghetto, called ‘superhuman medicine’ after the war. It is proof of the successful politics of the Jewish Council, which often was blamed as being corrupt and incompetent,” the researchers said.
The results were astounding.
As the historian Emanuel Ringelblum, who chronicled ghetto life, wrote in November 1941, “The typhus epidemic has diminished somewhat — just in the winter, when it generally gets worse. The epidemic rate has fallen some 40 percent. I heard this from the apothecaries, and the same thing from doctors and the hospital.”
The researchers are careful to note that the reduction in disease transmission corresponded with an increase in food allotments to the ghetto. Fewer residents were starving, so immune systems could better battle the pathogen.
But that explanation alone isn’t enough. In the cramped, filthy, starved conditions of the ghetto, hygiene and social-distancing campaigns saved countless lives.
“There are no other reasonable alternative hypotheses [to those campaigns] to explain the early demise of the epidemic at the onset of winter,” said the researchers, after modeling multiple scenarios in the search for what happened.
Mathematical models based on case reports in the lead-up to November 1941 suggest over 300,000 should have contracted the disease, three times the numbers that actually did.
“It’s one of the great medical stories of all time,” physician and historian Howard Markel, who coined the term “flatten the curve,” told The Christian Science Monitor.
“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,” he said.
In the end, up to 30,000 ghetto residents died from typhus by the time the ghetto was liquidated and its residents sent to die in Treblinka’s gas chambers, with many more succumbing during the period to a combination of starvation and typhus.